Peritoneal Dialysis Procedure
Overview
Peritoneal dialysis helps clear waste and excess fluid from the blood when the kidneys can no longer do this job. This technique uses the body’s abdominal lining, or peritoneum, as a natural filter instead of an external machine.
The process begins when a healthcare provider puts a special cleaning fluid into the abdomen through a soft tube. This fluid stays in the abdomen for a certain period, allowing wastes and extra water to pass from the blood through the peritoneal membrane.
After a set amount of time, the patient drains the used fluid carrying the wastes and replaces it with fresh fluid. Key facts about peritoneal dialysis:
| Feature | Details |
|---|---|
| Type | Kidney Dialysis |
| Where Performed | Home, work, or during travel |
| Who Can Use It | People with the ability to self-care or with caregiver help |
Reasons for Peritoneal Dialysis
Doctors use peritoneal dialysis when the kidneys can no longer clear waste and excess fluids from the blood. This is often necessary for people with kidney failure or advanced stages of kidney disease. When the kidneys lose function, waste and fluids build up, causing serious health problems. Several conditions can cause kidney function to worsen over time:
- Diabetes can slowly damage kidney tissues.
- High blood pressure puts stress on kidney blood vessels.
- Glomerulonephritis affects the kidneys’ ability to filter blood.
- Polycystic kidney disease leads to fluid-filled cysts throughout the kidneys.
- Chronic use of certain medications, especially pain relievers, can harm the kidneys.
When the kidneys get worse, dialysis takes over some of their work. There are two main types: peritoneal dialysis and hemodialysis. Peritoneal dialysis uses the lining inside a person’s belly to filter blood. Unlike hemodialysis, it does not need blood to be pumped out to a large machine. Key reasons why people may use peritoneal dialysis:
Retaining Independence: Individuals can often do this treatment at home, or even at work, which can help them keep a normal routine. They do not have to go to a medical center several times a week.
Diet Flexibility: Because this form of dialysis is gentler and more regular, some diet restrictions, like avoiding certain fluids and salts, are less strict than with hemodialysis.
Better Preservation of Kidney Function: Some patients using peritoneal dialysis keep the small amount of kidney function left for a longer time.
No Needles in the Arm: Treatment is done through a soft tube in the belly, not by placing needles in a vein each session.
These points can make living with renal failure or kidney failure easier for some.
Factors That Affect the Choice of Peritoneal Dialysis
Not everyone with kidney failure can use peritoneal dialysis. The choice depends on several things. Here is a comparison of key considerations:
| Consideration | Details |
|---|---|
| Kidney function | Some remaining function is helpful. |
| Health status | Must be able to avoid infections. |
| Support at home | Help may be needed for self-care. |
| Abdominal health | No major stomach scars or hernias. |
| Lifestyle needs | Good for those wanting to travel or work easily. |
People Who May Benefit Most
- Want more freedom in daily life.
- Prefer to travel or work without much disruption.
- Have some remaining kidney ability.
- Have trouble with hemodialysis side effects.
Who Might Not Be a Good Fit
- Have many scars or hernias in the belly area.
- Live alone and cannot manage self-care.
- Have certain digestive system conditions.
Each patient should talk with their healthcare team before starting treatment. The care team reviews health needs, preferences, and lifestyle before recommending peritoneal dialysis or another option. Over time, many patients may need to switch to another treatment, such as hemodialysis or a kidney transplant, if their condition gets worse.
Possible Dangers and Side Effects
Peritoneal dialysis brings important health benefits, but it also has several risks. Some are more common than others and can affect a person’s comfort or safety.
Infections
One of the main concerns is infection. Peritonitis, which is an infection of the lining of the abdomen, may happen if bacteria enter through the catheter. Not only can infection develop in the abdominal area, but the site where the tube enters the skin can also become infected.
Good hygiene, such as washing hands and cleaning the area around the catheter daily, lowers this risk. Wearing a surgical mask when handling the equipment also helps.
Weight Gain and Blood Sugar
The dialysate fluid used in peritoneal dialysis contains sugar. The body can absorb this sugar, which might add extra calories each day. Over time, this can cause weight gain. People with diabetes should pay special attention, as their blood sugar can go up even more. Keeping an eye on diet and exercise remains important.
Other Safety Tips
Certain actions increase the risk of complications. Bathing in hot tubs, taking baths, or swimming in lakes, ponds, or non-chlorinated pools can raise the risk of infection.
It is safer to take showers, and swimming in a chlorinated pool may be allowed if the catheter site is healed and dried well afterwards. People receiving peritoneal dialysis should also check with their doctor before taking medicine, especially any that could damage the kidneys.
Possible Complications Table
| Complication | Details | How to Lower Risk |
|---|---|---|
| Infection (Peritonitis) | Redness, pain, or swelling around the catheter; fever may appear | Clean hands and tube site daily, wear mask |
| Weight gain | Absorption of sugar from the dialysate can cause added calories | Track calorie intake, discuss with care team |
| Weak abdominal muscles | Strain from fluid in the abdomen may increase risk for hernias | Avoid heavy lifting, report any bulges |
| Treatment reduction | Dialysis may become less effective after several years | Regular check-ups, consider other options |
Getting Ready for the Procedure
Preparation for peritoneal dialysis involves these steps:
Catheter Placement: A surgeon places a thin tube called a dialysis catheter into the abdomen, often near the bellybutton. This tube allows the cleansing solution to move in and out of the peritoneal cavity.
Healing Time: After the catheter is placed, patients usually wait about two weeks to let the site heal properly and lower the risk of infection.
Learning the Process: The care team trains patients on how to use the equipment and how to care for the peritoneal dialysis catheter and the area around it.
Key Points Table
| Step | Purpose |
|---|---|
| Catheter surgery | Access for treatment |
| Healing time | Prevent infection, support healing |
| Equipment training | Safe, effective use at home |
Proper care of the peritoneum and close attention to cleanliness help support the procedure’s success and may reduce the need for antibiotic therapy related to infections.
What You Can Expect
Manual Daytime Peritoneal Dialysis
Continuous ambulatory peritoneal dialysis (CAPD) is a method people can do on their own, without needing a machine. During CAPD, a person fills their abdomen with a cleansing solution called dialysate, using a tube called a catheter. The solution stays inside for a set amount of time, known as the dwell time—usually between 4 and 6 hours.
Exchanges happen about three to five times each day, plus one longer exchange overnight. The force of gravity fills and drains the fluid in and out. While the dialysate is inside, a person can go about most normal activities, such as reading or walking. Exchanges can be done in a clean and dry place at home, work, or school.
Typical CAPD Day:
| Step | Action | Notes |
|---|---|---|
| Morning | First exchange | Fill abdomen, then dwell time begins |
| Midday | Second/third exchange | Repeat fill and drain |
| Afternoon | Third/fourth exchange | Repeat steps as needed |
| Night | Last exchange | Dwell overnight, longer duration |
Each exchange removes waste and excess fluid from the blood into the used dialysate, which is drained into a sterile bag and then thrown away. CAPD allows for more flexibility, but keeping the area and supplies clean is very important to prevent infection.
Automated Nighttime Peritoneal Dialysis
Automated peritoneal dialysis, also called continuous cycling peritoneal dialysis (CCPD), uses an automated cycler machine to do exchanges. The patient sets up the machine before bedtime, and it runs through several exchanges during the night while the person sleeps.
- CCPD Routine:
- The person attaches to the cycler before bed.
- The machine automatically fills the abdomen with dialysate.
- After a dwell time, it drains the solution and repeats the process several times.
- All used dialysate collects in a bag, which the patient empties in the morning.
During the day, people are usually not attached to a machine and can continue their normal routine. Sometimes, one final daytime exchange is done with a longer dwell time, as suggested by the healthcare team.
Key Points:
- Patients handle the catheter and system less often than with CAPD, which may reduce the risk of infection.
CCPD helps those who want their days free or have busy schedules.
| Feature | CAPD | CCPD |
|---|---|---|
| Number of daily exhanges | 3-5 daytime, 1 overnight | Several automatic nightly |
| Use of machine | No | Yes |
| Daytime Attachment | No machine | Not attached to cycler |
| Infection risk | Slightly higher | Possibly lower |
| Activity during dialysis | Regular activities possible | Sleep during treatments |
Choosing between CAPD and CCPD depends on medical needs, lifestyle, and personal preference. The care team helps create a schedule that fits the person’s routine while keeping them healthy.
Findings
Several factors play a role in how well peritoneal dialysis works for each person. Body size, speed of filtration across the abdomen’s lining, dialysis solution volume, the number of exchanges each day, dwell time length, and the type of solution all affect the removal of waste and fluid.
Main Factors That Influence Outcomes
| Factor | Effect on Dialysis |
|---|---|
| Body Size | Larger bodies may require more dialysate volume |
| Filtration Speed | Fast transporters clear waste quickly, but may lose fluid |
| Solution Volume | Larger volumes can improve waste and fluid removal |
| Number of Exchanges | More exchanges generally increase toxin clearance |
| Dwell Time | Longer or shorter times can change toxin and fluid movement |
| Sugar Concentration in Fluid | Higher dextrose helps remove more fluid |
Understanding Transport Characteristics
Transport characteristics refer to how quickly waste and water move between the blood and dialysis solution. The care team often tests this using the peritoneal equilibration test (PET). The PET helps determine if someone is a “fast” or “slow” transporter. Fast transporters may need shorter dwell times or different solutions to avoid too much fluid absorption.
Fluid Management and Dialysis Adjustments
When tests show not enough wastes are removed, the care team makes adjustments. They may:
- Increase the number of exchanges each day.
- Use more dialysate per exchange.
- Choose a stronger dialysate with more dextrose.
A glucose polymer solution is sometimes used for long dwell times, such as overnight. It helps manage fluids more effectively in people with high peritoneal absorption or fast transport rates by pulling fluid without relying on a high sugar concentration.
Role of Diet and Medication
The results also highlight the importance of eating foods high in protein and low in sodium and phosphorus. A dietitian can help set up a daily meal plan that fits a person’s needs.
People should take medications as directed. Medicines may help control blood pressure, help the body make red blood cells, keep nutrients at safe levels, and stop phosphorus from building up.
