Dialysis is a way of cleaning your blood when your kidneys can no longer do the job. It helps excrete the body's waste, extra salt, and water, which helps regulate blood pressure and maintains the normal composition of electrolytes in our body.
You need dialysis when you develop end-stage kidney failure --usually by the time you lose about 85 to 90 percent of your kidney function and have a glomerular filtration rate (GFR) of <15.
Click here to learn more about the stages of Chronic Kidney Disease and GFR.
Types of dialysis.
There are two kinds of dialysis. Hemodialysis pumps blood out of your body to an artificial kidney machine, and clean blood is returned to your body. All this requires a two-port catheter inserted in a large vein, mainly in the chest.
In peritoneal dialysis, the inside lining of your belly acts as a natural filter. A cleansing fluid called dialysate bathes the belly and, with repeated cycles, can excrete the waste.
A soft plastic tube (catheter) is placed in your belly by surgery. A sterile cleansing fluid is put into your belly through this catheter. After the filtering process is finished, the fluid leaves your body through the catheter.
There are two kinds of peritoneal dialysis:
Continuous Ambulatory Peritoneal Dialysis (CAPD)
Automated Peritoneal Dialysis (APD)
The basic treatment is the same for each. The number of treatments and the way the treatments are done make each method different.
CAPD is "continuous," machine-free, and done while you go about your normal activities such as work or school. You do the treatment by placing about two quarts of cleansing fluid into your belly and later draining it.
It is done by hooking up a plastic bag of cleansing fluid to the tube in your belly. Raising the plastic bag to shoulder level causes gravity to fill the fluid into your belly. When empty, the plastic bag is removed and thrown away.
When an exchange (putting in and taking out the fluid) is finished, the fluid (which now has wastes removed from your blood) is drained from your belly and thrown away.
This process is usually done three, four, or five times in 24 hours while awake during everyday activities.
Each exchange takes about 30 to 40 minutes. Some patients like to do their exchanges at mealtimes and bedtime.
APD differs from CAPD in that a machine (cycler) delivers and then drains the cleansing fluid for you. The treatment usually is done at night while you sleep.
What's the best kind of peritoneal dialysis.
The type of peritoneal dialysis that is best for you depends on your personal choice and medical condition. Your nephrologist will help you choose the one that is best for you.
How do I perform an exchange?
You'll need the following supplies:
• transfer set
• dialysis solution
• supplies to keep your exit site clean
If you choose automated peritoneal dialysis, you'll need a cycler.
Your health care team will provide everything you need to begin peritoneal dialysis and help you arrange for the supplies such as dialysis solutions and surgical masks delivered to your home, usually monthly.
Careful hand washing before and wearing a surgical mask over your nose and mouth while connecting your catheter to the transfer set can help prevent infection.
Use a transfer set to connect your catheter to the dialysis solution
A transfer set is tubing that you use to connect your catheter to the bag of dialysis solution. When you first get your catheter, the section of tube that sticks out from your skin will have a secure cap on the end to prevent infection. A connector under the cap will attach to any type of transfer set.
Where can I do peritoneal dialysis?
You can do both CAPD and automated peritoneal dialysis in any clean, private place, including at home, work, or traveling.
Before you travel, you can have the manufacturer ship the supplies to where you're going, even if it's international, so they'll be there. If you use automated peritoneal dialysis, you'll have to carry your machine with you, or you could do exchanges manually while you're away from home.
What changes will I have to make when I start peritoneal dialysis?
Your schedule will change as you work your dialysis exchanges into your routine. If you do CAPD during the day, you have some control over when you do the exchanges. However, you'll still need to stop your normal activities and take about 30 minutes to perform an exchange. If you do automated peritoneal dialysis, you'll have to set up your cycler every night.
You may need to limit some physical activities when your belly is full of dialysis solutions. You may still be active and play sports, but you should discuss your activities with your health care team; but for the most part, you can carry out almost all of your daily activities.
Make changes to what you eat and drink.
If you're on peritoneal dialysis, you may need to limit
• calories in your eating plan
You may also need to
• Watch how much liquid you drink and eat. Your dietitian will help you determine how much liquid you need to consume each day.
• Add protein to your diet because peritoneal dialysis removes protein.
• Choose foods with the right amount of potassium.
• Take supplements made for people with kidney failure.
Eating the right foods can help you feel better while you're on peritoneal dialysis. Talk with your dialysis center's dietitian to find a meal plan that works for you.
Your doctor may make changes to the medicines you take.
Adjusting to the effects of kidney failure and the time you spend on dialysis can be hard for both you and your family. You may have less energy and may not be as sharp as you were.
What are the pros and cons of being on peritoneal dialysis?
Some doctors feel that CAPD and APD have several benefits when compared to hemodialysis. With continuous dialysis, you can control extra fluid more efficiently, reducing stress on the heart and blood vessels.
You can do more of your daily activities, and it is easier to work or travel and enjoy an improved quality of life.
However, there are some people for whom peritoneal dialysis may not be appropriate. The abdomen or belly of some people, particularly those with multiple prior abdominal surgeries, may make peritoneal dialysis treatments difficult or impossible.
Peritonitis (infection of the abdomen) is an occasional complication, although it should be infrequent with appropriate precautions. When deciding on the type of treatment, you should consider that peritoneal dialysis is usually a daily process, similar to the kidney's normal function, and maybe more gentle with fluid removal from the body. Peritoneal dialysis is an effective form of dialysis, has been proven to be as good as hemodialysis.
Peritoneal dialysis is not for everyone. People must receive training and be able to perform each of the steps of the treatment correctly. You may also use a trained helper.
After training, most people can perform both types of peritoneal dialysis on their own. You'll work with a dialysis nurse for 1 to 2 weeks to learn how to do exchanges and avoid infections.
Most people bring a family member or friend to training. With a trained friend or family member, you'll better prepare for any possible sick day where you need help with exchanges.
If you choose automated peritoneal dialysis, you'll learn how to
• prepare the cycler
• connect the bags of dialysis solution
• place the drain tube
If you choose automated peritoneal dialysis, you also need to learn how to do exchanges by hand in case of a power failure or if you need an exchange during the day in addition to nighttime automated peritoneal dialysis.
Florida Kidney Physicians offers FREE Kidney Health 101 education classes. During the class, you will learn:
• What causes chronic kidney disease (CKD), and how can it be delayed?
• What is a kidney-friendly diet, and what information is available to help make the right food choices at home and while dining out?
• What actions can you take to lower blood pressure, manage blood sugar and make simple lifestyle changes?
• How can medication management help lead to better kidney health?
• How does continuing to work and having insurance coverage help with the quality of life?
• What treatment options are available that can fit a variety of work and lifestyle needs (including dialysis performed during the day or night, at home or in a clinic)?
• How does the transplant process work? Who can receive this treatment, and how may it lead to better health?
Sign up for a FREE Kidney Health 101 education. Your kidney health begins with your education.