Peritoneal dialysis (PD) is a treatment that uses the lining of your abdomen (belly area), called your peritoneum, and a cleaning solution called dialysate to clean your blood. Dialysate absorbs waste and fluid from your blood, using your peritoneum as a filter. One benefit of PD is that it is not done in a dialysis center. You can do your PD treatments any place that is clean and dry. This can allow you more freedom to work, travel or do other activities you enjoy without worrying about scheduling dialysis appointments. The two most common types of PD are continuous ambulatory PD (CAPD) and continuous cycler-assisted PD (CCPD). Your doctor can help you decide which is right for you.
- How does PD work?
- Preparing for PD
- Choosing a PD treatment plan
- Things to consider when choosing a PD treatment plan
- Prevent peritonitis
- Get to know your PD care team
How does PD work?
PD uses a cleaning solution called dialysate to draw waste and fluid from your blood, through your peritoneum. Your peritoneum is the lining of the wall that separates the inside of your abdomen from the rest of your body.
When you do PD, you will fill your abdomen (belly area) with dialysate and let it sit in your abdomen for a period of time while it does its job. This time is called a dwell time. Your doctor will tell you how long your dwell time should be. When the dwell time is over, you will drain the used dialysate out of your abdomen and refill your abdomen with fresh dialysate. This process of draining used dialysate and refilling your abdomen with fresh dialysate is called an exchange. Each exchange (drain and refill) usually takes between 30 and 40 minutes. Depending on the type of PD you choose to do, you may do these exchanges yourself or with the help of a machine.
Dialysate has a sugar in it called dextrose, which pulls fluid and waste from your blood, through your peritoneum, into the dialysate. The waste and fluid are held in the dialysate and removed from your body when you do an exchange. PD must be done every day or night. Your doctor will tell you how many exchanges you should do each day. Most people do their PD exchanges at home, but you can do them any place that is clean and dry.
Preparing for PD
Before you can begin PD, you will need to have a minor surgery to have a soft, flexible tube called a catheter put into your abdomen (belly area) or chest. The end of the catheter will stick out of your abdomen or chest, through a small incision (cut) in your skin. You will use the catheter to do your exchanges.
You will also need to make sure that you have clean, dry space in your home, workplace or anywhere you intend to do your treatments, as well as space where you can keep your PD supplies.
Getting a catheter
The catheter that is used for PD is a flexible tube that goes from inside your abdomen or chest to outside your body, through a small incision (cut) in your skin. You will use your catheter to fill your abdomen with dialysate and drain used dialysate from your abdomen.
Depending on how your doctor wants to put your catheter in, you may have your surgery under general anesthesia or with a local anesthetic only. General anesthesia is a medicine that makes you go to sleep and not feel any pain. Local anesthesia is a medicine that keeps you from feeling pain in the area where the surgery is happening, but allows you to stay awake.
Your catheter will be ready for use as soon as your surgery is over, but catheters usually work best after your body heals around it to hold it in place. This usually takes 2 to 3 weeks. If you need to use your catheter before it has finished healing, you will need to be very gentle with it, because it may not yet be held strongly in place.
Talk to your doctor about your lifestyle and the activities you enjoy. Having this information will help your doctor figure out whether a catheter in your chest or in your abdomen would be best for you.
Preparing your home
You will need a space in your home that is kept clean and dry, where you can do you your PD treatments. If you are doing CCPD , this room will likely be your bedroom. You will need to keep pets and plants out of the room. If you are doing CAPD , you can choose any room in your home, workplace or other location where you spend your time. Any room you choose must be free of pets and plants and must be kept clean and dry. If you do your PD exchanges at work, your social worker may be able to help you work with your employer to accommodate your treatment needs.
You will also need a place in your home where you can store your treatment supplies. This storage space should be clean, dry and easy for you to get to. Supplies are usually delivered to your home once a month. Each delivery might include many large, heavy boxes. Keep this in mind as you are choosing and preparing your storage space. Talk to your dialysis nurse or technician to learn more about what to expect when supplies are delivered.
Choosing a PD treatment plan
The most common types of PD are continuous cycler-assisted peritoneal dialysis (CCPD) and continuous ambulatory peritoneal dialysis (CAPD). CCPD uses a machine called a cycler to do exchanges.
CAPD uses gravity to help you do the exchanges by hand. Both types of PD can be done at home, by yourself, and CAPD can be done anywhere that is clean and dry. Depending on what fits best with your lifestyle and schedule, you may choose to do one or the other, or your doctor might recommend that you do both.
No matter which type of PD you choose, your doctor will ask you to have some tests during the first few weeks of your treatment. These tests are used to help your doctor figure out if you are getting the right amount of dialysis. Based on your test results, your doctor might tell you to change how often you do exchanges, the type of dialysate you use or the amount of dialysate you use.
Continuous cycler-assisted peritoneal dialysis (CCPD)
CCPD is usually done at night, while you sleep. You will connect your catheter to tubes going to a machine called a cycler. This machine does your exchanges for you. It will fill your abdomen with dialysate, wait for the correct dwell time, and then drain the used dialysate from your abdomen into a bag. The machine will refill your abdomen with clean dialysate and begin the process again.
In most cases, the cycler will do three to five exchanges overnight. This usually takes about nine hours. Every morning, the machine will fill your abdomen with dialysate for the last time. This time, the dialysate will sit in your abdomen for the whole day, until you go to bed and begin your nightly CCPD treatment again.
Your doctor will tell you how many exchanges you should do and how long your dwell times should be. Your dialysis nurse or technician will show you how to set up the cycler machine to give you the right treatment.
During the long daytime dwell time, some people have problems with their bodies holding on to too much of the dialysate. If this is a problem for you, your doctor may tell you to do one exchange during the day. Your doctor might also ask you to do some daytime exchanges if you weigh over 175 pounds or if you need to have more waste removed from your blood than what can be done during your CCPD treatments overnight.
Continuous ambulatory peritoneal dialysis (CAPD)
CAPD exchanges are done by hand, using gravity to help fill your abdomen with dialysate and drain it once the dwell time is over. These exchanges are called manual exchanges. Because you need to do each exchange yourself, this type of PD must be done during the day. You may do your exchanges anywhere that is clean and dry.
To fill your abdomen with dialysate, you will sit in a chair, with a tube attached to a bag of dialysate that is hanging above you. Gravity will pull the dialysate down from the bag, through the tube into your abdomen. To drain the used dialysate, you will attach a tube to your catheter, and let gravity pull the dialysate out of your abdomen, through the tube and into a bag below you. It usually takes between 30 and 40 minutes to drain and refill your abdomen with dialysate.
Between exchanges, you will let the dialysate sit in your abdomen for the dwell time. At the end of each day, you will fill your abdomen one last time, and the dialysate will sit in your abdomen all night long. In the morning, you will begin doing normal exchanges again. Your doctor will tell you how many exchanges you should do each day and how long your dwell times should be.
During the long nighttime dwell time, some people have problems with their bodies holding on to too much of the dialysate. If this is a problem for you, your doctor may tell you to use a minicycler to do some exchanges at night, while you sleep. A minicycler is a small version of the cycler machine that is used for CCPD. Your doctor might also ask you to use the minicycler at night if you weigh over 175 pounds or if you need to have more waste removed from your blood than what can be done during your CAPD treatments during the day.
Things to consider when choosing a PD treatment plan
When you are deciding whether you want to do peritoneal dialysis and what schedule is best for you, it is important to consider how the treatment will fit with your lifestyle. Do you travel often? Do you work or go to school during the day? Are you good about staying on your diet plan? PD exchanges take time and must be done in a clean, dry place. Missing PD treatments can cause serious health problems. If you are someone who needs in-person appointments to stay on track with your treatment, PD might not be right for you. Think about your personality and your daily routine when you are deciding on a treatment plan.
Most people who are on PD follow a diet that limits phosphorus, potassium, sodium and protein. However, the diet for people on PD may be less strict than the diet for people who are on hemodialysis. If you have trouble sticking to a strict diet plan, choosing PD instead of hemodialysis might help you by giving you slightly more freedom with what you eat and drink.
Work and school
PD exchanges can be done anywhere that is clean and dry. Therefore, people who are on PD often have a more flexible treatment schedule than people on in-center dialysis. Choosing to do PD instead of in-center hemodialysis may enable you to keep your regular schedule for work, school or other activities.
While PD allows for a more flexible schedule than in-center hemodialysis, it is important to understand that this does not mean it is ok to miss treatments. You must follow your doctor’s instructions regarding when and how many PD exchanges you do each day.
Travel and activities
Talk with your doctor about how often and where you plan to travel. Also make sure your doctor knows about the types of activities you enjoy. Peritoneal dialysis offers a lot of flexibility, but there are some limits on activities. Usually, your PD supplies can be shipped to your travel destinations, and you can do your exchanges in clean, dry locations on your trip. However, if you really enjoy swimming or using hot tubs, PD might not be right for you because you should not get your catheter area wet. If your doctor knows about the activities you enjoy, he or she might be able to recommend a treatment plan that allows you to continue those activities.
Paying for treatment
Medicare and most private insurance policies cover peritoneal dialysis. If you have Medicare, your coverage for PD may begin as early as the first month of treatment. Talk to your social worker to find out your insurance options, if you can get Medicare and whether you need a second type of insurance.
Peritonitis is an infection of your peritoneum, the lining inside of your abdomen that is used as a filter for peritoneal dialysis (PD). Peritonitis is the most common problem that happens in people who do PD.
Peritonitis is caused by bacteria that get into your abdomen through your catheter or through your catheter incision (where the tube enters your body). This can happen if your incision is not cleaned well. It can also happen when bacteria get into your catheter while you are connecting to or disconnecting from the tubes from your dialysate bags. Peritonitis is less common in people who have their catheters in their chests instead of their abdomens.
Taking good care of your catheter and doing your exchanges safely can help to prevent peritonitis. Use these tips to help prevent peritonitis:
- Wash your hands very well before touching your catheter
- Clean your catheter incision every day and use an antibiotic spray
- Keep your catheter dry at all times
- Store your PD supplies in a clean, dry area
- Wear a mask while you do exchanges
- Only do exchanges in clean, dry places
- Watch for signs of infection, including
- Redness or pain around the incision
- Dialysate that looks cloudy or off-color when you drain it from your abdomen
Ask your dialysis care team if you have any questions about caring for your catheter or how to do your exchanges. If you notice any signs of infection, contact your doctor or nurse immediately.
Get to know your PD care team
Think of everyone who helps to care for you as part of a team. You are the team captain, and your dialysis care team members all play different supporting roles to help you achieve your health goals. Communication between team members is the key to success!
Use the information here to learn what each team member does to help you through dialysis.
Your nephrologist is your kidney doctor. He or she can answer any questions you have about treatment options, medicines and how to care for your kidneys. You will meet with your nephrologist often to check on your kidney health and make any necessary changes to your care plan. If you have a kidney transplant, you will still see a nephrologist to make sure your new kidney stays healthy.
The nephrology nurse is a registered nurse who is trained to take care of kidney patients. You will see nephrology nurses in your doctor’s office and in your dialysis center. Your nurse will teach you how to do PD at home and will plan, coordinate and oversee your care. You may contact a nurse about any questions you have or help you need.
Your renal dietitian can help you meet your specific and unique nutrition needs. You may have already had to adjust your diet to control the amount of fluid, protein and certain vitamins and minerals in your blood. When you are on dialysis, your renal dietitian will help you understand what foods and drinks are healthy for you and which ones are not. He or she will also help you plan how much of each nutrient you should eat per day.
Nephrology social worker
Your social worker will support you in many ways as you go through dialysis. Social workers provide emotional support to you and your family, help you communicate your needs to the other members of your care team and help you find resources to improve your quality of life. If you need to stop working, for example, your social worker can help you apply for financial assistance programs. He or she can also help you get health insurance or keep it if you already have it.
If you are on peritoneal dialysis, the dialysis technicians will make sure you have all of the supplies you need to do your dialysis treatments.