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  • Treatment Methods for Kidney Failure

    PERITONEAL DIALYSIS

    U.S. Department of Health and

    Human Services

    NATIONAL INSTITUTES OF HEALTHNational Kidney and Urologic Diseases

    Information Clearinghouse

  • Treatment Methods for Kidney Failure

    PERITONEAL DIALYSIS

    NATIONAL INSTITUTES OF HEALTHNational Institute of Diabetes and Digestive and Kidney Diseases

  • ContentsIntroduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

    When Your Kidneys Fail . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

    How PD Works . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

    Getting Ready for PD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

    Types of PD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

    Customizing Your PD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

    Preventing Problems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

    Equipment and Supplies for PD . . . . . . . . . . . . . . . . . . . . . 7

    Testing the Effectiveness of Your Dialysis . . . . . . . . . . . . . 10

    Conditions Related to Kidney Failure and Their Treatments . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

    Adjusting to Changes . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

    Hope Through Research . . . . . . . . . . . . . . . . . . . . . . . . . . 19

    Resources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

    Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24

  • 1IntroductionWith peritoneal dialysis (PD), you have some choices in treat-ing advanced and permanent kidney failure. Since the 1980s,when PD first became a practical and widespread treatmentfor kidney failure, weve learned much about how to makePD more effective and minimize side effects. Since you donthave to schedule dialysis sessions at a center, PD gives youmore control. You can give yourself treatments at home, atwork, or on trips. But this independence makes it especiallyimportant that you work closely with your health care team:your nephrologist, dialysis nurse, dialysis technician, dietitian,and social worker. But the most important members of yourhealth care team are you and your family. By learning aboutyour treatment, you can work with your health care team togive yourself the best possible results, and you can lead a full,active life.

    When Your Kidneys FailHealthy kidneys clean your blood by removing excess fluid,minerals, and wastes. They also make hormones that keepyour bones strong and your blood healthy. When your kid-neys fail, harmful wastes build up in your body, your bloodpressure may rise, and your body may retain excess fluid andnot make enough red blood cells. When this happens, youneed treatment to replace the work of your failed kidneys.

  • 2How PD WorksIn PD, a soft tube called a catheter is used to fill yourabdomen with a cleansing liquid called dialysis solution. Thewalls of your abdominal cavity are lined with a membranecalled the peritoneum, which allows waste products and extrafluid to pass from your blood into the dialysis solution. Thesolution contains a sugar called dextrose that will pull wastesand extra fluid into the abdominal cavity. These wastes andfluid then leave your body when the dialysis solution isdrained. The used solution, containing wastes and extra fluid,is then thrown away. The process of draining and filling is

    Peritoneal dialysis.

    Catheter

    Abdominalcavity

    Peritoneum

    Dialysissolution

  • 3called an exchange and takes about 30 to 40 minutes. Theperiod the dialysis solution is in your abdomen is called thedwell time. A typical schedule calls for four exchanges a day,each with a dwell time of 4 to 6 hours. Different types of PDhave different schedules of daily exchanges.

    The most common form of PD, continuous ambulatory peri-toneal dialysis (CAPD), doesnt require a machine. As theword ambulatory suggests, you can walk around with thedialysis solution in your abdomen. Other forms of PD requirea machine called a cycler to fill and drain your abdomen, usu-ally while you sleep. The different types of cycler-assisted PDare sometimes called automated peritoneal dialysis, or APD.

    Getting Ready for PDWhether you choose an ambulatory or automated form ofPD, youll need to have a soft catheter placed in yourabdomen. The catheter is the tube that carries the dialysissolution into and out of your abdomen. After giving you alocal anesthetic to minimize any pain, your doctor will makea small cut, often below and a little to the side of your navel(belly button), and then guide the catheter through the slitinto the peritoneal cavity. As soon as the catheter is in place,you can start to receive solution through it, although youprobably wont begin a full schedule of exchanges for 2 to3 weeks. This break-in period lets you build up scar tissuethat will hold the catheter in place.

    The standard catheter for PD is made of soft tubing for com-fort. It has Dacron cuffs that merge with your scar tissue tokeep it in place. (Dacron is a polyester fabric.) The end ofthe tubing that is inside your abdomen has many holes toallow the free flow of solution in and out.

  • 4Types of PDThe type of PD you choose will depend on the schedule ofexchanges you would like to follow, as well as other factors.You may start with one type of PD and switch to another, oryou may find that a combination of automated and nonauto-mated exchanges suits you best. Work with your health careteam to find the best schedule and techniques to meet yourlifestyle and health needs.

    Continuous Ambulatory Peritoneal Dialysis (CAPD)If you choose CAPD, youll drain a fresh bag of dialysis solu-tion into your abdomen. After 4 to 6 or more hours of dwelltime, youll drain the solution, which now contains wastes,into the bag. You then repeat the cycle with a fresh bag ofsolution. You dont need a machine for CAPD; all you need isgravity to fill and empty your abdomen. Your doctor will pre-scribe the number of exchanges youll need, typically three or

    Two double-cuff Tenckhoff peritoneal catheters: standard (A), curled (B).

    A

    B

    Subcutaneouscuff

    Peritonealcuff

    Peritoneal cavity

    Outerskin

    Peritoneal cavity

    Subcutaneouscuff

    Peritonealcuff

    Outerskin

  • four exchanges during the day and one evening exchange witha long overnight dwell time while you sleep.

    Continuous Cycler-Assisted Peritoneal Dialysis (CCPD)CCPD uses an automated cycler to perform three to fiveexchanges during the night while you sleep. In the morning,you begin one exchange with a dwell time that lasts the entireday.

    Nocturnal Intermittent Peritoneal Dialysis (NIPD)NIPD is like CCPD, only the number of overnight exchangesis greater (six or more), and you dont perform an exchangeduring the day. NIPD is usually reserved for patients whoseperitoneum is able to transport waste products very rapidlyor for patients who still have substantial remaining kidneyfunction.

    Customizing Your PDIf youve chosen CAPD, you may have a problem with thelong overnight dwell time. Its normal for some of the dex-trose in the solution to cross into your body and become glu-cose. The absorbed dextrose doesnt create a problem duringshort dwell times. But overnight, some people absorb somuch dextrose that it starts to draw fluid from the peritonealcavity back into the body, reducing the efficiency of theexchange. If you have this problem, you may be able to usea minicycler (a small version of a machine that automaticallyfills and drains your abdomen) to exchange your solutiononce or several times overnight while you sleep. These addi-tional, shorter exchanges will minimize solution absorptionand give you added clearance of wastes and excess fluid.

    5

  • 6If youve chosen CCPD, you may have a solution absorptionproblem with the daytime exchange, which has a long dwelltime. You may find you need an additional exchange in themid-afternoon to increase the amount of waste removed andto prevent excessive absorption of solution.

    Preventing ProblemsInfection is the most common problem for people on PD.Your health care team will show you how to keep yourcatheter bacteria-free to avoid peritonitis, which is an infec-tion of the peritoneum. Improved catheter designs protectagainst the spread of bacteria, but peritonitis is still a commonproblem that sometimes makes continuing PD impossible.You should follow your health care teams instructions care-fully, but here are some general rules:

    Store supplies in a cool, clean, dry place.

    Inspect each bag of solution for signs of contaminationbefore you use it.

    Find a clean, dry, well-lit space to perform yourexchanges.

    Wear sterile gloves to perform exchanges.

    Wash your hands every time you need to handle yourcatheter.

    Clean the exit site with antiseptic every day.

    Wear a surgical mask when performing exchanges if youhave a cold.

  • 7Keep a close watch for any signs of infection and report themso they can be treated promptly. Here are some signs towatch for:

    Fever

    Nausea or vomiting

    Redness or pain around the catheter

    Unusual color or cloudiness in used dialysis solution

    A catheter cuff that has been pushed out

    Equipment and Supplies for PD

    Transfer SetA transfer set is tubing that connects the bag of dialysis solu-tion to the catheter. Two types of transfer sets are available.

    A straight transfer set is a straight piece of tubing thatstays connected to your catheter. To begin eachexchange, you connect the free end