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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 home dialysis. While many dialysis patients in the United States go to a dialysis center, PD offers more flexibility by allowing patients to dialyze at home, at work or on vacation.
To perform treatments, PD uses the thin membrane, called the peritoneum, which lines the abdomen. 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 and stays in the abdomen for a specified amount of time. Once the dialysate is drained, the wastes and 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.
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 APD because it allows most of their dialysis to be performed while they sleep. Every patient is different, and doctors and PD nurses will help patients decide which PD treatment regimen is best for them.
The benefits of PD include:
Patients who choose 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 every day, 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.
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.
Patients 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 offers several options. A cycler will fit comfortably on a bedside table to allow for exchanges while the patient sleeps.
PD patients will have an entire team of professionals—a nephrologist, PD nurse, dietitian and social worker—focused on their care to make sure they are getting the most out of their dialysis treatments.
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