Learn more about peritoneal dialysis and whether it's right for you
- How Peritoneal Dialysis Works
- Getting Started with CAPD
- Getting Started with CCPD
- Benefits and Considerations
Peritoneal Dialysis (PD) is a gentle, no needle treatment done at home, either by the patient alone or with a care partner if desired. PD is a treatment in which waste products and extra fluid are removed in a different way than hemodialysis. The blood does not leave the body, so no needles are involved. Instead, a tube called a PD catheter is placed in the belly, and the dialysis process happens by sterile fluid flowing through the lining of the belly (called the peritoneum). Blood is cleaned inside the body.
Gaining access for peritoneal dialysis
A peritoneal catheter is used to gain access to the peritoneum through the belly. The PD catheter is a flexible hollow tube with the size of a straw. It is placed in the patient’s lower abdomen. A small amount of tubing remains outside the body and can be covered when it isn't being used.
Planning for access is important
Timing is critical. A peritoneal catheter takes 3–4 weeks to heal before it can be used for dialysis treatment. The PD catheter is usually placed by a surgeon in an operating room (to minimize infection), often under local anesthesia. The catheter is placed through the wall of your belly. Once it heals, a nurse will teach you how to use it and take care of it.
Peritoneal dialysis training
Before you start training, someone from the peritoneal dialysis team will visit your home to see which room would be best for your exchanges and where you can store the supplies you’ll need.
Peritoneal dialysis requires a week or two of training. You’ll practice while your training nurse watches to be sure you’re doing all of the steps correctly. Be assured that your healthcare team will work with you until you feel confident. You will learn how to:
- Set up a place to do an exchange.
- Wash your hands thoroughly to remove bacteria and help prevent infection.
- Care for your catheter and clean and dry your exit site.
- Connect your catheter to a PD bag in a sterile way to prevent infection.
- Add medicine to your PD bag if you need to.
- Drain out used PD dialysate and put in fresh dialysate. This is known as an exchange.
- Keep good treatment records.
- Order enough supplies of each type to last you a month.
- Safely dispose of medical wastes.
You’ll also have information to take home and review, and you can always call your nurse if you have any questions.
Working with your care team
On peritoneal dialysis, YOU are the most important member of your care team. You are giving yourself these treatments and you know how you’re feeling. The members of your care team are there to help you watch your health and make changes to your dialysis prescription, diet and medications when needed.
Here is a list of things to tell your nurse so she or he, along with your care team, can help keep you as healthy as possible. Tell your nurse:
- About any medications you are taking, whether they are prescribed by your doctor or bought over the counter.
- If you do not feel comfortable doing your PD for any reason.
- If you are not feeling well, or you feel “different” than you normally do. If you find any signs of infection at your catheter exit site, or in your abdomen.
The exchange process
The peritoneum acts like the membrane of a dialyzer or artificial kidney in hemodialysis. There are many tiny holes in the peritoneal membrane in your belly that can filter out waste products and chemicals from the blood.
A special cleaning solution, called dialysate, flows into the peritoneal cavity through the catheter. Wastes and water move from the blood into the dialysate fluid. In a few hours, the patient drains the dialysate out and puts fresh fluid in. This is called an exchange. A peritoneal dialysis patient will need to do 4 or 5 exchanges every day.
Peritoneal Dialysis (PD) Exchange Process: Drain—Fill—Dwell
An exchange process consists of 3 key steps: drain, fill, dwell:
- Drain: Dialysate solution is drained out through the catheter.
- Fill: Fresh dialysate flows into the peritoneal cavity.
- Dwell: The dialysate solution stays in the abdomen for a period of time.
Exchanges can be done:
- During the day.
- At night, by using a PD dialysis machine called a “cycler”.
- Both day and night.
Two ways to do PD exchanges
Manually: With Continuous Ambulatory (CAPD), the patient can perform peritoneal dialysis treatments manually. No machine needed.
With a machine: With Continuous Cycling PD (CCPD), the patient performs peritoneal dialysis treatments using a machine called a cycler.
Getting started with Continuous Ambulatory Peritoneal Dialysis
Continuous Ambulatory Peritoneal Dialysis (CAPD) is a home dialysis treatment that you can perform manually without a machine. Learn more about this type of home dialysis to see whether it may be right for you.
With CAPD, you do the “drain, fill, dwell” exchanges manually 4-5 times daily. The process includes using the peritoneal catheter to fill the abdomen with dialysate fluid, letting the fluid remain in the cavity for several hours, and then draining the fluid out using the catheter. Once you’ve drained out the fluid, you repeat the process using fresh dialysate.
This exchange process is usually repeated every 4 – 5 hours (depending on doctor’s orders) and it typically only takes a half hour to perform the exchange. Exchanges are typically performed:
- In morning, when you wake up
- at lunch time
- at dinner
- at bedtime
and at any other times prescribed by your doctor.
Exchanges can be performed at home, work, or while traveling—it just requires a sterile (clean), well-lit area.
You will receive training that will get you completely comfortable with performing an exchange. You will learn which dialysate solution your kidney doctor has prescribed (it comes in different concentration and strengths) and you will learn how to adjust the solution based on your daily weight and blood pressure results.
You will also need to be sure you have enough storage to store a month’s supply of CAPD tubing sets, dialysate solutions and other necessary supplies.
Getting started with Continuous Cycling Peritoneal Dialysis
Continuous Cycling Peritoneal Dialysis (CCPD) is a home dialysis treatment that can be performed using a machine called a cycler. Learn more about this type of home dialysis to see whether it may be right for you.
With CCPD, you will connect to the cycler machine for the “drain, fill, dwell” exchange process daily. Most people prefer to do CCPD during the night while they are sleeping. The entire nightly exchange process takes about 8 - 10 hours to complete. Some patients may need to do an extra manual CAPD exchange during the day if prescribed by the nephrologist (kidney doctor).
With CCPD, you will learn how to set up the cycler to perform exchanges. You will also learn how to adjust the dialysate solution based on your daily weight and blood pressure results.
During the night while you sleep, the cycler automatically fills and drains the dialysate from your peritoneal cavity, including time for the solution to “dwell.” When you wake up in the morning, you disconnect from the cycler. Fresh dialysate is left in your peritoneal cavity during the day, and the same process takes place each night.
Exchanges can be performed at home, work, or while traveling. It requires an electrical outlet hook-up and should always be done in a sterile (clean), well–lit area.
There are storage requirements for CCPD, including space to store the cycler and 1 month of supplies and the dialysate solution.
Benefits of Peritoneal Dialysis (CAPD and CCPD)
- It's a more gentle treatment because it works more like a "normal kidney"
- Treatment schedule is flexible, which allows more time for family, work and school
- Can help you feel more independent and in control of your life and care
- Easier to travel with peritoneal dialysis
- May provide more flexibility in diet and less fluid restrictions
- Fewer medications may be possible
- You only have to travel to the dialysis facility once a month to visit with the care team and review lab results
- For most patients, no home partner or caregiver is needed
- No needles are required in the peritoneal dialysis exchange process
Considerations of Peritoneal Dialysis (CAPD and CCPD)
- You have a catheter (PD tube) in your abdomen or chest all of the time
- Your belly is full of dialysate fluid all of the time
- You must do their peritoneal dialysis exchange treatments every day
- There is a risk of getting "peritonitis," a serious infection of the catheter exit site, or on the space inside your abdomen (the peritoneal cavity)
- Weight gain can occur, from sugar in the peritoneal dialysis fluid
- You will need to have enough storage space at home to store a month's worth of peritoneal dialysis supplies
- You must have a sterile environment at all times to perform peritoneal dialysis exchanges