Peritoneal Dialysis (PD) – We have a membrane called a peritoneal membrane and it lines our abdominal cavity. Thankfully we can use that peritoneal membrane as a filter.
A catheter is surgically placed in your abdominal cavity where we do something called an exchange. Fluid is put into the abdominal cavity, we let it sit there for a few hours and then we drain it. With the drain comes excess water and waste products.
There are two kinds of peritoneal dialysis:
Manually during the day – (CAPD)
Automated Peritoneal Dialysis (APD)
The basic treatment is the same for each. However, the number of treatments and the way the treatments are done make each method different.
TYPE 1: Continuous Ambulatory Peritoneal Dialysis (CAPD)
This type is “machine-free” or “manual.”
How does it work?
- Catheter tube is surgically placed in the belly
- Tube will have one end INSIDE your abdomen and one end OUTSIDE
- Outside tube is attached to a bag of cleansing solution
- By holding the bag high, the abdominal cavity is filled
- Fluid cleanses for 2-3 hours: This is called a “dwell”
- After the dwell cleanses waste, fluid is drained
The entire process is called an “exchange” and is repeated several times depending on your doctor’s prescription. During an exchange, the cleansing solution (dialysate) has a high glucose level and draws out water from the blood vessels along with urea, creatinine and electrolytes. Diabetics may need to monitor their blood sugars more closely and adjust their medications.
The exchanges are done manually 4-5 times a day without a machine. An exchange can be done almost anywhere—home, work, vacation—even in a car. That’s why it’s called ambulatory.
Filling and draining take about 30 minutes apiece, and the dwell time is 2-3 hours.
The entire exchange can be done while you are at home or work. It should be done 3-5 times a day, so mealtimes and bedtime are common choices.
TYPE 2: Continuous Cycling Peritoneal Dialysis (CCPD)
The basic process works the same as CAPD, but it is done via a cycler machine while you sleep. The cycler takes 8-10 hours so you don’t have the hassle of doing your exchanges manually through the day.
- Peritoneal catheter is surgically placed, needs 2-6 weeks to heal
- Peritoneal dialysis solution (3 types with varying concentration of GLUCOSE)
- 1.5% (yellow bag, lowest glucose or sugar level)
- 2.5% (green bag, middle concentration)
- 4.25% (red bag, highest glucose or sugar concentration)
- Adequate storage space to store the dialysis solution
- Clean hygienic home environment
PD Catheter Insertion & Care
Before PD can begin, a tube must be surgically placed. The catheter can be used right away but it’s safer if given time to heal. Your infection risk is highest immediately after surgery. You should not touch or wet the post-surgical gauze for 7-10 days. Unfortunately for those around you, that means NO SHOWERING! Hygiene is limited to a washcloth or sponge. Let the area rest as much as possible, and know that dressing changes need to be done by a trained nurse.
- Nurse will train you how to clean exit site
- Wash exit site daily with antiseptic/antibacterial soap from its original bottle
- Do NOT use hydrogen peroxide or alcohol
- Wash your hands with soap and put on clean, fresh gloves before cleaning
- If the skin is firm, red, painful or has pus, there may be an infection
Take good care of the catheter, it is your life line!
Is Peritoneal Dialysis Right for Me?
Some doctors feel that CAPD and APD have several benefits when compared to hemodialysis:
- With continuous dialysis, you can control extra fluid more easily, and this may reduce stress on the heart and blood vessels
- Patients are able to eat more
- Fewer medications are needed
- Better quality of life because treatments are integrated with your normal routines
Conversely, peritoneal dialysis may not be appropriate for patients that:
- Are obese
- Have multiple prior abdominal surgeries
It’s always best to consult your nephrologist about what kind of dialysis is right for you.
Complications of Peritoneal Dialysis
Living with PD
Diet: Each exchange takes away protein, so steal it back by eating MORE protein! Think meat, milk, chicken, eggs, fish… Also, limit food with a lot of phosphorus like dairy products, cheese, liver, nuts, and chocolate.
Weight Gain: You must weigh yourself daily. Diabetics may need to have their medications adjusted because of the high glucose level in the dialysate.
Constipation: This can create a hernia. Take stool softeners or laxatives as needed.
Physical activity: Don’t exert yourself with fluid in your belly.
Time requirements: It is important to perform each exchange and dwell exactly as recommended. You may have to cut back on some responsibilities to avoid illness and hospitalization.
Remember: Peritoneal dialysis is done daily! To prepare for this, patients work very closely with staff nurses and go through a training process to make sure that they perform the steps correctly. This ensures your safety and the quality of your PD treatment long term.
You may be concerned that peritoneal dialysis is not performed in a hospital setting. But never fear! Peritoneal dialysis is an effective form of dialysis, and it has been proven to be as good as hemodialysis.