Peritoneal Dialysis

Peritoneal Dialysis (Click for French version of this page)peritoneal, click for larger version

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

Where to Start
An assessment session will be required prior to your training. There will be a nurse, a PD nephrologist, and a social worker. They will review the entire process of Peritoneal Dialysis with you and answer any questions or concerns you may have. It is recommended to bring a partner or support person to the assessment meeting if possible. You will be asked to perform some simple tasks to determine if you would need assistance with PD or not.

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

What’s Involved – An Overview

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.

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.

Types of Peritoneal Dialysis

Manual method – CAPD (Continuous Ambulatory Peritoneal Dialysis)

  • Dialysate dwells in the peritoneal cavity at all times
  • Exchanges are done by the person 4 to 5 times every day
  • Also known as “Twin Bag” method
  • Each exchange can take about 30 minutes to complete

Automatic 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 dwells in the 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 cavity the entire day
  • In some cases, people using the automatic method may have to do a manual exchange during the day

What the Patient 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
  • Suitable water, plumbing and electricity as determined by MRP technicians

Training & Clinic Visits
PD training takes about one week and happens daily (weekdays). Training is provided by PD nurses at either St. Boniface Hospital or at Seven Oaks General Hospital in Winnipeg. 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. As well, MRP has kidney friendly cookbooks available through MRP’s main office or the renal dietitian. Additional resources and information can be found on the MRP website: www.kidneyhealth.ca.

 

FREQUENTLY ASKED QUESTIONS

Can people who live in apartments do dialysis at home?

Yes, PD can be done in apartments.

What equipment will is needed in my home?

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.

What other supplies will need to be in my home?

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

Where should PD dialysis supplies and equipment be kept?

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.

Do any changes have to be made to the home in order to accommodate the dialysis equipment?

No changes to the home are required for PD.

What happens if the patient decides to stop 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.

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