This information is for people who have kidney failure and are considering peritoneal dialysis as a treatment option. Healthy kidneys clean your blood by removing toxins and excess fluid. As your kidney fails, harmful toxins build up in your body and your body may accumulate excessive fluid. Peritoneal dialysis is one of the available treatment options to remove waste products and excess fluid from your body when the kidneys are no longer functioning. Another treatment option is hemodialysis where the toxins and excess fluid are removed from the blood via a hemodialysis machine. The best treatment option is a kidney transplant where a new kidney is put inside your body. You will have to discuss with your attending Nephrologist on which treatment option is best for you.
Peritoneal Dialysis: Information for Patients
What is Peritoneal Dialysis?
Peritoneal dialysis is the removal of toxins and extra fluid from your body using the peritoneal membrane as a filter. The peritoneal membrane is the natural lining of your abdomen that surrounds most of your organs. The peritoneal membrane has a good blood supply and can act as a filter to enable dialysis to take place. A soft tube, called a catheter, is surgically placed in your abdomen. This catheter makes it possible for you to connect to a special tubing allowing 2 litres of cleansing fluid (called dialysate) to flow into your abdomen. The dialysate usually stays in your abdomen for a few hours (dwell time) and during this dwell time wastes and extra fluid pass through the peritoneal membrane into the cleansing fluid. During the dwell time, the catheter is capped and you can continue your usual activities. After your dwell time, you drain the cleansing fluid from your abdomen into an empty bag and discard it. You then repeat the in-and-out process usually 4 times a day using fresh dialysate. The process of exchanging bags (called an exchange) usually takes 20 to 30 minutes
The training staff at your peritoneal dialysis centre will teach you everything you need to know about how to do the exchanges, order supplies, clean your catheter and guard against infection. Once you and the training staff are comfortable with your ability to do the peritoneal dialysis on your own, you can start doing your own treatment at home.
Types of Peritoneal Dialysis therapy
There are 2 types of peritoneal dialysis treatment – continuous ambulatory peritoneal dialysis (CAPD) and automated peritoneal dialysis (APD).
CAPD is carried out by hand every day. There are usually 4 exchanges of dialysate during the day – first thing in the morning, around lunch time, before dinner time and before going to bed at night. You can carry out normal daily activities in between the bag exchanges. Since you do not have dialysis sessions at a dialysis unit, you can do your own treatment at home, at work or on holiday. Automated peritoneal dialysis (APD) requires a machine to fill and drain your abdomen; performing three to five exchanges during the night while you sleep. The process usually lasts 8–10 hours. You will need to prepare the machine before you go to bed. This takes about 20 to 30 minutes. When you go to bed, you attach your catheter to the lines on the machine. While you are sleeping the machine will perform the 3 to 5 bag exchanges overnight. Every morning, the machine will fill your abdomen with dialysate for the last time and this dialysate will sit in your abdomen for the whole day till your next treatment at night. On waking up in the morning you can detach your catheter from the machine and discard the used lines and bags of fluid.
- PD can be done in many locations, making it easier to travel and work.
- No needles.
- Flexible schedule and increased independence.
- Fewer fluid and diet restrictions than haemodialysis.
- For CAPD, no machine is necessary.
- Training is easier than home haemodialysis.
- APD is usually done while you sleep
- Often provides better blood pressure control.
- Prolongs remaining kidney function
- Treatment is usually performed four times per day for CAPD and nightly for APD.
- Not all dialysis facilities offer CAPD.
- Your abdomen is always full of fluid, which may increase the size of your waist.
- Requires the insertion of a permanent catheter.
- Procedures must be closely followed to reduce the risk of infection in the peritoneal cavity or at the exit site.
- Storage space is needed in your home for supplies.
- For APD, a machine is needed which may disturb sleep during the night.