What is Peritoneal Dialysis?
Peritoneal dialysis (PD) is a type of dialysis treatment for kidney failure that uses the inner lining of the abdomen, known as the peritoneum, as a natural filter to remove waste and excess fluid from the body. With PD, a cleansing solution called dialysate is introduced into the abdominal cavity through a small tube or catheter.
How does Peritoneal Dialysis work?
There are two main types of Peritoneal Dialysis - continuous ambulatory peritoneal dialysis (CAPD) and automated peritoneal dialysis (APD). In CAPD, the dialysate is manually put into and drained from the abdomen several times per day by the patient or a care partner. Each cycle, called an exchange, typically lasts 4-6 hours. In APD, a machine called a cycler automatically infuses dialysate into the abdomen during sleep at night and allows it to drain before the next cycle begins, eliminating the need for multiple daily manual exchanges.
In both CAPD and APD, waste and extra fluid move from the bloodstream through the peritoneal membrane and into the dialysate during the dwell time. This process, called diffusion, occurs as blood circulates in millions of tiny blood vessels located within the peritoneum. The dialysate then drains from the abdominal cavity, removing the waste and fluid from the body. Fresh dialysate is instilled for the next cycle to continue the cleansing process.
Benefits of Peritoneal Dialysis
Flexibility: CAPD allows greater freedom and mobility since it can be performed anywhere at a time convenient for the patient. APD is performed overnight at home.
Less disruptive: Peritoneal dialysis is less disruptive to lifestyle compared to hemodialysis which requires regular clinic visits. With PD, treatment occurs gradually throughout the day or night.
Residual kidney function: PD may better preserve residual kidney function since the treatment is gentle and continuous as opposed to intermittent hemodialysis. This can delay or prevent the need for kidney transplant.
Independent living: PD allows patients to do their own dialysis treatments which provide a greater sense of control and independence compared to hemodialysis. With proper training, it can be done discretely at home or work.
Potentially better nutrition: Getting dialysis frequently through PD may help with management of diet and fluid intake, leading to better nutrition and weight control compared to intermittent hemodialysis.
Lower risk of infections: The risk of infections related to vascular access sites is eliminated with peritoneal dialysis since no external machinery or catheters entering the bloodstream are involved.
Cost-effectiveness: PD has a lower overall treatment cost compared to hemodialysis, especially when performed at home, since it avoids expensive machines and dialysis clinics. Possible travel costs are also reduced.
Patient selection and catheter placement
Not everyone is a candidate for peritoneal dialysis. Factors like medical co-morbidities, lifestyle, ability and willingness to perform treatments must be considered. Adequate space in the abdominal cavity is also important.
If approved for PD, a surgeon will implant an indwelling peritoneal catheter through a small incision, typically below the navel. This flexible tube provides permanent access to the peritoneal cavity. It takes 1-2 weeks to fully recover from the minor surgery. Proper catheter care is important to prevent infections.
Potential risks and complications
Infection: Peritonitis from bacteria entering through the catheter is the most common complication. It leads to inflammation of the peritoneum and must be treated promptly with antibiotics.
Blocked catheter: Fibrous tissue can block the catheter over time. This may require minor surgery to replace the catheter.
Hernia: The weakened abdominal wall at the catheter site increases risk of hernia. This may need surgical repair.
Electrolyte imbalances: Fluid and electrolyte disturbances can occur if dialysis treatment is inadequate or fluid intake is excess. This is usually managed by adjusting prescriptions.
Leakage: Rarely, dialysate leakage from the catheter site into the abdomen may require temporary switch to hemodialysis while the leakage heals.
Catheter site pain: Discomfort at the catheter site is common at first. Most patients get used to it over time.
Poor clearance: In some cases, peritoneal dialysis cannot adequately clear wastes due to poor membrane function. Altering prescriptions or switching to hemodialysis may be needed.
Proper training and care from the renal team helps minimize risks. Most complications are manageable if diagnosed early. Peritoneal dialysis is well-suited for many patients dependent on close monitoring by the patient’s nephrologist and dialysis nurses. With cooperation between the patient and healthcare providers, PD offers an important renal replacement option for those with end-stage kidney disease.
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