Peritoneal Dialysis

Peritoneal Dialysis

Peritoneal dialysis (PD) is a form of dialysis done at home either by the patient, a caregiver, or, in certain circumstances, with the assistance of a visiting nurse.

Patients start on dialysis once their kidneys are no longer working and their bodies need help to get rid of fluid and waste. Your care team will work with you to plan a transition onto dialysis.

Benefits of Peritoneal Dialysis versus In-Centre Hemodialysis

  • Independence in your care and schedule
  • Ability to work
  • Ability to travel
  • Less food/diet restrictions
  • Less fluid/drink restrictions
  • Less risk of infections
  • No travel to and from a dialysis unit
  • Remaining kidney function lasts longer
  • No needles

Where to Start

Assessment:

An assessment appointment is the first step to finding out if peritoneal dialysis (PD) is a good fit for you. During the appointment different care team members may ask questions and:

  • review the entire process of Peritoneal Dialysis with you
  • answer any questions or concerns you may have
  • ask you to perform some simple tasks to determine if you would need assistance with PD or not

It is recommended to bring a partner or support person to the assessment meeting if possible. After the PD assessment, if the patient and health-care team agree PD is a good option for the patient, they will work with the patient to plan the steps towards education and training.

How PD Works

With PD, the blood is cleaned inside the body, using it as a natural filter, rather than being cleaned outside in a machine. It is a more gentle form of dialysis, that lets your kidneys hold onto their remaining function longer.

A peritoneal catheter (soft tube) is placed into the peritoneal cavity in your belly (under the ribs and above the hips). The peritoneal cavity membrane surrounds internal organs and is the filter that will be used to clean the blood.

Using the catheter, the peritoneal cavity is filled with clear fluid (called dialysate). Over time the fluid put into your body will collect waste. This waste fluid is then drained through the catheter before fresh fluid is put in again. This is called a PD exchange.

Schedule

A patient choosing PD dialyzes seven days a week, usually overnight while they sleep. Patients only need to visit the PD clinic every two to four months for assessment by health-care team members.

Types of Peritoneal Dialysis

Manual or Twin Bag Method
aka CAPD (Continuous Ambulatory Peritoneal Dialysis)

  • Is the first method to be taught
  • No machine is used, only gravity
  • Dialysate fluid stays in the peritoneal cavity (belly area) at all times
  • Exchanges are done by the person 4 to 5 times every day
  • Each exchange can take about 30 minutes to complete

Automatic/Cycler Method – CCPD (Continuous Cycling Peritoneal Dialysis) or APD (Automated Peritoneal Dialysis)

  • Done by a compact, portable machine overnight for about nine hours while asleep
  • Dialysate fluid stays in the belly cavity for short periods of time before the machine drains it out and fills with fresh dialysate (this is called cycling)
  • In the morning one last fill will occur before disconnecting
  • This fluid may stay in the belly cavity the entire day
  • In some cases, people using the automatic method may have to do a manual exchange during the day

What You Will Need

The patient will need to have the following at home in order to have the best possible environment for PD:

  • Telephone
  • Clean work area
  • Storage space for supplies

Training & Clinic Visits

PD training takes three to five days and happens daily (weekdays). Training is provided by PD nurses at St. Boniface Hospital, Seven Oaks General Hospital or the Brandon Regional Health Centre. Once training is complete, PD program staff is still available for questions and there is 24-hour trouble-shooting support for PD cycler machines.

Clinic appointments for PD patients are every two to four months.

Getting There
Talk with your health-care team if you plan on driving to training or if you need help arranging transportation.

Responsibilities

Being on home dialysis means managing one’s own care. While this is a responsibility, it also allows freedoms such as setting the dialysis schedule. The patient will have to ensure they are willing and able to:

  • Manage their own care
  • Order supplies
  • Attend clinic appointments

Catheter

Catheter surgery takes about an hour and requires only a few hours stay in hospital (not overnight). It is very important to keep the catheter site clean to prevent infections. Keeping the catheter site clean and free of infection will ensure the patient is able to stay on PD for a longer time. The patient is taught how to care for the catheter site and how to watch for infection.

If you have concerns or questions about your catheter site, always ask the health-care team.

Eating & Drinking

One of the great things about PD is that it allows more freedom in diet than in-hospital hemodialysis. Because the patient is dialyzing daily and PD is a more gentle form of dialysis, the body is better able to process foods including minerals and nutrients. However, there still are some restrictions.

Every person has different needs and restrictions when it comes to foods and liquids. The renal dietitian will customize a special diet just for the patient. Always talk to the dietitian if there are concerns about nutritional needs. Visit the Nutrition & Peritoneal Dialysis section by clicking the button below.

Frequently Asked Questions

Yes, PD can be done in apartments.

There will be boxes of dialysis solutions and a warmer. If using the CCPD method of PD there will also be a night cycler that is about 7” x 19.5” x 15.7” and weighs about 27 lbs. As well, there are some other small supplies for cleaning the PD catheter exit site. All PD supplies are provided by the Manitoba Renal Program and delivered to the home. The patient will be responsible for ordering supplies as needed.

There needs to be a reliable scale for a daily weight and a blood pressure monitor. This can be discussed with the training nurse.

Supplies can be stored in any warm, dry space preferably away from pets. Ideally, the patient should not need any more than a large linen closet to store supplies in.

No changes to the home are required for PD.

If the patient decides to discontinue PD they will return to the in-centre hemodialysis unit or train for home hemodialysis. The dialysis machine and warmer will be removed from the home. The patient will be responsible for disposing of other dialysis supplies.