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Peritoneal Dialysis

Peritoneal Dialysis is the most common type of dialysis done at home.

  • About 90% of all dialysis patients are on hemodialysis.
    • Of this, about 89% are on in-center hemodialysis.
  • Only about 10% of all dialysis patients are at home (either on peritoneal dialysis or hemodialysis).
    • Of this, about 9% are on peritoneal dialysis and only about 1% are on hemodialysis.

 

When is dialysis necessary? (*)

You need dialysis if your kidneys no longer remove enough wastes and fluid from your blood to keep you healthy. This usually happens when you have only 10 to 15 percent of your kidney function left. You may have symptoms such as nausea, vomiting, swelling and fatigue. However, even if you don't have these symptoms yet, you can still have a high level of wastes in your blood that may be toxic to your body. Your doctor is the best person to tell you when you should start dialysis.

 

What is peritoneal dialysis (also known as PD)? (*)

PD uses your body’s abdominal lining, the peritoneal membrane, as a natural filter and filters your blood continuously throughout the day. With PD, no blood leaves your body and it’s a therapy that’s performed in the comfort of your own home—safely and without needles.

 

Where can I do PD treatments? (*)

PD treatments are usually done at home in a clean, dry place.  Because PD is fairly portable, you may also do it while traveling.  This makes it a more flexible treatment option.

While you do not need to go to a dialysis center for your treatments, you will still need to work with a center to learn how to do your PD exchanges and to get your supplies.

 

How does the peritoneal dialysis process work?  (*)

PD is a way of cleaning waste and extra fluid from your blood. PD uses a special fluid called dialysate and the lining of your belly to do this. The organs in your belly are inside a special lining called the peritoneum. This natural lining is thin and acts like a filter. It lets some things through and keeps others out.

For PD, you will have a soft flexible tube (called a catheter) that goes from outside your body to inside your peritoneum.  This catheter is placed during a minor surgery.  Then, you will:

  1. Put dialysate fluid into your belly through your catheter
  2. Let the dialysate sit in your belly for several hours
  3. During this time, the dialysate fluid pulls waste and extra fluid out of your blood.  This is called the “dwell time.”
  4. Drain the dialysate, along with the waste and extra fluid, out through your catheter
  5. Put new dialysate fluid into your belly and repeat the process
This process is called an exchange. Your doctor will tell you how many exchanges to do each day. Your doctor will also tell you what kind of dialysate to use.

 

What are your peritoneal dialysis options?

There are 2 ways of doing peritoneal dialysis. One type uses a machine and one is done without a machine. Some people use a combination of the two types:

1. Continuous Ambulatory Peritoneal Dialysis (CAPD) does not require a machine. It is done during the daytime while the person is awake CAPD cleans your blood most hours of the day, 7 days a week. And you can walk around, even during exchanges. Exchanges usually take about 30 minutes 3-4 times a day and only require a solution bag with tubing attached to it that connects to your catheter. The fluid from the solution bag "dwells" in your abdomen for about five hours, drawing waste products and excess fluid from the bloodstream. An exchange can be performed in any clean area - at home, work or while traveling..

 

2. Continuous Cyling Peritoneal Dialysis (CCPD) - (also know as APD or Automated Peritoneal Dialysis) uses a machine called a “cycler”. It is done at night while the person sleeps. CCPD is usually done overnight, with a cycler machine that performs exchanges automatically, while you sleep. Exchanges are painless, take about 8-11 hours, and need to be done each night. CCPD is good for people who want more freedom from dialysis during the day. Since you don’t have to do exchanges during the day, you have more independence. You can also take the cycler with you when you travel to do manual exchanges on vacation.

 

Preparing for PD (*)
Catheter placement can be done as an outpatient procedure. It usually requires two or more weeks healing time before it can be used. Some people have little or no pain; others have some pain for a few days afterward.

Ask your surgeon to put a "transfer set" onto your catheter in the operating room. This tubing extension has a valve to open and close the catheter, and will make it easier for you to get started. And, ask the surgeon to make sure the catheter won't come out of your body, or "exit," at your belt-line or under a skin fold.

Your PD training nurse will check your catheter, flush it with fluid, and change the dressings weekly until it heals.

 

How much time, training and space does PD require? (*)
With PD, you have to be responsible to do your treatment every day as you were trained. PD patients must maintain a clean environment and need space in the home for dialysis supplies.

 

After your catheter is placed, you'll have a week or more of training. Your PD training nurse will teach you how to:

  • Set up an exchange room

  • Wash your hands

  • Care for your catheter and exit site

  • Use the cycler

  • Learn which dialysate to use

  • Store and order your supplies

  • Keep treatment logs

  • Take your blood pressure

  • Follow your diet and fluid limits

  • Recognize and report any problems

A PD nurse will be on call if you need help. Note: When you first begin to put fluid in, you are likely to feel very full and even stretched. After a week or two, you'll get used to the fluid and it won't bother you.

 

Once you're trained, you'll have monthly clinic visits to check your lab tests and treatment logs. You'll also need to allow time to check your supply levels, order supplies each month, and receive the shipment. Supply delivery is usually once a month, so you will need to be able to store a month's worth of boxes of dialysate—about 30 boxes that are about one foot by two feet—plus a couple of smaller boxes with other supplies. The boxes are heavy because they contain fluid, and they must be kept dry. If you keep them in a basement, they should be stored on a pallet so they are not on the floor. Otherwise, a closet will do. Some people just line up the boxes against a wall where they are easy to reach.

 

Do I need a helper (partner) to do PD?  (*)

No. You can do either type of PD without a helper. Even blind people can do PD. If you have someone who can help you, this person might help you gather supplies, move boxes, or in some cases, help with your exchanges.


How is PD paid for? (*)

For most Americans who qualify (93%), a large part of the cost of dialysis—including PD—is paid for by the Medicare End-stage Renal Disease (ESRD) Program, no matter how old you are.

 

If you are working, Medicare is "secondary" to your work insurance for the first 30 months of treatment. This means that your work insurance pays first, and Medicare may pay some or all of the remaining costs. After 30 months, Medicare becomes primary. Having two forms of insurance can reduce your out-of-pocket costs, because care that is not paid for by one insurance company may be picked up by the other. If you are not working, Medicare becomes "primary" (pays first) in the month you begin PD training.

As hard as it can be, it is very important to read your policy. Some insurance carriers have begun to charge co-pays per day for PD (and per-treatment for hemodialysis). You may be able to avoid plans like these if you read the fine print.

Life Options offers a free 108-page booklet called Employment: A Kidney Patient's Guide to Working and Paying for Treatment. Download it here.


What are some of the pluses and minuses of peritoneal dialysis? (*)

The 3 major advantages of PD include:

  • PD provides continuous therapy, so it acts more like your natural kidneys. It also offers a more flexible lifestyle and allows you to maintain your independence. You can even do your exchange overnight, while you sleep. And since you don’t have to travel to a dialysis unit for treatment, you can cut your clinic visits down to about once a month.

  • PD helps preserve a patient's residual kidney function. If you still have some residual kidney function and are interested in a kidney transplant, PD may be a good option. In fact, PD patients have been shown to be more likely to have a transplant when compared to HD patients.

  • It may happen that over a number of years on dialysis, you may need to use multiple types of therapy. That's why it's important to keep your options for access open. Because PD is administered through a catheter in your abdominal cavity, your veins are not involved and the integrity of the veins can be preserved.

Some other benefits of PD include: (*)

  • PD is a continuous treatment with few ups and downs, so you feel the same all the time. You won't feel wiped out or tired after exchanges.

  • There are fewer diet and fluid limits with PD than with in-center hemodialysis.

  • You decide your schedule and can fit in your exchanges around your day. CCPD can give you your days free from dialysis.

  • PD is a work-friendly form of treatment.

  • CAPD uses no needles, and the exchanges themselves are painless.

  • Your own peritoneum – not a dialyzer – is used to clean your blood. Your blood does not go outside of your body.

  • You can do PD at home, at work, in a car, or while traveling. Supplies can be shipped to you anywhere in the US – even to campsites.

  • You won't be around other patients except at clinic visits—and you may be more likely to think of yourself as basically healthy.

  • Research shows that the more you know about your treatment and the more you do for yourself, the longer you are likely to live.

Some of the negatives to PD include: (*)

  • Having fluid—and a catheter—in your belly can change your appearance and your feelings about your body. (Having a fistula, graft, or catheter for hemodialysis can also change your appearance.)

  • Dialysate has sugar in it, which can cause weight gain.

  • The catheter is a portal into your body. Infection (peritonitis) can occur at any exchange, so you need to follow hand-washing and technique instructions exactly.

  • Because of the risk of infection, some activities like lake or pond swimming or tub baths may not be approved by your care team.

  • With exchanges several times a day, there are no breaks from CAPD. With exchanges every night, CCPD can cut into your social schedule and make you feel tied down.

  • With CCPD, machine alarms or noises may disturb your sleep.

  • Supply delivery times may not be convenient (you may have to miss work), and the boxes are heavy to lift.

Is PD right for you? (*)
The most important factor in whether you are suited for either types of PD is how much you want to do it. However, several conditions may prevent your doctor from prescribing PD, including previous abdominal surgeries or the presence of intestinal diseases, such as inflammatory bowel disease or diverticulitis. Risks of PD include peritonitis or exit-site infections. Glucose found in the PD solution may lead to high blood sugar in patients with diabetes. Every patient is different, so it is important to talk to your doctor, nurse or social worker to determine if there are other reasons why PD may not be right for you.

 

How can I stay healthy on PD?  (*)

One of the most common problems with PD is the risk of peritonitis.  This is when your peritoneum, that natural lining in your belly, gets infected.  This might happen if germs get into your belly through your catheter.

Bad infections can keep you from being able to do the PD treatments you need.  To help prevent an infection:

  • Learn the right way to do your exchanges
  • The staff at your dialysis center can help.  Don’t be afraid to ask questions.
  • Keep all of your PD supplies in a clean, dry place
  • Do all of your exchanges in a clean, dry place
  • Always wash your hands before doing an exchange
  • Wear a surgical mask when you do exchanges

If you think you do have an infection, get treatment quickly.  Tell your doctor right away if:

  • You see pink or red around your catheter
  • You have pain around your catheter
  • Your catheter shifts or starts to come out
  • Any of the clamps on your catheter break
  • Your dialysate looks cloudy
  • You have a fever
  • You feel very sick or throw up

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