Peritoneal Dialysis

1 What is a Peritoneal Dialysis?

Peritoneal dialysis is a blood-filtering method that is designed to remove waste products from your blood when your kidneys are not effectively functioning.

A cleansing fluid flows through a tube (catheter) into part of your abdomen and filters waste products from your blood.

After a prescribed period of time, the fluid with filtered waste products flows out of your abdomen and is disposed of.

Peritoneal dialysis differs from hemodialysis, which is a more commonly used blood-filtering procedure. With peritoneal dialysis, you can give yourself treatments at home, at work or while travelling.

Peritoneal dialysis cannot be an option for everyone with kidney failure. You need manual dexterity and the ability to care for yourself at home, or a reliable caregiver.

2 Reasons for Procedure

The main reason peritoneal dialysis is required is if your kidneys do not function adequately on their own.

Kidney damage usually gets worse over a number of years as a result of long-term conditions, such as:

The benefits of peritoneal dialysis compared with hemodialysis include:

Greater lifestyle flexibility and independence. These are especially considered if you work, travel or live far from a hemodialysis center.

More flexible dietary guidelines. Peritoneal dialysis is done more continuously compared to hemodialysis, resulting in less accumulation of potassium, sodium, and fluid.

More stable blood chemistry and body hydration. Peritoneal dialysis does not require intravenous (IV) access, which can disrupt your circulation and level of fluid.

Longer lasting residual kidney function. Individuals who used peritoneal dialysis might retain kidney function slightly longer than those who use hemodialysis. Your doctor will help you determine the best type of dialysis for you.

The following factors will be considered:

  • Your kidney function, as measured by blood and urine tests.
  • Your overall health.
  • Your personal preferences.
  • Your home situation.

Peritoneal dialysis may be a better option for you in the following cases:

  • If you cannot tolerate rapid changes in fluid balance associated with hemodialysis.
  • If you want to maximize the disruption of your daily activities, and work or travel easier.
  • If you have some residual kidney function.

Peritoneal dialysis will be ineffective in the following cases:

  • If you have extensive surgical scars in your abdomen.
  • If you have a large area of weakened abdominal muscles (a hernia).
  • If you have limited ability to care for yourself, or lack of caregiving support.
  • If you have protein malnutrition.
  • If you have a critical illness.

Most individuals who start dialysis with peritoneal dialysis will eventually experience a decline in kidney function and will require hemodialysis or kidney transplant.

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3 Potential Risks

The following are the potential risks of peritoneal dialysis:

Infections. An infection of the abdominal lining (peritonitis) is a common complication of peritoneal dialysis.

An infection can also occur at the site where the catheter is inserted to carry the cleansing fluid (dialysate) into and out of your abdomen. The risk of infection id higher if the individual doing the dialysis is not adequately trained.

Weight gain. The dialysate contains sugar (dextrose). Absorbing some of the dialysates might cause you to take in several hundred extra calories per day, which in turn will lead to weight gain. The extra calories can also cause high blood sugar especially if you have diabetes.

Hernia. Hold fluid for a sustained period of time can strain your muscles.

Inadequate dialysis. Peritoneal dialysis can be ineffective after several years. You might need to switch to hemodialysis.

You need to avoid the following if you have peritoneal dialysis:

  • Certain prescription over-the-counter medications that can damage your kidneys, including nonsteroidal inflammatory drugs (NSAIDs).  
  • Soaking in a bath or hot tub, or swimming in a lake, pond, river or nonchlorinated pool, which increases the risk of infection.
  • Showers and swimming in a chlorinated pool are generally acceptable.

4 Preparing for your Procedure

In preparing for your peritoneal dialysis , you must follow your doctor’s orders. You will be trained to understand what peritoneal dialysis involves and how to use the equipment.

You will also need an operation to insert the catheter hat carries the dialysate in and out of your abdomen.

This operation can be done under local or general anesthesia. The tube is usually inserted in your bellybutton.

You doctor will probably recommend waiting at least two weeks before starting peritoneal dialysis treatments to give the catheter site enough time to heal.

Complete healing of the catheter site can take up to two months.

5 What to Expect

Here’s what you can expect before, during, and after your peritoneal dialysis.

In peritoneal dialysis, a sterile cleansing solution (dialysate) flows through the catheter into your abdomen. The solution remains in your abdomen for a prescribed period of time, known as dwell time.

During this dwell time, waste, chemicals, and extra fluid in your blood pass from tiny blood vessels (capillaries) in the lining of your abdominal cavity (peritoneum) into the dialysis solution.

The solution contains a sugar that draws wastes and extra fluid through the capillaries in your peritoneum into your abdomen. Your belly may feel fuller than usual while the dialysis solution is there, but it's generally not uncomfortable.

When the dwell time is over, the solution, along with waste products drawn from your blood and any excess fluid, drains into a sterile collection bag. The process of filling and then draining your abdomen is called an exchange.

Different methods of peritoneal dialysis have different schedules of daily exchanges. The two main schedules are continuous ambulatory peritoneal dialysis (CAPD) and continuous cycling peritoneal dialysis (CCPD).

Some people use a combination of both methods. Continuous ambulatory peritoneal dialysis (CAPD) With this form of peritoneal dialysis, you fill your abdomen with dialysis solution and later drain the fluid.

Gravity moves the fluid through the tube and into and out of your belly. Each exchange includes filling your abdomen with dialysate fluid, letting the fluid dwell in your abdomen, then draining the fluid.

You may need three to four exchanges during the day and one with a longer dwell time while you sleep. You can do the exchanges at home, work or any clean place. You're free to go about your normal activities while the dialysis solution dwells in your abdomen between exchanges.

Continuous cycling peritoneal dialysis (CCPD) With CCPD, which may also be called automated peritoneal dialysis (APD), a machine called an automated cycler performs three to five exchanges at night while you sleep.

The cycler automatically fills your abdomen with dialysis solution, allows it to dwell there and then drains it to a sterile drainage bag that you empty in the morning.

This gives you more flexibility during the day, but you must remain attached to the machine for 10 to 12 hours at night. In the morning, you begin one exchange with a dwell time that lasts the entire day.

You're not connected to the machine during the day. Which form of peritoneal dialysis is best for you depends on your lifestyle, personal preferences, and medical condition.

You may also customize your program by combining the two forms. For instance, if you're using CCPD, you may do one extra exchange in the afternoon to remove more waste and prevent absorption of excess fluid.

6 Procedure Results

Understanding the results of your peritoneal dialysis will be made possible by your doctor.

There are many factors that affect how well peritoneal dialysis works in removing wastes and extra fluid from your blood.

These factors include:

  • Your size
  • How quickly your peritoneum filters waste (peritoneal transport rate)
  • How much dialysis solution you use (fill volume)
  • The number of daily exchanges
  • Length of dwell times
  • The concentration of sugar (dextrose) in the dialysis solution

Your health care team will perform several tests to check if your dialysis is removing enough waste products.

During the first weeks of dialysis, these tests help determine whether you're receiving an adequate amount, or dose, of dialysis. Peritoneal equilibration test (PET).

This test measures how much sugar has been absorbed from a bag of used dialysis solution. It also measures how much of two waste products — urea and creatinine — are in the solution after a four-hour exchange.

Clearance test. Samples of used dialysis solution and venous blood are collected to compare the amount of urea in the used solution with the amount in the blood.

If you still produce urine, your doctor may take a urine sample at the same time to measure its urea concentration.

If the test results show that your dialysis schedule is not removing enough wastes, your doctor may change your dialysis routine.

This might involve changing the number of exchanges, increasing the amount of solution you use for each exchange or using a dialysis solution with a higher concentration of dextrose.

You can improve your dialysis results and your overall health by eating the right foods, including foods low in sodium and phosphorus.

A dietitian can help you develop an individualized meal plan based on your weight, your personal preferences, your remaining kidney function and other medical conditions, such as diabetes or high blood pressure.

Taking your medications as prescribed also is important for getting the best possible results.

While you're receiving peritoneal dialysis, you'll likely need various medications to control your blood pressure, stimulate the production of red blood cells, control the levels of certain nutrients in your blood and prevent the buildup of phosphorus in your blood.

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