Peritoneal Dialysis

Topic written or edited by:

Ehab R. Saad, MD, FACP, FASN, MA

Peritoneal dialysis (or PD) cleans your blood and removes extra fluids using one of your body’s own membranes, the peritoneal membrane, as the filter. The peritoneal membrane is the lining that surrounds the peritoneum or abdominal cavity, which contains your stomach, spleen, liver and intestines.

PD solution is a place in the peritoneum. The peritoneal membrane filters waste and fluids from your blood into the solution. The solution containing the wastes is drained from your peritoneum after several hours and replaced with fresh solution. This is called an exchange. A nurse experienced in PD will train you to perform peritoneal dialysis in the dialysis unit as an outpatient. Most people can learn to do PD within a few days. If you have concerns or problems, the nurse and doctor are never more than a phone call away. You will probably need to visit your clinic each month.

PD Supplies

Your doctor will write a prescription for the dialysis supplies you need. Your nurse will help you learn to order them. The supplies are delivered to your house. The driver of the van carries the supplies into your house and helps you organize them. You will need a place in your home to store 25-30 boxes

Peritoneal DialysisRemoving PD solution containing wastes and excess fluids from the peritoneum (drain) and replacing it with fresh PD solution (fill) is called an exchange. An exchange takes 20-30 minutes. After you fill the peritoneum with fresh PD solution, you leave this solution in the peritoneal cavity for four hours or more (dwell).

Peritoneal Dialysis Catheter
A small, soft tube called a catheter is put through the wall of your abdomen into the peritoneal cavity. The catheter is called an access because it provides a way to get PD solution into your peritoneum. Solution flows in and out of the peritoneal cavity through the catheter. Placing the catheter requires minor outpatient surgery.

The opening for the catheter should heal for a few weeks before starting dialysis. The catheter is usually not painful and stays in place throughout your time on PD.

Peritoneal Dialysis CatheterCatheter
The catheter is usually placed about 1 inch below and to the side of the navel. It is about ¼ -inch in diameter. Only 4-6 inches of it are outside of your body. You and your doctor can plan where to place the catheter so that it is comfortable and hidden by clothing.

Two types of Peritoneal Dialysis

- Continuous Ambulatory Peritoneal Dialysis (CAPD)
- Automated Peritoneal Dialysis (APD)

How will PD affect your lifestyle?

Most people enjoy the flexibility and independence that they have with PD. Your dietician can help you manage your diet. It is very important to follow the meal plan recommended by your dietician in order to avoid malnutrition. Also, poor diet can cause depression, tiredness, and a lower quality of life.

You can do most sports and exercise after checking with your doctor. To travel, you pack your CAPD supplies in a suitcase. If you use APD, you can pack along your cycler, or you can switch to CAPD while you are traveling. If you go on a long trip or travel to a foreign country, the dialysis company can ship supplies to your destination ahead of time.

People on PD can lead normal lives. It is easy to adjust the treatment schedule according to your work, school, or travel plans because you are in charge of your own treatment.

Possible complications of PD

The major complication of PD is an infection of the peritoneal membrane called peritonitis. The best way to keep from getting an infection is to wash your hands and to perform your exchanges exactly as instructed. You will be taught to recognize the early signs of infection. Peritonitis is treated with antibiotics, which usually can be taken at home.

Exit-Site Infection
The area around your catheter can also become infected. This area, called the exit-site, should be cleaned daily. You will learn how to care for your exit site during PD training. Exit-site infections are treated with antibiotics.

Peritoneal Dialysis Advantages

  • A flexible lifestyle and independence
  • Clinic visits about once a month
  • Doesn’t use needles
  • Provides continuous therapy, which is more like your natural kidneys
  • Don’t have to travel to dialysis unit for treatment
  • Easy to do your therapy while you travel
  • Can do therapy while sleeping (APD)

Peritoneal Dialysis Disadvantages

  • Need to schedule exchanges into your daily routine, seven days a week
  • Requires a permanent catheter, outside the body
  • Runs some risk of infection
  • May gain weight/have a larger waistline
  • Very large people may need extra therapy
  • Need storage space in your home for supplies
  • Need space in your bedroom for equipment (APD)