Dialysis Services at Guthrie

Principles of Peritoneal Dialysis

Peritoneal dialysis removes waste products from the blood by use of the peritoneum, the membrane covering the intestinal organs in the abdominal cavity. Using a surgically-implanted catheter, a sterile dialysis solution is introduced into the peritoneal cavity and the peritoneum operates as the dialyzing membrane. Peritoneal dialysis usually requires the introduction and disposal of solutions four times a day (CAPD = Continuous Ambulatory Peritoneal Dialysis) or is supported by a machine cycling solution to and from the patient’s peritoneum during sleep (APD = Automated Peritoneal Dialysis). Most peritoneal treatments are self-administered by patients in their homes and workplaces.

If you choose peritoneal dialysis, a surgeon will place a catheter into your peritoneal cavity. This procedure is done under local anesthesia. The catheter will allow the sugar-based liquid called either dianeal, dialysate or Delflex to be infused into the peritoneal cavity. Waste products will pass from the blood through the peritoneal membrane and into the dianeal in the peritoneal cavity. After a 3-6 hour dwell time, the used dianeal, called effluent, will be drained by gravity from the cavity via the catheter and be replaced with a new bag of dianeal.

Because the patient is not required to make frequent visits to a Hemodialysis clinic, a patient on peritoneal dialysis may experience much less disruption to life than a patient on hemodialysis. However, the risk of infection leading to episodes of peritonitis, a bacterial infection of the peritoneum, can limit peritoneal dialysis. In addition, patients using peritoneal dialysis must have some residual renal function. Both factors limit peritoneal dialysis as a long-term therapy for some patients. Therefore, in general, patients with end-stage renal disease require hemodialysis treatment at some point during the course of their treatment.

Hemodialysis is the more frequently used treatment. Approximately 85% of the worldwide patient population is treated with hemodialysis, while only 15% are on peritoneal dialysis. Yet depending on different factors such as status of the medical institution and reimbursement differences for treatment, there are significant differences in the utilization of hemodialysis and peritoneal dialysis in various countries.

Peritoneal dialysis is not difficult to learn but must be done exactly as taught in order to prevent an infection called peritonitis. The dialysis nurse will teach you and a family member who is willing to be a backup the proper technique for peritoneal dialysis and will make sure you are confident performing it. Training is done in the home training room at Robert Packer Hospital or in the patient’s home, and usually takes about five days to learn. Each patient can choose a preferred type of peritoneal dialysis, depending on medical needs. The two types are CAPD (Continuous Ambulatory Peritoneal Dialysis) or CCPD (Continuous Cycling Peritoneal Dialysis).

CAPD is done at least 4 times per day, 7 days a week, leaving the peritoneal cavity filled with at least 2 liters of dianeal at all times. Each treatment takes 30-40 minutes to complete. The used solution (effluent) is first drained from the cavity and the new solution is instilled into the peritoneum by using a Y-set tubing and gravity (the new solution will be being on an IV pole) After instillation of the dianeal, the tubing is detached and the effluent is disposed of in the toilet. The new dianeal stays in the cavity for a period of 3-6 hours. The overnight dwell may be longer (8-12 hours) so your sleep is not disturbed. CAPD can be done anywhere as long as the work area is well-lit, clean and has adequate privacy. CAPD increases your independence for traveling, schooling and employment because you are not dependent on a machine in a fixed location.

CCPD uses a machine called a Freedom Cycler to control the stages of drain fill and dwell. You connect your catheter to the cycler at night and while you sleep, the cycler performs your treatment at the programmed times. You will be taught how to program the cycler, load the tubing and how to troubleshoot any alarms that may occur during the night. In the morning, you disconnect yourself and go about your daily activities. This is done seven days a week, for approximately 10-13 hours each night. You will come off the cycler full with at least 2 liters of dianeal. This last fill will allow for some additional dialysis while you are conducting your daytime activities.