Peritoneal Dialysis (PD)
Peritoneal dialysis (PD) is a way to clean the blood when the kidneys can't do their job. It uses the lining of the belly (peritoneum) as a natural filter to remove waste, extra salts, and fluids from the body. This method has been used since the 1920s and is now a good choice for most people with severe kidney disease.
PD is a continuous treatment, unlike hemodialysis, which is done a few times a week. This continuous nature of PD helps keep the body’s fluid and blood chemistry more stable. It also gives people more freedom and flexibility since they can do PD at home and at their own pace. PD can also be cost-effective and is easier to manage while traveling.
PD is often a self-care treatment that most people can do themselves. However, some might need help from family or a caregiver. Overall, PD can be a good option for people who want more control over their treatment and can handle the daily routine it involves.
2 Types of Peritoneal Dialysis
Continuous Ambulatory Peritoneal Dialysis (CAPD)
CAPD involves manually changing the dialysis fluid throughout the day, usually 3-5 times, by filling the belly with fresh cleaning fluid (dialysate), allowing it to absorb waste, and then draining it out and replacing it. This method gives you the freedom to perform dialysis anywhere without a machine.
Automated Peritoneal Dialysis (APD)
APD uses a machine called a cycler to automatically perform the fluid exchanges at night while you sleep. The cycler fills and drains the dialysate from your belly during the night, freeing up your daytime. APD requires less manual work, but you need to connect to the machine every night.
Both methods offer benefits, so the choice depends on your preferences and lifestyle.
Benefits
Some clients may find PD to be a more positive experience with improved outcomes as compared to hemodialysis. Those with poor vasculature making vascular access for HD very challenging may be better suited for PD. Those with severe congestive heart failure or other advanced cardiovascular diseases may find the continuous nature of PD gentler and more tolerable in terms of fluid and electrolyte regulation.
There are considerable benefits of PD as both a long-term therapy as well as an initial therapy option for clients. These benefits include but are not limited to:
- Improved blood-pressure and volume control due to continuous ultrafiltration
- Preservation of residual renal function due to its slow, continuous nature
- Delayed use of blood access sites that may be required in future if a switch to HD is required.
- Minimizes cardiovascular instability.
- Decrease in potential for systemic inflammation
- Client independence and self-management opportunities
- Flexibility makes it suitable for those who want to travel
- Focus on home and self-care can help reduce healthcare costs
Challenges
While peritoneal dialysis (PD) can be empowering for those who can manage their own treatment, it does come with challenges. Self-care may not be suitable for everyone, so clients and caregivers need to understand the daily commitment involved in performing PD. Clients need good manual dexterity and vision to handle PD, and cognitive abilities of both the client and any potential caregivers must be evaluated.
The living space needs to have enough room to store PD supplies and equipment. Though nephrology care is available through PD programs, phone consultations, and home visits from PD nurses, clients typically need regular clinic or follow-up appointments every two to three months. These factors should be considered when deciding whether PD is the right treatment option. We are here to assist you.
Contraindication
Our healthcare team will help you thoroughly assess your condition to determine if peritoneal dialysis is the right choice for you.
History of multiple abdominal surgeries. Scar tissue may reduce the effective surface area of the peritoneal membrane.
Known peritoneal fissures. Openings between the peritoneum and pleura can cause complications.
Chronic and severe back pain. This can be exacerbated by the pressure from PD fluid.
Morbid obesity: Insufficient dialysis may not lead to optimal outcomes for the patient.
Acute and Active diverticular disease: The thin intestinal wall may rupture, leading to peritonitis.
Advance chronic obstructive pulmonary disease (COPD): Increased pressure on the diaphragm could worsen symptoms.
Incapacitation: If the patient cannot manage self-care and a caregiver isn't available, PD may not be feasible.
Our healthcare team will help you thoroughly assess your condition to determine if peritoneal dialysis is the right choice for you.
How PD Works
Peritoneal dialysis (PD) performs two main functions of the kidneys: regulating and excreting waste and fluids. Both PD and hemodialysis (HD) help maintain fluid and electrolyte balance and remove waste and toxins. The main difference is that PD is a continuous treatment done inside the body, while HD is usually intermittent.
In PD, a catheter is used to fill the peritoneal cavity with a special fluid called dialysate. Waste and excess fluids from the blood in the peritoneal capillaries move across the peritoneal membrane into the dialysate. This process helps cleanse the blood.
The peritoneal membrane's permeability is crucial for controlling the diffusion of solutes and toxins. Measurement of peritoneal membrane permeability through the peritoneal equilibrium test (PET) is important for determining a client's membrane transport characteristics and identifying the appropriate PD prescription.
Peritoneal Dialysis (PD)
Peritoneal dialysis (PD) is a way to clean the blood when the kidneys can't do their job. It uses the lining of the belly (peritoneum) as a natural filter to remove waste, extra salts, and fluids from the body. This method has been used since the 1920s and is now a good choice for most people with severe kidney disease.
PD is a continuous treatment, unlike hemodialysis, which is done a few times a week. This continuous nature of PD helps keep the body’s fluid and blood chemistry more stable. It also gives people more freedom and flexibility since they can do PD at home and at their own pace. PD can also be cost-effective and is easier to manage while traveling.
PD is often a self-care treatment that most people can do themselves. However, some might need help from family or a caregiver. Overall, PD can be a good option for people who want more control over their treatment and can handle the daily routine it involves.
2 Types of PD
Continuous Ambulatory Peritoneal Dialysis (CAPD)
CAPD involves manually changing the dialysis fluid throughout the day, usually 3-5 times, by filling the belly with fresh cleaning fluid (dialysate), allowing it to absorb waste, and then draining it out and replacing it. This method gives you the freedom to perform dialysis anywhere without a machine.
Automated Peritoneal Dialysis (APD)
APD uses a machine called a cycler to automatically perform the fluid exchanges at night while you sleep. The cycler fills and drains the dialysate from your belly during the night, freeing up your daytime. APD requires less manual work, but you need to connect to the machine every night.
Both methods offer benefits, so the choice depends on your preferences and lifestyle.
Benefits
Some clients may find PD to be a more positive experience with improved outcomes as compared to hemodialysis. Those with poor vasculature making vascular access for HD very challenging may be better suited for PD. Those with severe congestive heart failure or other advanced cardiovascular diseases may find the continuous nature of PD gentler and more tolerable in terms of fluid and electrolyte regulation.
There are considerable benefits of PD as both a long-term therapy as well as an initial therapy option for clients. These benefits include but are not limited to:
- Improved blood-pressure and volume control due to continuous ultrafiltration
- Preservation of residual renal function due to its slow, continuous nature
- Delayed use of blood access sites that may be required in future if a switch to HD is required.
- Minimizes cardiovascular instability.
- Decrease in potential for systemic inflammation
- Client independence and self-management opportunities
- Flexibility makes it suitable for those who want to travel
- Focus on home and self-care can help reduce healthcare costs
Challenges
While peritoneal dialysis (PD) can be empowering for those who can manage their own treatment, it does come with challenges. Self-care may not be suitable for everyone, so clients and caregivers need to understand the daily commitment involved in performing PD. Clients need good manual dexterity and vision to handle PD, and cognitive abilities of both the client and any potential caregivers must be evaluated.
The living space needs to have enough room to store PD supplies and equipment. Though nephrology care is available through PD programs, phone consultations, and home visits from PD nurses, clients typically need regular clinic or follow-up appointments every two to three months. These factors should be considered when deciding whether PD is the right treatment option. We are here to assist you.
Contraindication
In the past, certain conditions clearly ruled out peritoneal dialysis (PD) for patients. However, recent advances and improved technology have expanded the use of PD. Despite this, PD may not be suitable for individuals with certain conditions such as:
History of multiple abdominal surgeries. Scar tissue may reduce the effective surface area of the peritoneal membrane.
Known peritoneal fissures. Openings between the peritoneum and pleura can cause complications.
Chronic and severe back pain. This can be exacerbated by the pressure from PD fluid.
Morbid obesity: Insufficient dialysis may not lead to optimal outcomes for the patient.
Acute and Active diverticular disease: The thin intestinal wall may rupture, leading to peritonitis.
Advance chronic obstructive pulmonary disease (COPD): Increased pressure on the diaphragm could worsen symptoms.
Incapacitation: If the patient cannot manage self-care and a caregiver isn't available, PD may not be feasible.
In the past, certain conditions clearly ruled out peritoneal dialysis (PD) for patients. However, recent advances and improved technology have expanded the use of PD. Despite this, PD may not be suitable for individuals with certain conditions such as:
How PD Works
Peritoneal dialysis (PD) performs two main functions of the kidneys: regulating and excreting waste and fluids. Both PD and hemodialysis (HD) help maintain fluid and electrolyte balance and remove waste and toxins. The main difference is that PD is a continuous treatment done inside the body, while HD is usually intermittent.
In PD, a catheter is used to fill the peritoneal cavity with a special fluid called dialysate. Waste and excess fluids from the blood in the peritoneal capillaries move across the peritoneal membrane into the dialysate. This process helps cleanse the blood.
The peritoneal membrane's permeability is crucial for controlling the diffusion of solutes and toxins. Measurement of peritoneal membrane permeability through the peritoneal equilibrium test (PET) is important for determining a client's membrane transport characteristics and identifying the appropriate PD prescription.
