Purpose
Peritoneal dialysis is another procedure that removes extra water,
wastes, and chemicals from your body. This type of dialysis uses
the lining of your abdomen to filter your blood. This lining is
called the peritoneal membrane and acts as the artificial kidney.
How It Works
A mixture of minerals and sugar dissolved in water, called
dialysis solution, travels through a soft tube into your abdomen.
The sugar, called dextrose, draws wastes, chemicals, and extra
water from the tiny blood vessels in your peritoneal membrane into
the dialysis solution. After several hours, the used solution is
drained from your abdomen through the tube, taking the wastes from
your blood with it. Then you fill your abdomen with fresh dialysis
solution, and the cycle is repeated. Each cycle is called an
exchange.
Getting
Ready
Before your first treatment, a surgeon places a small, soft tube
called a catheter into your abdomen. The catheter tends to work
better if there is adequate time--usually from 10 days to 2 or 3
weeks--for the insertion site to heal. This is another way in
which planning your dialysis access can improve treatment success.
This catheter stays there permanently to help transport the
dialysis solution to and from your abdomen.
Who Performs It
Both types of peritoneal dialysis are usually performed by the
patient without help from a partner. CAPD is a form of
self-treatment that needs no machine. However, with CCPD, you need
a machine to drain and refill your abdomen.
Possible Complications
The most common problem with peritoneal dialysis is peritonitis, a
serious abdominal infection. This infection can occur if the
opening where the catheter enters your body becomes infected or if
contamination occurs as the catheter is connected or disconnected
from the bags. Peritonitis requires antibiotic treatment by your
doctor.
To avoid
peritonitis, you must be careful to follow procedures exactly and
learn to recognize the early signs of peritonitis, which include
fever, unusual color or cloudiness of the used fluid, and redness
or pain around the catheter. Report these signs to your doctor
immediately so that peritonitis can be treated quickly to avoid
serious problems.
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Types
of Peritoneal Dialysis
There are three types of peritoneal dialysis.
1.
Continuous Ambulatory Peritoneal Dialysis (CAPD)
CAPD is the most common type of peritoneal dialysis. It requires
no machine and can be done in any clean, well-lit place. With CAPD,
your blood is always being cleaned. The dialysis solution passes
from a plastic bag through the catheter and into your abdomen,
where it stays for several hours with the catheter sealed. The
period that dialysis solution is in your abdomen is called the
dwell time. Next, you drain the dialysis solution back into the
bag for disposal. You then use the same catheter to refill your
abdomen with fresh dialysis solution so the cleaning process can
begin again. With CAPD, the dialysis solution stays in your
abdomen for a dwell time of 4 to 6 hours (or more). The process of
draining the used dialysis solution and replacing it with fresh
solution takes about 30 to 40 minutes. Most people change the
dialysis solution at least four times a day and sleep with
solution in their abdomen at night. With CAPD, it's not necessary
to wake up and perform dialysis tasks during the night.
2.
Continuous Cycler-Assisted Peritoneal Dialysis (CCPD)
CCPD uses a machine called a cycler to fill and empty your abdomen
three to five times during the night while you sleep. In the
morning, you begin one exchange with a dwell time that lasts the
entire day. You may do an additional exchange in the middle of the
afternoon without the cycler to increase the amount of waste
removed and to reduce the amount of fluid left behind in your
body.
3.
Combination of CAPD and CCPD
If you weigh more than 175 pounds or if your peritoneum filters
wastes slowly, you may need a combination of CAPD and CCPD to get
the right dialysis dose. For example, some people use a cycler at
night but also perform one exchange during the day. Others do four
exchanges during the day and use a minicycler to perform one or
more exchanges during the night. You'll work with your health care
team to determine the best schedule for you.
Diet for Peritoneal Dialysis
A peritoneal dialysis diet is slightly different from a
hemodialysis diet.
-
You'll
still need to limit salt and liquids, but you may be able to
have more of each, compared with hemodialysis.
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You
must eat more protein.
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You may
have different restrictions on potassium.
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You may
need to cut back on the number of calories you eat because
there are calories in the dialysis fluid that may cause you to
gain weight.
Your doctor
and a dietician who specializes in helping people with kidney
failure will be able to help you plan your meals.
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