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Treatments Peritoneal Dialysis


Peritoneal Dialysis – Is it the right choice for me?

How does PD differ from other types of dialysis?

There are a couple of ways to help patients with kidney failure remove impurities and waste materials from the blood. Dialysis is a medical treatment that removes waste and extra fluids from the blood that the kidneys can no longer remove.

Hemodialysis is a type of dialysis that cleans your blood by taking it outside of your body. Peritoneal dialysis (PD) is done inside of your body. A thin membrane called the peritoneal membrane lines the abdomen. This membrane also covers the organs within the abdominal cavity. It is semipermeable, which means it only lets certain things pass through it. PD uses this membrane to filter your blood during dialysis.

How does this happen?

First, a small, soft tube, called a catheter, is surgically placed through the abdominal wall into the peritoneal cavity.  Depending on the type of catheter placed, this permanent access can usually be used for peritoneal dialysis therapy 10-14 days after the procedure.

This tube allows the passing of dialysis solution into the peritoneal cavity. The peritoneal cavity is then filled with 2 to 3 liters (a little over 2-3 quarts) of fluid, which most adults can comfortably hold.

Once the dialysis solution is inside the peritoneal cavity, waste products then pass or filter from the bloodstream, through the peritoneal membrane, and into the dialysis solution. From there, waste products will be removed from your body. This is called the dwell phase of a peritoneal dialysis exchange and can last a few hours at a time.

Is PD a cure for kidney failure?

No. No form of dialysis is a cure for kidney failure. However, over the last fifty years, advances in medicine have allowed doctors to duplicate some of the normal kidney functions. PD is one of those advances.

Types of Peritoneal Dialysis (PD)

Is there more than one type of PD? 
Yes.  There are two types of PD.  One is CAPD or Continuous Ambulatory PD. The other is APD or Automated PD.


CAPD  

This type of self-dialysis is done seven days a week, four to five exchanges each day, without the use of a machine. CAPD is often called “machine-free dialysis.”

Here’s how CAPD works using an “exchange” procedure. You perform an exchange by following a few basic steps that are taught to you during training.

First, your PD catheter is connected to a tubing set. The solution that is present in your abdomen from a previous exchange must first be drained out of the peritoneal cavity into a pre-connected bag. This bag is placed below the level of the abdomen, allowing the fluid and waste to flow out of the body by gravity. Once the fluid has completely drained from your peritoneal cavity, the fresh dialysis solution flows through your catheter, filling the peritoneal cavity with the prescribed amount of fluid. The bags and tubing set are then disconnected from your catheter and discarded. It is during the dwell time, when the fluid remains in your peritoneal cavity, that the actual dialysis or filtering of waste and fluid occurs. With no connection to the tubing or bags during the dwell time, you are free to enjoy your daily activities while the dialysis takes place inside of your peritoneal cavity.

Removing PD solution containing wastes and excess fluids from the peritoneal cavity (drain) and replacing it with fresh PD solution (fill) is called an exchange. An exchange takes 20-30 minutes. After you fill the peritoneal cavity with fresh PD solution, you may leave this solution in the peritoneal cavity for four hours or more if directed (dwell).

Typically, you do four to five daily exchanges. Each exchange lasts about thirty minutes and is done every four to six hours. Your last evening exchange remains or “dwells” inside your peritoneal cavity overnight while you are sleeping.

Using the CAPD dialysis method gives you the freedom to do dialysis at home, at work, or on vacation. That means you can continue to enjoy your life, whether that means retirement, working. going to school, traveling, or performing hobbies and other activities, just like you did before you started dialysis.


APD

In Automated PD, the exchanges of dialysis solution are done by a machine while you sleep. These exchanges are referred to as “cycles.”

At bedtime, you connect your catheter to a tubing set designed to fit into the front of the cycler machine. This then allows attachment to the bags of dialysis fluid required during the night.

APD occurs seven days a week, for approximately nine to ten hours each night. The machine and solution are placed near the bed, usually on a nightstand. While you sleep, the APD machine controls all three phases of the cycles: draining used solution, refilling with fresh solution, and monitoring the time the solution remains inside the peritoneal cavity (dwell time). In the morning, the machine does a “final fill” for most patients. That solution stays in the peritoneal cavity until bedtime the next night or until the next required exchange of fluid occurs.

In either CAPD or APD, you and your renal care team can discuss the option that best fits your needs.

How do I know how well PD therapy is working?

Simple, routine tests are scheduled by the PD nurse. Each test involves taking samples of blood and drained fluid from the peritoneal cavity and sending them to a lab. The results show how well the PD is clearing waste from the bloodstream. Your doctor may make changes based on the individual results of these tests. This helps to ensure that your dialysis prescription is providing good removal of waste and excess fluid from your body. Remember, any changes that your doctor makes will be in your best interest to provide you with the best dialysis and quality of life on PD therapy.

What does PD involve?

Will I be trained to do everything right?  Yes.  You will receive one-on-one training to give you the skills you need to perform the treatment. This custom training usually takes between five days and a few weeks and is done by a qualified nurse. There’s no need to be afraid of going “solo.” Your nurse will be there every step of the way to make sure you do things right.

Getting ready / Storing supplies

Once trained, you will  be able to prepare for and perform PD exchanges. You will  also receive advice on how to store your supplies.

CAPD frees you from being connected to a machine. So, you can perform an exchange in any private, clean, well-lit place where you can prepare for it.

If you use APD, you will need a small table or nightstand next to your bed to place the cycler machine and fluids needed for the night.

You will need a space about four feet high by six feet long to store one month’s worth of supplies. This is a little smaller than a walk-in closet.

How do I get my supplies?  What if I have questions? 
You’ll never be out of touch with your product customer service person or renal care team. A month’s worth of supplies will be sent once a month or more frequently, according to a convenient schedule. You can even have them sent to your job site or vacation spot, if that is more convenient.

Lifestyle Aspects

How will having a catheter affect my everyday life? 
Peritoneal dialysis is NOT painful. After the catheter is inserted and the area has healed, it is pain free. You may feel a sensation when the fluid begins to flow into or out of your peritoneal cavity during an exchange. But after a little while, you should not even notice this or the extra fluid in your abdomen. Your body will quickly adjust to the exchange and easily hold the extra fluid.

Does my catheter need special care? 
Yes. You must be very careful to keep your catheter site and tubing clean and free from contact with bacteria that can cause illness.

REMEMBER: ALWAYS wash your hands with soap and water BEFORE you touch your catheter. NEVER let your tubing or any part of the connection touch anything that would contaminate it. If this happens, it can lead to an inflamed peritoneal membrane and cavity. This condition is called peritonitis. It is painful and requires medication to heal it.
Your renal care team will review the proper way for you to do an exchange and care for your catheter. By strictly doing what they show and tell you, you can help avoid this problem.

Will having a catheter affect my sexual function? 
NO. Patients with catheters can enjoy normal sex lives. Having a catheter or being on PD will NOT inhibit you from having sexual relations with your partner. The catheter should be secured in place so no tugging or pulling occurs.

What about diet?  Are there any guidelines? 
YES, you will have to watch what you eat. In fact, all forms of dialysis restrict the individual’s diet to some extent. Some treatment options, such as hemodialysis, have more restrictions than others. PD lets you have more protein, fluids, and potassium in your diet. Please discuss this matter with your renal dietitian.

Your renal care team will advise you on how to adjust your diet plan and eating habits around your new dialysis treatment.

How active can I be on PD? 
An exercise routine is VERY helpful for all dialysis patients. With PD, it is wise to keep a few points in mind:

  • Normal housework and lawn work are typically not restricted
  • Discuss your participation in exercise and sports with your doctor

The bottom line is that you CAN be active in sports, exercise, and other physical activities while
on PD!

How different will my life be on PD? 
Whether retired, at work, at home, in school, or in a nursing home, you can conduct your PD anywhere you have privacy and a well-lit environment. There is some adjustment required, such as changing your daily schedule to allow for dialysis, planning for supplies, and learning a treatment technique. You might want to discuss this option with others who use this form of therapy. Groups such as those listed Under “Read All about It…” include many patients who have shared their personal stories to help individuals like you make this important decision.

Likely Candidate for PD

What kind of patients are candidates for PD?  A wide variety of patients can benefit from PD.  

  • Those wanting a lifestyle with more freedom and flexibility as compared to the more regimented in-center hemodialysis schedule (e.g., those who travel, are retired, have busy work/home schedules, or attend school).
  • Those with diabetes, cardiovascular disease, or hypertension
  • Patients who live a long way from their dialysis clinic and/or who have had problems with hemodialysis
     

PD – Is it the best choice for me?

Your renal care team will help you decide if PD will give you the therapy AND lifestyle you are looking for. Remember to ask all your questions and to be upfront with any concerns or goals you have. Your renal care team is here to help you make the best treatment choice.

 

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