Peritoneal dialysis cleans your blood and removes extra fluids using one of your body’s own membranes, the peritoneal membrane, as the filter. The peritoneal membrane is the lining that surrounds the peritoneal cavity or abdominal cavity, which contains your stomach, spleen, liver, and intestines.
PD solution is placed in the peritoneal cavity. The peritoneal membrane filters waste and fluids from your blood into the solution. The solution containing the wastes is drained from your peritoneal cavity after several hours and replaced with fresh solution. This is called an exchange.
A nurse experienced in PD will train you to perform peritoneal dialysis in the dialysis unit as an outpatient. 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 your peritoneal cavity. Solution flows in and out of the peritoneal cavity through the catheter. Placing the catheter requires 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.
There are two types of Peritoneal Dialysis:
– Continuous Ambulatory Peritoneal Dialysis (CAPD)
– Automated Peritoneal Dialysis (APD)
Continuous Ambulatory Peritoneal Dialysis (CAPD)
CAPD cleans your blood 24 hours a day, 7 days a week. And you’re ambulatory (which means you can walk around), even during exchanges. That’s because the CAPD system just requires a solution bag and tubing connected to your catheter, which is hung on a pole with wheels during exchanges.
Most people need four exchanges a day: when they wake up in the morning, at lunch, before dinner and before they go to sleep.
An exchange takes about 30 minutes. The solution is left in the peritoneal cavity between exchanges and overnight. While performing an exchange, you can do any quiet activity: watch TV, talk on the phone, work at a desk or read. An exchange can be performed in any clean area – at home, work or while traveling.
Automated Peritoneal Dialysis (APD)
APD is done overnight, with a cycler machine that performs exchanges automatically, while you sleep. Most people leave fluid in the peritoneal cavity during the day or do an extra daytime exchange.
APD is good for people who want more freedom from dialysis during the day or who need help with dialysis. With APD, you don’t have to do exchanges every 4-6 hours during the day, so you have more independence. APD is also sometimes called Continuous Cycling Peritoneal Dialysis (CCPD).
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 dietitian 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
- Dietitian 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