Peritoneal Dialysis

Peritoneal Dialysis

A mixture of minerals and sugar dissolved in water, called a dialysis solution, is introduced into the abdomen through a soft tube. The sugar, called glucose, extracts waste, chemicals and excess water from the tiny blood vessels of the peritoneum and leads them to the dialysis fluid. After several hours, the solution is removed with the blood waste from the abdomen through the tube. Then the abdomen is filled again with a new dialysis solution and the cycle is repeated. Each cycle is called exchange.

How to prepare ?
Before the first treatment, a surgeon places a small, soft tube called a catheter inside the abdomen. The catheter works best if the insertion site has had enough time to heal, which happens 10 days to 2 or 3 weeks. This is another way in which access planning for dialysis can contribute to treatment success. This catheter is left there permanently to carry the dialysis solution in and out of the abdomen.

Types of peritoneal dialysis
There are three types of peritoneal dialysis.

1. Continuous ambulatory peritoneal dialysis (CAPD)
This is the most common type of peritoneal dialysis. It does not require a machine and can be done in any clean, well-lit place. With CAPD the blood is constantly being purified. The dialysis solution leaves a plastic bag through the catheter and enters the abdomen, where it remains for several hours with the catheter sealed. The period in which the dialysis solution is inside the abdomen is called the residence time. Then, the patient draws the dialysis solution back into the bag to discard it. Using the same catheter, the abdomen is refilled with a new dialysis solution so that the process begins again. In the CAPD the solution has a residence time in the abdomen of 4 to 6 hours (or more). The process of extracting the used solution and replacing it with the new one lasts 30 to 40 minutes. Most people change the dialysis solution at least four times a day and sleep with their abdomen full of solution at night. In continuous ambulatory peritoneal dialysis, it is not necessary to wake up to perform dialysis tasks at night.

2. Continuous cyclic peritoneal dialysis (CCPD)
The CCPD uses a device called a cycler that fills and empties the abdomen three to five times during the night, while the patient sleeps. In the morning, the patient initiates an exchange with a permanence time that lasts all day. An additional exchange can be made in the middle of the afternoon without the cycler to increase the amount of waste removed and to decrease the amount of fluid left in the body.

3. Combination of CAPD and CCPD
If the person weighs more than 175 pounds or if the peritoneum slowly filters out the waste, a combination of CAPD and CCPD may be needed to reach the proper level of dialysis. For example, some people use a cycler at night but also perform an exchange during the day. Others make four exchanges during the day and use a mini-cycler to perform one or more exchanges during the night. With the help of your health care team you will determine the most appropriate program for you.

Who makes it ?
The patient usually performs both types of peritoneal dialysis without the help of another person. CAPD is a form of self-administered treatment that does not require devices. For the CCPD, however, a machine is needed that drains and replenishes the abdomen.

Possible Complications
The most common problem with peritoneal dialysis is peritonitis, which is a serious abdominal infection. This infection can occur if the hole through which the catheter enters the body is infected or if there is contamination when the catheter is connected or disconnected from the bags. Peritonitis requires the doctor to formulate antibiotics.

To avoid this, the procedures must be followed to the letter and you must learn to recognize the initial signs of peritonitis, such as fever, turbidity or unusual color of the fluid used, and pain or redness around the catheter. Inform the doctor immediately of the appearance of these signs so that the peritonitis can be treated quickly and serious problems are avoided.

Diet for peritoneal dialysis patients
The diet in the case of peritoneal dialysis is slightly different from that of hemodialysis patients.

  • In any case, you will have to restrict the consumption of salt and liquids, but you can consume them in greater quantity, compared with a hemodialysis patient.
  • You must consume more proteins.
  • The restrictions on potassium consumption may be different.
  • You may need to decrease the amount of calories you eat because the dialysis fluid contains calories that can make you gain weight.

The doctor and a nutritionist who specializes in treating people with kidney failure will help you plan your meals.

Advantages and disadvantages
Each type of peritoneal dialysis has advantages and disadvantages.

CAPD

Advantage

+ You can do it alone.
+ You can do it at the hours you want as long as you make the number of exchanges needed for each day.
+ It can be done in different parts.
+ A machine is not needed.
Disadvantages

– You can alter your schedule each day.
– It is a continuous treatment and all exchanges must be made 7 days a week.

CCPD

Advantage

+ It can be done at night, mainly while you sleep.
Disadvantages

– A machine is needed.

Collaborate with your health care team
Questions you can think of:

  • Is peritoneal dialysis the treatment that suits me best? Why? If it is, which type is better?
  • How long will it take me to learn how to do peritoneal dialysis?
  • How does it feel during peritoneal dialysis?
  • How does peritoneal dialysis affect blood pressure?
  • How will I know if I have peritonitis? What is the treatment?
  • As a peritoneal dialysis patient, can I continue working?
  • How much exercise should I do?
  • Where should I store the implements?
  • How often will I have a consultation with the doctor?
  • Who will be part of my health care team? How can these people help me?
  • Who should I call when there is a problem?
  • With whom can I talk about financial issues, sexuality or concerns related to my family?
  • How or where can I talk to other people who have had to face this decision?

Dialysis is not the cure
Hemodialysis and peritoneal dialysis are treatments that help to perform the work that the kidneys performed. These treatments help you feel better and live longer, but they do not cure kidney failure. Although today patients with kidney failure live longer than before, over the years kidney disease can cause problems such as heart disease, bone diseases, arthritis, nerve damage, infertility and malnutrition. These problems will not go away with dialysis, but doctors now have new and better ways to prevent or treat them. You should discuss these complications and treatments with the doctor.

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