In peritoneal dialysis, your blood is cleaned inside the body. In order to accomplish this, our interventional nephrologist will place a plastic tube called a catheter into your abdomen (belly) for access. During the treatment, this area (called the peritoneal cavity) is slowly filled with “dialysate” (a blood-cleansing solution) through the catheter, while blood stays in the arteries and veins that line the area. Extra fluid and toxins are removed from your blood and into the dialysate. After a period of time, this solution is drained and replaced with fresh fluid. There are many ways of handling this type of dialysis, but two major ones are most common:
• Continuous Ambulatory Peritoneal Dialysis (CAPD) – This is the only type done without machines and can be done on your own four or five times a day while at home or at work. By putting a bag of dialysate into your peritoneal cavity through the catheter, the dialysate stays there for about four or five hours before it is drained back and thrown away (called an “exchange”). Each time an exchange is performed, you use a new bag of dialysate. This enables normal activities while the dialysate is in your peritoneal cavity.
• Continuous Cycling Peritoneal Dialysis (CCPD) – This type is usually performed at home using a machine called a “cycler”. Similar to CAPD, a number of cycles (exchanges) occur and each cycle lasts about 1-1/2 hours. Using this method, exchanges are usually performed throughout the night while sleeping.
A nurse experienced in PD will train you to perform peritoneal dialysis. Most people can learn to do PD within a few days. If you have concerns or problems, the nurse and doctor are never more than a phone call away. You will probably need to visit your clinic each month.
Your doctor will write a prescription for the dialysis supplies you need. Your nurse will help you learn to order them. The supplies are delivered to your house. The driver of the van carries the supplies into your house and helps you organize them. You will need a place in your home to store 25-30 boxes.
Peritoneal Dialysis Catheter
A small, soft tube called a catheter is put through the wall of your abdomen into the peritoneal cavity. The catheter is called an access because it provides a way to get PD solution into the peritoneal cavity. Solution flows in and out of the peritoneal cavity through the catheter. Placing the catheter requires a minor outpatient surgery.
The opening for the catheter should heal for a few weeks before starting dialysis. The catheter is usually not painful and stays in place throughout your time on PD.
How will PD affect your lifestyle?
Most people enjoy the flexibility and independence that they have with PD. Your dietician can help you manage your diet. It is very important to follow the meal plan recommended by your dietician in order to avoid malnutrition. Also, poor diet can cause depression, tiredness, and a lower quality of life.
You can do most sports and exercise after checking with your doctor. To travel, you pack your CAPD supplies in a suitcase. If you use APD, you can pack along your cycler, or you can switch to CAPD while you are traveling. If you go on a long trip or travel to a foreign country, the dialysis company can ship supplies to your destination ahead of time.
People on PD can lead normal lives. It is easy to adjust the treatment schedule according to your work, school, or travel plans because you are in charge of your own treatment.
Possible complications of PD
The major complication of PD is an infection of the peritoneal membrane called peritonitis. The best way to keep from getting an infection is to wash your hands and to perform your exchanges exactly as instructed. You will be taught to recognize the early signs of infection. Peritonitis is treated with antibiotics, which usually can be taken at home.
The area around your catheter can also become infected. This area, called the exit site, should be cleaned daily. You will learn how to care for your exit site during PD training. Exit-site infections are treated with antibiotics.
• Control your dialysis schedule
• A flexible lifestyle and independence
• Patients tend to have more energy and feel better
• Don’t have to travel to dialysis unit for treatment
• Be involved in your own care
• Can provide continuous therapy, which is more like your natural kidney
• Doesn’t use needles or blood for dialysis
• Dietician may have more flexibility adjusting your diet
• May require fewer medications
• Can do therapy while sleeping (APD)
• Portable therapy, ease for travel
• No partner is required to perform treatment
• Need to schedule exchanges into your daily routine, seven days a week
• Requires a permanent catheter typically in the abdomen
• Runs some risk of infection
• May gain weight/have a larger waistline
• Training is needed to learn to perform treatment
• Need space in your home for supplies and equipment as well as space to perform treatment
• Must be committed to self care