Peritoneal dialysis is one type of dialysis treatment for kidney failure.
A soft plastic tube (catheter) is placed in your belly by surgery that transports fluid in
or out of your body.
A sterile cleansing solution called dialysate is put into your belly through this catheter.
This solution is a type of cleansing liquid that contains water, salt and other additives.
The tissue that covers most of the organs in your belly (the peritoneum) acts as a filter
for this process.
The dialysate will stay in your belly for a period of time, usually four to six hours,
while it cleans your blood. This time is called dwell time. Then, the used dialysate will
be drained out of your belly and refilled with fresh dialysate. This process is called an
exchange.
You may do these exchanges yourself or with the help of a machine.
Peritoneal dialysis takes place at home.
What happens before and after peritoneal dialysis?
Before: About three weeks before you start peritoneal dialysis, you will have
a minor surgical procedure. A surgeon inserts a catheter through your belly and into the peritoneum.
This catheter stays in place permanently. A healthcare provider will teach you how to perform
peritoneal dialysis at home and prevent infections at the catheter site.
After: The liquid in your belly can make you feel bloated or full. You might feel uncomfortable,
but the treatment isn’t painful. Your stomach may stick out more than usual when it’s filled with
fluid.
Will there be activity restrictions while I am on dialysis?
Many patients on dialysis continue to live active lives. When you travel,
your healthcare provider can help arrange for you to get dialysis at a centre at your new location.
If you do either type of self-dialysis, you can take dialysis solution bags and the portable home
dialysis machine (if needed) with you.
People using peritoneal dialysis may need to limit certain physical activities when the
abdomen fills with dialysis fluid. Otherwise, exercising is typically OK for people on dialysis.
You should consult your doctor about participating in specific activities or sports.
Types of peritoneal dialysis
There are two kinds of peritoneal dialysis:
- Continuous Ambulatory Peritoneal Dialysis (CAPD)
- Automated Peritoneal Dialysis (APD)
The basic treatment is the same for each. However, the number and the way the treatments are done make each method different.
CAPD is "continuous," machine-free and done while you go about your normal activities such as work. The treatment is done by placing about two quarts of cleansing fluid into your belly and later draining it. This is done by hooking up a plastic bag of cleansing fluid to the tube in your belly. Raising the plastic bag to shoulder level causes gravity to pull the fluid into your belly. When empty, the plastic bag is removed and thrown away. When an exchange is finished, the fluid (which now has wastes removed from your blood) is drained from your belly and disposed of. This process is usually repeated three- five times in a 24-hour period while you are awake. Each exchange takes about 30 to 40 minutes. Some patients prefer doing their exchanges at mealtimes and bedtime.
In APD, a machine (cycler) delivers and then drains the cleansing fluid for you. The treatment is usually done at night while you sleep.
The pros and cons of being on peritoneal dialysis
Some doctors feel that CAPD and APD have several benefits when compared to hemodialysis.
- With continuous dialysis, you can control extra fluid more easily, and this may reduce stress on the heart and blood vessels.
- You are able to eat more and use fewer medications.
- You can participate in more daily activities and it is easier to work or travel.
However, there are some people for whom peritoneal dialysis may not be appropriate.
- The abdomen or belly of some people, particularly those who are morbidly obese or those with multiple prior abdominal surgeries, may make peritoneal dialysis treatments difficult or impossible.
- Peritonitis (infection of abdomen) is an occasional complication although should be infrequent with appropriate precautions.
- Peritoneal dialysis is not for everyone. People must receive training and be able to perform correctly each of the steps of the treatment. A trained helper may also be used.
When making a decision about the type of treatment, you should take into consideration that peritoneal dialysis is usually a daily process, similar to the working of the kidney and may be more gentle with fluid removal from the body. Peritoneal dialysis is an effective form of dialysis, and has been proven to be as good as hemodialysis.