Peritoneal dialysis

A brief overview of peritoneal dialysis

Peritoneal dialysis (PD) has been a widely accepted method of treating end stage renal disease (ESRD) since the 1980s, and it is now the most common method of at-home dialysis. While many dialysis patients in the U.S. go to a dialysis center for hemodialysis three times a week for about four hours per treatment, PD offers more flexibility by allowing patients to dialyze wherever they may be - at home, at work or on vacation.

PD uses the thin membrane, called the peritoneum, which lines the abdomen to perform dialysis treatments. During treatments, a cleansing fluid called dialysate is put into the patient's abdomen through a small, flexible tube called a PD catheter.

The dialysate pulls the waste and extra fluid from the patient's blood into the peritoneal cavity. The dialysate remains in the abdomen for a specified amount of time before it is drained and replaced with fresh dialysate. The time during which the dialysate remains in the patient's abdomen is known as the dwell time. When the dialysate is drained, the wastes and extra fluids are also drained, and fresh dialysate is replaced to clean the blood. This filling and draining process is called an exchange because the dialysate that has been in the abdomen is being exchanged for new, fresh dialysate. Exchanges can be done manually or with a machine called a cycler.

There are three basic requirements patients must meet in order to qualify for peritoneal dialysis (PD). Patients must have the motivation to adhere to a treatment schedule, basic manual dexterity and a functional peritoneal membrane.

History of PD

The first step toward PD was taken in the 1920s when U.S. and German medical professionals discovered that peritoneal dialysis was effective in treating end stage renal disease (ESRD). Over the years that followed this discovery, developments were made in regard to equipment and materials to ensure safety and cleanliness. In 1968, Henry Tenckhoff created a PD catheter that could remain in a patient's abdomen permanently, instead of being inserted for every treatment. This reduced the risk of infection. Tenckhoff's catheter and the development of continuous cycling peritoneal dialysis (CCPD) in 1981 turned PD into a common form of dialysis treatment.

Types of peritoneal dialysis

Continuous ambulatory peritoneal dialysis (CAPD)

With CAPD, the patient manually performs his or her exchanges. Exchanges, which take approximately 30 minutes, are performed four times during the day by placing a bag of dialysate fluid on an IV pole or coat rack. Gravity then makes the filling and draining process possible. This form of PD can even be performed while the patient is at work, as long as he or she has a sterile environment to perform the exchanges.

Automated peritoneal dialysis (APD)

Automated peritoneal dialysis (APD), commonly referred to as continuous cycling peritoneal dialysis (CCPD), requires a cycler machine to automate the filling and draining process. Most patients choose this form of PD because it allows most of their dialysis to be performed while they sleep, freeing up the day for other activities. Many patients can have all their dialysis done while they sleep. Some patients will carry dialysis fluid in their abdomen during the day, and some will need to perform a manual fluid exchange during the day. Every patient is different, and doctors and PD nurses will help patients decide which peritoneal dialysis (PD) treatment regimen is best for them.

Benefits of peritoneal dialysis

The benefits of peritoneal dialysis (PD) include:

Fewer negative side effects (such as nausea, vomiting, cramping, and weight gain) than in-center hemodialysis
Fewer dietary restrictions than in-center hemodialysis
Needle-free treatments
Direct shipment of PD supplies to your home or travel destination
Infrequent trips to the dialysis center
Greater flexibility and freedom in your treatment schedule

In addition, because PD patients take an active role in performing their dialysis, they are more involved in their care and more educated about their conditions. Research indicates that patients on dialysis who are more involved in their healthcare tend to be healthier and have a better outlook regarding their treatment.

Peritoneal dialysis training

Patients who choose peritoneal dialysis (PD) are thoroughly trained to perform the dialysis treatments safely and effectively. Patients are trained to wash their hands before touching their catheters, clean their exit sites everyday, wear surgical masks when doing exchanges and check solution bags for contamination. Patients are also trained to spot the signs of an infection, some of which include fever, nausea and/or irritation around the catheter.

PD training usually takes one to two weeks. However, home training peritoneal dialysis nurses will not leave a patient alone to do his or her treatments until both the nurse and the patient feel that training has been completed and the patient is comfortable performing the treatments. Training is given to the patient as well as the patient's care partner if he or she has someone who will be helping with the PD treatments. A trained PD nurse is generally available by phone 24 hours per day to answer questions and help troubleshoot minor problems that may arise.

Peritoneal dialysis equipment and home modifications

While PD patients will not need to make any plumbing or electrical modifications to their homes, they will need space to store PD supplies. In addition, patients will also need running water, electricity and a sterile environment to do their exchanges.

In regard to equipment, patients who choose CCPD will need a cycler machine. Small, portable cyclers are available to be purchased from a number of medical device manufacturers, each of which offer several options. A cycler will fit comfortably on a bedside table to allow for exchanges while the patient sleeps.

Peritoneal dialysis support team

Choosing PD does not mean patients will be on their own in their treatments. Instead, they will have an entire team of professionals focused on their care and monitoring their lab values to make sure they are getting the most out of their dialysis treatments.

A nephrologist will prescribe dialysis treatments, diet and medication, as well as manage ongoing medical care.
A home training PD nurse will train and guide. Home training PD nurses will plan, coordinate and oversee all aspects of patients' dialysis care in keeping with their doctors' orders.
A renal dietitian will guide patients on what to eat and review their lab results with them each month to determine where improvements can be made in their diets.
A social worker will counsel patients regarding the emotional aspects and adjustment of dialysis and insurance issues.