Peritoneal Dialysis

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.

 

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.

  • You must eat more protein.

  • You may have different restrictions on potassium.

  • 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.

 
Pros

CAPD :

  • You can do it alone.

  • You can do it at times you choose as long as you perform the required number of exchanges 
    each day.

  • You can do it in many locations.

  • You don't need a machine.

 Cons

 

  • It can disrupt your daily schedule.

  • This is a continuous treatment & all exchanges must be performed 7 days a week.

 
CCPD :

  • You can do it at night, mainly while you are sleeping.

 

 

  • You need a machine.

 

Questions to ask:

 

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