Home Peritoneal Dialysis (PD)

Peritoneal dialysis (PD) is the most common form of at-home dialysis. PD is needle-free and requires surgical insertion of a soft plastic tube called a catheter into your abdomen. Your own peritoneal membrane film (stomach lining) is used as the filter to clean the blood for dialysis. During the treatment, your abdominal area (called the peritoneal cavity) is slowly filled with a fluid called dialysate through the catheter. Extra fluid and waste products are drawn out of your blood and into the dialysate using the peritoneal membrane as a filter. Once the wastes have been absorbed, the dialysate is drained and the abdomen is filled with fresh dialysate Peritoneal dialysis can be done in the comfort of your home.

Peritoneal Dialysis preserves your remaining kidney function. This is important because:

  • You feel better if your own kidneys are still working a little
  • You do better medically
  • If you are considering transplant, your bladder muscles will still be working and will be in better shape to use for the new kidney. It won’t take time to remember how to work again.

How does PD work?

  • Your own peritoneal membrane film is used as the filter to clean the blood for dialysis
  • Solution is placed in your peritoneal cavity/space
    • The peritoneal cavity of most adults can hold about 2-3 quarts of fluid
  • This solution removes toxins and extra fluid
  • Waste and toxins are filtered through the peritoneal membrane into the solution

PD3

How does this Solution get into my Abdomen/Body?

An access for Peritoneal Dialysis is called a Peritoneal Catheter.

This is different from the kind of catheter you may have seen in someone’s neck or chest that is sometimes used for hemodialysis.

A Peritoneal Dialysis catheter is surgically placed inside your abdomen by an outpatient surgery

  • Usually it is placed a little below and to the side of the belly button
  • About 6 inches of the tubing sticks outside of the body
  • The tubing is soft and flexible

Once the catheter is put in you, it cannot be used for 2-4 weeks. It must have time to heal.

Training for Peritoneal Dialysis

You spend a week in training with a Peritoneal Dialysis nurse at the clinic

Usually a significant other also comes to some of the training.

On the last day of training the nurse comes to your house to make sure you are all set up and ready.

Two Types of Peritoneal Dialysis

There are two methods of Peritoneal Dialysis and they are done at home by you or sometimes by someone chosen by you to be a care partner.

  • Manual Method
    • Continuous Ambulatory Peritoneal Dialysis (C.A.P.D.)
  • Cycler at night
    • Automated Peritoneal Dialysis (A.P.D.)

Manual Method

Also called Continuous Ambulatory Peritoneal Dialysis (C.A.P.D.)

  • Can be done at home, work, school or on vacation
  • 4 exchanges a day

Drain, Fill, Dwell

  • Drain: the first thing you do is drain the used fluid in your abdomen. It is drained into the empty bag
  • Fill: The second step is to let the new solution fill into the abdomen.
  • Dwell: At the end of the exchange, you disconnect from the tubing and place a sterile cap on the end of your catheter
    • The new solution now dwells for 4 hours. This is when the actual dialysis (cleaning of the blood) occurs

ghswebsite_treatmentoptions_PDsleeping.jpgCycler at Night

Also called Automated Peritoneal Dialysis (A.P.D.)

During the night, the machine does the dialysis. It cycles through all of your exchanges while you sleep.

Before going to sleep, you connect the cycler tubing to your catheter

  • A.P.D. is often called “the cycler” because the machine cycles through your dialysis exchanges while you sleep

Some people also do one manual exchange during the day

  • You must first learn the manual exchanges, so in case your power goes off you can still perform dialysis

Travel-Yes, you can still travel!

Peritoneal Dialysis supplies are sent by the company who provides products for your care to your travel spot.

If traveling by airplane,your medical supplies do not count as part of your suitcase weight. You will not be charged for supplies you carry on.

  • If using the cycler, the machine weighs about 25 pounds and has its own soft sided suitcase for travel

Is my age or weight a factor?

Absolutely not!

People of all ages are able to live long and well on peritoneal dialysis. Age is not a factor.

Very large or overweight people may require one extra exchange but are still able to use PD as treatment.

What Should I Consider if I Think I Might Prefer Peritoneal Dialysis?

  • You preserve your remaining kidney function
  • You have continuous therapy which is more like your natural kidneys
  • Continuous therapy allows for some diet flexibility
  • Increased flexibility with treatment schedule
  • Increased Independence
  • Does not use needles
  • P.D. is a bloodless method
  • There is no blood that you see in this type of dialysis
  • It is the dialysis fluid and your peritoneal lining that cleans the blood\
  • Dialysis in the comfort of your own home
  • Do not need to go to the dialysis unit 3 times a week
  • Easier to travel with this method
  • Dialysis while you sleep (cycler)
  • Remain in close contact with P.D. staff:
    • Nurses, Dietician, Social Worker, Doctor
  • You come to the unit two times a month, once for your labs and another to see your doctor, nurse, social worker and dietitian all in the same appointment.

What are the “Other” Things I Should Consider About Peritoneal Dialysis?

  • There are no days off
    • You dialyze 7 days a week, 4 times per day or every night
  • There is a catheter; part of it is outside your body
  • No baths (showers are OK)`
  • No swimming in non-chlorinated water (e.g. lakes) but oceans are ok

Possibility of developing peritonitis or an exit-site infection

  • Peritonitis is the infection some patients get, usually caused by not using the sterile technique they are trained to use
  • Because you have a catheter that goes directly into your peritoneum, it is relatively easy to treat peritonitis on an outpatient basis with antibiotics put into your solution bags
  • The risk of getting peritonitis is lower than the risk of infection in an in-center dialysis unit 
  • May gain weight due to the glucose in the bags (extra calories)
  • You carry additional weight in your abdominal area because this is where the extra fluid is located
  • Need storage space in your home for supplies (Can be kept under tables, in closets, etc.)
  • Need a clean area to do dialysis
  • A room that you can shut the door
  • You can do your dialysis in your bedroom

Do I Get to Know my Greenfield Care Team?

Of course!  You are in no way left alone. Team members are available in person during business hours or on-call after hours.