Peritoneal dialysis: A flexible treatment option for kidney failure

Your kidneys contain millions of tiny blood vessels that filter waste from your blood and eliminate it in your urine. But diabetes and other diseases can damage this delicate filtering system. If your kidney function dips too low, your doctor may recommend dialysis.

There are two types of dialysis: peritoneal dialysis and hemodialysis. Either of these can bide time until a possible kidney transplant. If you're considering peritoneal dialysis, here's what you need to know.

What is peritoneal dialysis?

Dialysis is an artificial way to remove waste products and extra fluid from your blood when your kidneys can no longer do so on their own. With peritoneal dialysis, the network of tiny blood vessels in your abdomen (peritoneal cavity) is used to filter your blood.

Who needs peritoneal dialysis?

If your kidneys are failing, you may need dialysis to help control your blood pressure and maintain the proper balance of fluid and various chemicals — such as potassium and sodium — in your body. Dialysis also helps your body maintain the proper acid-base balance.

Sometimes kidney failure is caused by a specific kidney disease. In other cases, it's a complication of another condition, such as:

• Diabetes
• High blood pressure (hypertension)
• Kidney inflammation (glomerulonephritis)
• Inflammation of blood vessels (vasculitis)
• Polycystic kidney disease

But peritoneal dialysis isn't appropriate for everyone with kidney failure. You're probably not a candidate for peritoneal dialysis if you:

• Have extensive surgical scars in your abdomen or a condition that prevents effective peritoneal dialysis
• Have a limited ability to care for yourself or lack caregiving support at home
• Have inflammatory bowel disease or frequent bouts of diverticulitis

How do you prepare for peritoneal dialysis?

Before you start peritoneal dialysis, a surgeon places a plastic tube (catheter) into your abdomen. Your doctor will probably recommend waiting at least a month before starting treatment to give the area time to heal.

What happens during peritoneal dialysis?

A sterile mixture of sugar and minerals dissolved in water flows through the catheter into your abdomen from a bag attached to a pole or a machine called a cycler. Waste, chemicals and extra fluid are drawn into the solution in your abdominal cavity.

Your doctor will tell you how long the dialysis solution must stay in your abdomen — often from four to six hours during the day or for about two hours at night if a cycler is doing the exchanges for you while you sleep. This is known as dwell time. Your abdomen may feel fuller than usual while the dialysis solution is in your abdomen, but it's generally not uncomfortable.

When the dwell time is over, you'll reconnect the catheter to a drain line or the machine will drain the fluid from your abdomen for you. The solution — along with the waste products pulled from your blood through the tiny blood vessels in your peritoneum and any excess fluid — flow into a sterile collection bag. Then the cycle begins again.

Peritoneal dialysis

Peritoneal dialysis

During peritoneal dialysis, dialysis solution flows through the peritoneal catheter into your abdomen and dwells there until it's time for it to flow out through a drain line into a sterile collection bag.

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Are there different types of peritoneal dialysis?

Peritoneal dialysis can be done manually throughout the day or with a machine at night. Some people use a combination of both methods.

• Continuous ambulatory peritoneal dialysis (CAPD). With CAPD, you fill your abdomen with dialysis solution and drain the fluid by hand. Each time you drain the fluid and replace it with new dialysis solution, it's known as an exchange. Each exchange takes about 30 to 40 minutes. You may need three or four exchanges a day and one in the evening with a longer dwell time while you sleep. You can do the exchanges at home, work or any clean place — and you're free to do your normal activities while the dialysis solution dwells in your abdomen between exchanges.
• Continuous cycling peritoneal dialysis (CCPD). With CCPD, also called automated peritoneal dialysis, a machine automatically infuses dialysis solution into your peritoneal cavity and drains it several times during the night while you sleep. This gives you more flexibility during the day, but you must be attached to the machine for 10 to 12 hours at night. In the morning, you begin one exchange with a dwell time that lasts the entire day. You're not connected to the machine during the day.

Is there a special diet for people on peritoneal dialysis?

Eating the right foods — including foods low in sodium and phosphorus and high in protein — can improve your dialysis results and your overall health. Your dietitian will help you develop an individual meal plan based on:

• Your weight
• Your personal preferences
• How well your kidneys still function
• Other medical conditions you might have, such as diabetes or high blood pressure

What about medication?

While you're receiving peritoneal dialysis, you'll likely need various medications:

• Blood pressure medication to control your blood pressure
• Erythropoietin to stimulate your bone marrow to produce new blood cells
• Calcium, iron and other nutritional supplements to control the level of certain nutrients in your blood
• Phosphate binders to prevent the buildup of phosphorus in your blood
• Stool softeners and laxatives to manage constipation

Your doctor will do frequent blood tests to monitor your condition.

What are the potential complications of peritoneal dialysis?

Peritonitis — an infection of the peritoneum and abdominal cavity — is the most common problem for people receiving peritoneal dialysis. To prevent infection, wash your hands before you handle the catheter, and clean the area around the catheter with antiseptic every day. Store your supplies in a cool, clean place.

Notify your doctor if you have a fever, if the dialysis solution is cloudy or has an unusual odor, or if the area around your catheter is red or painful. You may need antibiotics.

Dialysis of any type is a serious responsibility. Weigh the pros and cons of each treatment option with your health care team to help decide what's best for you.

Related

Kidney dialysis: When is it time to stop?
Hemodialysis for kidney failure: Is it right for you?
Hemodialysis: Compare conventional and daily treatment schedules
Slide show: A step-by-step look at peritoneal dialysis
Slide show: A step-by-step look at hemodialysis
Potential complications of dialysis
Hemodialysis and peritoneal dialysis: What's the difference?
Dialysis: Managing your medications
Dialysis medications: What they do, what to watch for