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Introduction to Peritoneal Dialysis (PD)

Introduction to Peritoneal Dialysis (PD) 

WHAT IS HAPPENING TO ME?

When you hear you have chronic kidney disease, it can be a shock: dialysis or a kidney transplant can affect many aspects of your life and have a big impact on the way you live. Understanding what is happening may help you and your family to organise the future in the best possible way and help you to adapt to the new situation. 

THE KIDNEYS: HOW DO THEY WORK?

The kidneys play an important role in your health. Most people are born with 2 kidneys – one on each side of the backbone just below the rib cage. Shaped like a kidney bean, each kidney is about the size of a small fist (12 cm) and weighs about 150 grams. 

NORMAL HEALTHY KIDNEYS:

  • Clean waste products from your blood
  • Remove excess fluid
  • Help to control your blood pressure
  • Help to make red blood cells
  • Produce vitamin D to keep bones healthy and strong 

WHAT IS PERITONEAL DIALYSIS?

If you’re starting dialysis, peritoneal dialysis (PD) might be one of the treatment options available to you. Peritoneal dialysis (PD) is usually done at home and can even be done while you sleep. It is also possible to do peritoneal dialysis (PD) treatments while you travel. So, it might be the right therapy if remaining mobile or having a flexible treatment schedule are important to you. 

Peritoneal dialysis (PD) uses the lining of your own abdomen (tummy), called the peritoneal membrane, to filter and clean your blood. This lining is where peritoneal dialysis (PD) gets its name. 

During peritoneal dialysis (PD), a fluid called dialysis solution (or dialysate) passes into your abdomen through a catheter (a soft plastic tube). Once the dialysis fluid has flowed into your abdomen, it stays there, cleaning your blood by absorbing any waste and excess fluid. This happens because of two processes called osmosis and diffusion, which allow the waste and fluid to be transferred from your blood into the dialysis solution. After a period of between 1 and 4 hours, the dialysis solution containing the waste and excess fluid from your body is drained out of your abdomen through your catheter. This whole process is called an exchange. 

The PD catheter is placed during a simple minor operation under a local or a general anaesthetic. The catheter and the exit site (the place where the catheter comes outside), will need daily care. 

There are two forms of peritoneal dialysis (PD): continuous ambulatory peritoneal dialysis (CAPD) and automated peritoneal dialysis (APD). The basic treatment is the same for each, but the way the exchanges are done, and the number of exchanges needed, are different. 

Peritoneal dialysis (PD) is done at home, typically by yourself, and occasionally with the support of a caregiver. If you need assistance to perform the therapy, a community nurse or healthcare assistant can come and help you. Doing dialysis at home means that you can tailor your treatments to your lifestyle, rather than the other way around. For example, peritoneal dialysis (PD) may give you the opportunity to work, study or travel. Since peritoneal dialysis (PD) is normally done every day, this flexibility may be a big benefit for you. 

In terms of how the therapy feels, peritoneal dialysis is considered a painless therapy, and does not involve the use of needles on a consistent basis. You may, however, experience a sense of fullness after therapy, depending on the prescription your physician determines is appropriate for you. 

What is Continuous Ambulatory Peritoneal Dialysis (CAPD)?

CAPD is a type of peritoneal dialysis (PD) that uses gravity, rather than a machine, to “exchange” your old dialysis solution for fresh solution. 

CAPD is a possible option for children with kidney disease, but it may depend on how much urine your child still makes.  3 – 4 exchanges each day are recommended, with the ‘fill’ volume measured, for your child’s size.  Each exchange usually takes between 30 -40 mins. 

To do this, a bag of dialysis solution is connected to a tube that goes into your abdomen. The exchange starts by placing the drain bag portion of the system on the floor and draining out the used solution in your peritoneal cavity (effluent). The new solution bag is hung above your head on a coat stand or hook in the wall, and then gravity is used to pull the fresh solution into your abdomen. Once this is completed, the system is disconnected from your catheter, and you are free to move about until your next exchange. Each of these exchanges lasts about 20 minutes.  

If you are on CAPD your abdomen will always contain dialysis solution and each time it is exchanged, you’ll go through the following steps: 

  1. Connect

You will connect a new bag of dialysis solution to your catheter using a “non-touch” technique, which will be taught to you by your clinician. 

  1. Drain

The existing dialysis solution inside your abdomen is drained out, removing the waste and excess fluid from your body. 

  1. Flush

Your catheter is flushed with new dialysis solution to wash away any germs that may have got onto the end of it during connection. 

  1. Fill

Once your abdomen has been completely drained of the old dialysis solution and the flush is complete, your abdomen is filled with fresh dialysis solution. 

  1. Disconnect

When the new solution has filled your abdomen, the tubing and bags are disconnected using the “non-touch” technique. The fluid is thrown away and the empty bags are discarded. Your peritoneal dialysis (PD) catheter will remain in place and be protected with a sterile cap and may be tucked. It can be tucked away when the exchange is complete. Between now and the next exchange, dialysis is cleaning your blood. This is known as the “dwell” period. You are free to move around and be involved in normal activities until your solution needs to be replaced again. 

This CAPD exchange process is done between 1 and 4 times per day, depending on your dialysis requirements. Each exchange takes about 20 minutes to perform. Your clinicians will discuss your medical and lifestyle needs with you in order to determine your individual dialysis prescription. 

CAPD is termed a “continuous” therapy. This has several benefits in comparison to other types of dialysis. Waste products and excess fluid can be controlled more easily during the treatment process, which may reduce stress on your body. If you’re doing CAPD, you might be able to eat more of the foods you enjoy and take fewer medications than if you were doing haemodialysis (HD). CAPD equipment is also more portable than other types of dialysis equipment, so it’s possible for you to continue doing normal daily activities while you’re performing treatment, and it is easier for you to do your dialysis in other places, such as a workplace or a relative’s home. 

What is Automated Peritoneal Dialysis (APD)?

APD is a form of peritoneal dialysis (PD) that uses a machine called a cycler to perform dialysis exchanges. The cycler is programmed to give you the dialysis treatment by your clinician. Typically, an APD programme lasts between 8 and 12 hours, and is performed overnight. 

APD is the most commonly used form of PD for children with kidney disease, as it enables the child to attend school each day, and the parent / caregiver to work during the day, without the need for any dialysis interventions during daytime hours. 

Before each treatment, your APD cycler is set up with tubing that connect it to 10-15 litres of clean dialysis solution. A cycler tube is then connected to your catheter. The APD cycler is programmed to control the movement of clean dialysis solution into your abdomen by the machine. It drains the used dialysis solution from your body and replaces it with new solution at regular intervals throughout the therapy. You will have to set up the dialysis machine with fresh equipment and dialysis fluid every time you do your APD therapy. Since every patient needs a different amount of dialysis, your APD cycler’s program will be customised to your specific needs. 

During each APD treatment the cycler will automatically perform your therapy, made up of the following steps: 

  1. Drain

The cycler drains the used dialysis solution from your abdomen, removing the waste and excess fluid from your body. 

  1. Fill

Once the cycler has completely drained your abdomen of the old solution, it fills it with fresh dialysis solution. 

  1. Dwell

When the new solution has filled your abdomen, your cycler will leave the new solution in your peritoneal cavity for a set time period. After this time has finished, the cycler will repeat these three steps again. These three steps are called an exchange, or cycle. The dialysis machine will perform several exchanges throughout the prescribed treatment time. 

APD treatment usually lasts between 8 and 12 hours, depending on your medical and lifestyle requirements. It is typically done while you sleep, giving you the freedom to carry on your normal activities during the day. For the treatment to be completed, you need to be connected to your APD cycler. However, it is possible to temporarily disconnect from the machine if necessary. There is also sometimes longer tubing that allows you more freedom to move around while you’re connected to the machine. Sometimes patients may need to do extra daytime dialysis exchanges. Your clinician will advise you if you if this is necessary for you. 

APD helps control the excess waste and fluid during treatment, which can help reduce the stress on your body. It may also provide you increased flexibility with your diet and the number of medications you need to take while on dialysis. Your treatments will normally happen at night, which may make it easier for you to continue working, studying or socializing during the day. You will need to prepare your cycler each day and discard the used equipment after your treatment has finished.

 Remote Patient Management with Automated Peritoneal Dialysis (APD)

You and your clinician may consider using Remote Patient Management to manage your APD treatments. Remote Patient Management allows your clinician to follow your treatment and ensure you are on the right track, which may increase your confidence about doing your treatment at home. 

If your APD cycler has Remote Patient Management capabilities, it can collect accurate information about your home treatments daily and send it to your clinician at the hospital or clinic. Your clinician can monitor your therapy progress, change your machine programmes remotely and discuss any problems you are having over the phone. 

Remote Patient Management allows your clinician to easily manage your disease while you’re doing treatment at home. If there are any issues during your treatment, your APD cycler will collect data related to this issue, which can then be reviewed by your clinician. The information your cycler sends to the clinic will help them decide on any changes to your treatment. You can feel confident managing your treatment at home knowing that your clinician is able to track and adjust your treatment. You will still need to contact your clinician or cycler manufacturer to address concerns during treatment that cannot wait until the morning. 

It is important to note that not all cyclers have Remote Patient Management capabilities. Your clinician will let you know what is available to you at your hospital. 

Learning to Perform Peritoneal Dialysis (PD)

The idea of performing peritoneal dialysis (PD) at home may make you feel anxious, but it is actually quite a manageable process. Almost everybody can perform peritoneal dialysis (PD) with proper training. In most cases, this will usually require between 2 and 5 days of training, depending on what type of PD therapy you choose. 

For a child needing PD, your renal unit may advocate those 2 caregivers learn how to do the dialysis (this can include the patient, if an adolescent).  For APD, training time usually takes 7-10 days. 

Your clinician will schedule training for you that will include:

  • Setting up your treatment area
  • Caring for your catheter exit-site
  • Performing PD treatment
  • Washing your hands to ensure safe handling of PD solutions
  • Storing and ordering supplies for treatment
  • Keeping manual treatment logs (if necessary)
  • Measuring your own blood pressure, pulse, temperature and weight
  • Recognizing and reporting problems with your treatment
  • Managing your diet and fluid intake 

You will not have to perform at-home peritoneal dialysis (PD) by yourself until you and your clinician feel that you are ready. Even after this, you will not be alone with your treatment – always remember that your healthcare team is ready to support you at any time. 

While performing peritoneal dialysis (PD) at home, you will still have regular appointments with your healthcare team and will be able to ask him or her questions about your treatment or about how to get connected with other resources that can help. 

Benefits of Peritoneal Dialysis (PD)

Peritoneal dialysis (PD) may be the right treatment for you if you work, study or travel regularly and if it suits your lifestyle and medical and physical condition. Doing peritoneal dialysis (PD) at home increases the flexibility and independence of your life on dialysis. It can save you frequent trips to the hospital or clinic and gives you more freedom to do the activities you love. 

Peritoneal dialysis (PD) may provide you more lifestyle flexibility than other types of dialysis. The equipment you need is portable, making it easier to perform treatment in other locations. Peritoneal dialysis (PD) treatments don’t require daily needles and are usually painless. Also, they are usually considered gentler on your body than other types of dialysis, which may result in you feeling better after treatment. Finally, because peritoneal dialysis (PD) is performed daily, it cleanses the blood continuously over 24 hours, which means you are receiving more frequent dialysis. 

There are other things you should consider before discussing peritoneal dialysis (PD) with your clinician. You should be aware that peritoneal dialysis (PD), like any dialysis treatment, requires special considerations: 

  • It will take time to get used to the feeling of performing PD. You may experience some physical symptoms, such as fullness, when you begin your treatments.
  • You will have to follow certain important precautions to avoid the risk of infection, which you will be taught about by your healthcare team.
  • You will need storage space in your home for PD supplies and equipment.
  • You will have a catheter implanted in your abdomen for the duration of your therapy.

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