Peritoneal dialysis

There are two main types of peritoneal dialysis:

• continuous ambulatory peritoneal dialysis (CAPD) – where your blood is filtered several times during the day

• automated peritoneal dialysis (APD) – where a machine helps filter your blood during the night as you sleep

• Both treatments can be done at home once you've been trained to carry them out yourself. They're described in more detail below.

 

Preparing for treatment

Before you can have CAPD or APD, an opening will need to
be made in your abdomen. This will allow the dialysis fluid (dialysate) to be pumped into the space inside your abdomen
(the peritoneal cavity).

An incision is usually made just below your belly button. A thin tube called a catheter is inserted into the incision and the opening will normally be left to heal for a few weeks before treatment starts.

The catheter is permanently attached to your abdomen, which some people find difficult. If you're unable to get used to the catheter, you can have it removed and switch to haemodialysis instead.

 

Continuous ambulatory peritoneal dialysis

The equipment used to carry out CAPD consists of:

• a bag containing dialysate fluid

• an empty bag used to collect waste products

• a series of tubing and clips used to secure both bags
  to the catheter

• a wheeled stand that you can hang the bags from

 

At first, the bag containing dialysate fluid is attached to the catheter
in your abdomen. This allows the fluid to flow into the peritoneal
cavity, where it's left for a few hours.

While the dialysate fluid is in the peritoneal cavity, waste products
and excess fluid in the blood passing through the lining of the cavity are drawn out of the blood and into the fluid.

A few hours later, the old fluid is drained into the waste bag.
New fluid from a fresh bag is then passed into your peritoneal
cavity to replace it, and left there until the next session. This process of exchanging the fluids is painless and usually takes about 30-40 minutes to complete.

Exchanging the fluids isn't painful, but you may find the sensation
of filling your abdomen with fluid uncomfortable or strange at first.
This should start to become less noticeable as you get used to it.

Most people who use CAPD need to repeat this around four times
a day. Between treatment sessions, the bags are disconnected and the end of the catheter is sealed. 

 

Automated peritoneal dialysis (APD)

Automated peritoneal dialysis (APD) is similar to CAPD, except a machine is used to control the exchange of fluid while you sleep.

 

You attach a bag filled with dialysate fluid to the APD machine before you go to bed. As you sleep, the machine automatically performs a number of fluid exchanges.

 

You'll usually need to be attached to the APD machine for 8-10 hours. At the end of the treatment session, some dialysate fluid
will be left in your abdomen. This will be drained during your next session.

During the night, an exchange can be temporarily interrupted if,
for example, you need to get up to go to the toilet.

Some people who have APD worry that a power cut or other technical problem could be dangerous. However, it is usually safe
to miss one night’s worth of exchanges as long as you resume treatment within 24 hours. You'll be given the telephone number
of a 24-hour hotline you can call if you experience any technical problems. 

 

Fluid and diet restrictions

If you're having peritoneal dialysis, there are generally fewer restrictions on diet and fluid intake compared with haemodialysis because the treatment is carried out more often.

However, you may sometimes be advised to limit how much fluid you drink and you may need to make some changes to your diet.
A dietitian will discuss this with you if appropriate.

 

Dialysis and pregnancy

Becoming pregnant while on dialysis can sometimes be dangerous
for the mother and baby.

It's possible to have a successful pregnancy while on dialysis, but you'll probably need to be monitored more closely at a dialysis unit and you may need more frequent or longer treatment sessions.

If you're considering trying for a baby, it's a good idea to discuss
this with your doctor first.

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Dialysis equipment

If you're having home haemodialysis or peritoneal dialysis, the supplies and equipment you need will normally be provided by
your hospitalor dialysis clinic.

You'll be told how to get and store your supplies as part of your training in carrying out the procedure. It's important to make sure you have enough supplies of equipment in case of an emergency, such as adverse weather conditions that prevent
you from obtaining supplies. Your doctor or nurse may suggest keeping at least a week's worth of equipment as an emergency backup supply.

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You should also let your electrical company know if you're using home haemodialysis or automated peritoneal dialysis. This is so they can treat you as a priority in the event that your electrical supply is disrupted.