Peritoneal Dialysis: Treatment for Renal Insufficiency, Types and Procedure

Definition: is a treatment for kidney failure that uses the lining of your abdomen, or belly, to filter the blood inside your body.

Doctors call this lining the peritoneum. A doctor will place a soft tube, called a catheter, in your belly a few weeks before starting treatment.

When peritoneal dialysis begins, the dialysis solution – water with salt and other additives – flows from a bag through the catheter to your belly. When the bag is empty, you can disconnect the catheter from the bag and cover it so you can move and do your normal activities.

While the dialysis solution is inside your belly, it absorbs waste and extra fluid from your body. After a few hours, drain the used dialysis solution into a drainage bag. You can then get rid of the used dialysis solution, which is now filled with waste and extra fluid, in a toilet or in the drain of a sink or bathtub.

Then, start over with a new bag of dialysis solution.

The initial draining process of the dialysis solution used, and then its replacement by a fresh solution, is called exchange. Most people make four to six exchanges every day, or at night with a machine that moves the fluid in and out.

The process continues permanently, so you will always have dialysis solution in your belly, absorbing waste and extra fluid from your body.

To get the best results from peritoneal dialysis it is important that you perform all your exchanges as directed by your doctor.

What are the two types of peritoneal dialysis?

The two types of peritoneal dialysis are continuous ambulatory peritoneal dialysis, also called automated peritoneal dialysis, or continuous peritoneal dialysis with cycles.

After learning about the types of peritoneal dialysis, you can choose the type that best suits your schedule and lifestyle. If a schedule or type of peritoneal dialysis does not suit you, you can talk to your doctor about trying another type.

Continuous ambulatory peritoneal dialysis does not require a machine. You can do it in any clean, well-lit place. The period of time that the dialysis solution is in your belly is called the time of permanence.

With continuous ambulatory peritoneal dialysis, the dialysis solution remains in the abdomen for a period of time of 4 to 6 hours, or longer. Each exchange lasts between 30 and 40 minutes. During an exchange, you can read, talk, watch TV or sleep.

Usually, you change the dialysis solution at least four times a day and sleep with solution in your belly at night. You do not have to wake up and make exchanges overnight.

Automated peritoneal dialysis uses a machine called a cycler to fill and empty your belly three to five times during the night while you sleep. In the morning, you start an exchange with a one day stay.

You can make an additional exchange around the middle of the afternoon to increase the amount of waste removed and reduce the amount of fluid left in your body.

If you weigh more than 175 pounds or if your peritoneum slowly filters out the waste, you may need a combination of continuous ambulatory peritoneal dialysis and automated peritoneal dialysis.

For example, some people wear type at night and make an exchange during the day. Your health care team will help you determine the best time for you.

Who does it?

After a short period of training, most people can perform both types of peritoneal dialysis on their own. You will work with a dialysis nurse for 1 to 2 weeks to learn to:

  • Make manual exchanges for continuous ambulatory peritoneal dialysis without leaving bacteria in your catheter.
  • Perform automated peritoneal dialysis.
  • Prepare the cycler.
  • Connect the dialysis solution bags.
  • Place the drain tube.

People who perform automated peritoneal dialysis need to learn to make manual exchanges so they can receive treatment in the event of power failure or if they need an exchange during the day in addition to automated peritoneal dialysis during the night.

Where is it done?

You can perform ambulatory and automatic peritoneal dialysis in any clean and private place, at home, a hotel, a friend’s house, an office, before traveling, you can have the manufacturer send the supplies to your destination in advance.

What equipment and supplies will I use during peritoneal dialysis?

The equipment and supplies you need will depend on the type of peritoneal dialysis you will use. You may need the following equipment and supplies:

  1. Catheter and transfer set.
  2. Dialysis solution.
  3. Supplies to keep your exit site clean.

The health care team will provide you with the equipment you need to start peritoneal dialysis and will help you have supplies such as dialysis solution and surgical masks delivered to your home, usually monthly.

How do I make an exchange?

With continuous ambulatory peritoneal dialysis, you will make the changes manually, following these steps:

  1. Always wash your hands before handling the catheter and transfer set and wear a surgical mask when connecting the transfer set to the disposable tube.
  2. Drain the used dialysis solution from your abdominal cavity into the drainage bag. Near the end of the drain, you may feel a soft pull sensation that tells you that most of the fluid is gone.
  3. After emptying the used solution from your belly, it will close or hold the transfer set so that the fresh solution does not flow to the abdomen.
  4. Then, let some of the fresh solution flow directly into the drainage bag. This step removes air from the tubes.

The final step is to hold the line going to the drainage bag, open the transfer set and fill the belly with fresh dialysis solution from the hanging bag.

How will peritoneal dialysis affect my lifestyle?

You may not be able to do all the things you used to do. Adjustment to the effects of kidney failure can be difficult. You can have less energy.

You may have to make changes in your work life or in your home, giving up some activities and responsibilities.

Following your schedule of exchanges will require some adjustment. If you perform continuous ambulatory peritoneal dialysis during the day, you have some control over when you do the exchanges.

A couple of times a day you should stop your normal activities and take about 30 minutes to make an exchange. If you do automated peritoneal dialysis at night, you will have to set your cycler every night. You may have to go to bed early to get all the dialysis hours prescribed by your doctor.

Maintaining the same schedule you maintained when your kidneys worked can be difficult now that your kidneys have failed. Accepting this new reality can be difficult for you and your family.

A renal counselor or social worker can answer your questions and help you. The word “renal” refers to the kidneys. Renal social workers specialize in helping people with chronic kidney disease (CKD) and kidney failure .