Treatment Choice: Peritoneal Dialysis
- Treatment Choice: Peritoneal Dialysis
Peritoneal dialysis is another procedure that removes wastes, chemicals, and extra water from your body. This type of dialysis uses the lining of your abdomen, or belly, to filter your blood. This lining is called the peritoneal membrane and acts as the artificial kidney.
- How Peritoneal Dialysis Works
A mixture of minerals and sugar dissolved in water, called dialysis solution, travels through a catheter into your belly. 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 your abdomen is refilled with fresh dialysis solution, and the cycle is repeated. The process of draining and refilling is called an exchange.
- Getting Ready
Before your first treatment, a surgeon places a catheter into your abdomen or chest. 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. Planning your dialysis access can improve treatment success. This catheter stays there permanently to help transport the dialysis solution to and from your abdomen.
- Types of Peritoneal Dialysis
Three types of peritoneal dialysis are available:
- Continuous Ambulatory Peritoneal Dialysis (CAPD)
CAPD 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 time period that dialysis solution is in your abdomen is called the dwell time. Next, you drain the dialysis solution into an empty bag for disposal. You then 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 abdomens at night. With CAPD, it’s not necessary to wake up and perform dialysis tasks during the night.
- 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.
- 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.
- Who Performs Peritoneal Dialysis
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. Infection is less common in presternal catheters, which are placed in the chest. 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 or nurse immediately so that peritonitis can be treated quickly to avoid additional problems.
- Diet for Peritoneal Dialysis
A peritoneal dialysis diet is slightly different from an In-Center Hemodialysis Diet.
You’ll still need to limit salt and liquids, but you may be able to have more of each, compared with In-Center Hemodialysis.
- You must eat more protein.
- You may have different restrictions on potassium. You may even need to eat high-potassium foods.
- 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 dietitian who specializes in helping people with kidney failure will be able to help you plan your meals.
- Working With Your Health Care Team
Questions you may want to ask:
- Is peritoneal dialysis the best treatment choice for me? Why? If yes, which type is best?
- How long will it take me to learn how to do peritoneal dialysis?
- What does peritoneal dialysis feel like?
- How will peritoneal dialysis affect my blood pressure?
- How will I know if I have peritonitis? How is it treated?
- As a peritoneal dialysis patient, will I be able to continue working?
- How much should I exercise?
- Where do I store supplies?
- How often do I see my doctor?
- Who will be on my health care team? How can these people help me?
- Whom do I contact with problems?
- With whom can I talk about finances, sexuality, or family concerns?
- How/where can I talk with other people who have faced this decision?
- Dialysis Is Not a Cure
Hemodialysis and peritoneal dialysis are treatments that help replace the work your kidneys did. These treatments help you feel better and live longer, but they don’t cure kidney failure. Although patients with kidney failure are now living longer than ever, over the years kidney disease can cause problems such as heart disease, bone disease, arthritis, nerve damage, infertility, and malnutrition. These problems won’t go away with dialysis, but doctors now have new and better ways to prevent or treat them. You should discuss these complications and their treatments with your doctor.