What is peritoneal dialysis (PD)? Today, I'm going to give you a quick guide to better understanding PD. Your kidneys are your two organs located in your lower back or your flanks, and they are responsible for filtering your blood, cleaning out excess toxins, getting rid of excess water from your blood, and balancing out your electrolytes among other things. Unless you have at least one functioning kidney, you cannot live unless you have some form of renal replacement therapy or kidney replacement therapy, such as a kidney transplant or dialysis.
Types Of Dialysis
Now, there are a couple of types of dialysis, you have in-center dialysis or hemodialysis, where you actually go into a dialysis unit at least three times a week for several hours. And then there's another type of dialysis that you can actually do yourself in the comfort of your own home, and that is PD or peritoneal dialysis. Now, if you have to do dialysis, wouldn't you rather do it at home sweet home? I would too. So let's talk about it.
I'm Dr. Frita, I'm a medical doctor who has been triple board certified in nephrology or the study of kidneys and hypertension, as well as internal medicine and pediatrics. I'm the founder of my own nephrology practice in Atlanta, and I'm the medical director for a nonprofit dialysis unit. So I take care of dialysis patients and kidney patients on a daily basis. I'm very excited about today's topic, peritoneal dialysis because it is a wonderful option for patients who need to have that renal replacement therapy.
Hemodialysis is when you have patients who go into the dialysis unit three times a week to receive their treatments in person. And it is a wonderful treatment, as far as being that lifeline while the kidneys are not working. However, it does have a lot of setbacks as far as scheduling and independence. In order to learn about hemodialysis, be sure to watch my YouTube video on hemodialysis after you finish reading this article.
So today, we're going to talk about peritoneal dialysis or PD, and that is the dialysis you can do yourself at home. We'll discuss:
- Benefits of Peritoneal Dialysis
- How Does Peritoneal Dialysis Work?
- Types of Peritoneal Dialysis
- Types of Access for Peritoneal Dialysis
- How to Control How Much Fluid Is Removed From Your Body with PD
- Complications of Peritoneal Dialysis
What Is Peritoneal Dialysis or PD?
Peritoneal dialysis is a treatment used to manage chronic kidney failure. It allows people who have received a kidney transplant or those who are not candidates for a transplant to remove waste and excess fluids from their blood by means of the peritoneum, the membrane that covers the abdominal organs and lines the abdominal cavity. Waste and excess fluids drain from the blood into the dialysate which is a liquid solution similar to blood minus red and white blood cells. The waste and excess fluids are removed from the body when the spent dialysate is drained from the abdomen.
1. Benefits Of Peritoneal Dialysis
More Independence and Flexibility
A major benefit of PD is that you have more independence, more flexibility with your schedule, and more autonomy. Let's compare it to in-center hemodialysis. If you're doing in-center hemodialysis, you have to be on a set schedule three times a week at least, Monday, Wednesday, Friday, or Tuesday, Thursday, Saturday, where you go into the dialysis unit, and you're there for several hours. If you want to travel, you have to really plan in advance, and make sure there's a dialysis unit that's available with nurses who can take care of you. You are limited in what you can do with your schedule.
With peritoneal dialysis, however, because you do the PD yourself, you can pretty much set your own schedule. If you work, for example, during the day, you can set your PD to do it at night. If you go to school, if you have classes that change, or if you have after-school meetings, you can adjust and do the PD when your schedule permits. If you have a meeting in the morning or a meeting in the evening, you have that flexibility.
The same thing with travel. You can say, "Hey, I'm coming to LA, Las Vegas, or New York," and you call up the company, tell them to send your dialysis fluids to wherever you're going to be. You get there, and you do your own PD.
If you're someone who's active, or if you are a grandparent, or if you want to go to your kid's school plays, or to their other activities, which often vary in time, with peritoneal dialysis, you can work around your daily schedule, your daily life, and it just gives you that freedom and that flexibility.
Also, patients on peritoneal dialysis tend to have a more liberal diet. You have fewer food restrictions in most cases. And patients on PD have less hemodynamic instability. You have fewer blood pressure fluctuations as well.
Hold On To Your Residual Kidney Function
Another benefit of PD is that you tend to hold on to your residual kidney function. So if your own kidneys have any function, then on PD, you're likely to hold on to that function a little longer, which helps you to do better in the long run.
2. How Does Peritoneal Dialysis Work?
With peritoneal dialysis, your blood is able to be cleaned without the blood actually being removed from your body. So with PD, there is a dialysate or peritoneal fluid, which is infused into your abdomen. And your abdomen is actually surrounded or lined by a peritoneal membrane, your peritoneum. This peritoneal membrane is what allows us to clean your blood.
So here's what happens. The fluid is infused into your abdomen, and that peritoneal fluid or that dialysate acts almost like a magnet, and it's able to pull excess toxins like urea, creatinine, and excess fluids from your blood through the peritoneal membrane. After that, fluid sits in your abdomen for a while, and after it pulls these toxins and excess fluid out, then that peritoneal fluid is drained out of your abdomen. And this is called an exchange, and we do several of these exchanges a day, and this cleans your blood and takes out excess fluid.
3. Types of Peritoneal Dialysis
There are two types of peritoneal dialysis. There's CAPD or continuous ambulatory peritoneal dialysis, and then there is APD or automated peritoneal dialysis.
CAPD or Continuous Ambulatory Peritoneal Dialysis
With CAPD, you actually do the exchanges manually. You will hang a bag of PD fluid, and then through a catheter, you will infuse that fluid into your abdomen, and through gravity, that's how the fluid will get in there, you allow it to sit or to dwell, until those exchanges we talked about take place. The toxins are pulled from your body through that peritoneum and the excess fluid is pulled away, and then you manually drain the fluid yourself out of your PD catheter. And you do those exchanges several times a day, depending on what your kidney doctor has prescribed, and that is how you clean your blood. It's all done manually by hand, you do it yourself.
APD or Automated Peritoneal Dialysis
Automated PD tends to be a little more convenient and efficient, because with automated PD, you program a machine, a cycler, and it essentially does the dialysis for you. You put the dialysis fluid on the machine, you press a few buttons, which we teach you how to do, and then through an automated process, the fluid is inserted into your catheter, and then it sits there. You have the dwell, it is taken away out of your catheter, it's drained, and the process keeps repeating itself, only it's being done with a cycler, a machine. And so you can do it over eight to 10 hours while you sleep. You don't have to get up, hang bags, change bags, no, you set the machine, you're done, you go to bed and it takes about 15 minutes to do the setup.
The cycler tends to be very popular because you can set the cycler up while you sleep. For example, if you're working an eight-hour day, you get up in the morning, you go take care of what you need to take care of, you eat your breakfast, your lunch, and you're gone on your way. You come home, you take your shower, you put on your PJs. In a very sterile, clean technique, you set everything up, you put your cycler up, you set it, and then you go to bed. You forget about it. You wake up in the morning, you go through your process of unhooking yourself, leave that cycler where it is. You go into work, you're done with it, you're not doing it manually.
Same thing for travel. With that cycler, it's not a very large machine. It can fit in most overhead bins in airplanes. It can certainly fit in the corner of a trunk. It's something you can travel with very easily. I've had patients on PD who've used the cycler, who have traveled literally all over the world and they've just taken their PD fluid and they've been able to plan their lives like that. And that's what I'm talking about with flexibility. So those are the types of personal dialysis, CAPD, and APD.
4. Types of Access for Peritoneal Dialysis
What type of access do you need in order to do the peritoneal dialysis? Well, you need a peritoneal dialysis catheter or a PD catheter. So the PD catheter is a soft tube or a port that is inserted surgically into your abdomen right next to your belly button. And it's a minimally invasive surgical procedure. And most patients are actually able to go home on the same day. What happens is, as we've discussed, through that catheter, you have fluid that is infused into your abdomen. And through that same catheter, that same port, the fluid is drained from your abdomen. You must be careful to keep that area very clean around the PD catheter, and your dialysis nurses and your nephrologist will definitely train you on how to do that.
5. How to Control How Much Fluid Is Removed From Your Body with PD
How can you control how much fluid you remove from your body through PD? Well, you do that through the concentration of the peritoneal dialysis fluid, or the dialysate. So we have different concentrations and we use a dextrose or a sugar solution. If we want to pull a lot of fluid, if you're fluid overloaded, like if you have fluid in your lungs, and you have swelling in your legs, then we'll use a high concentration, like a 4.25% dextrose bag of dialysis fluid, and that will pull a lot of fluid from the lining of your peritoneum into the dialysate that's dwelling or sitting in your abdomen. When you drain it out, you would have drained quite a bit of fluid.
So for example, if you infuse two liters of fluid into your abdomen, and we have a high concentration of fluid, so that we're trying to pull a lot of fluid, then when it's time to drain, you may drain out 2.5 liters. What does that mean? The 2.5 minus the two liters that went in there, you have now drained a net of 0.5 liters. So you've gotten rid of about 1.1 pounds of fluid.
And then if you are not very fluid overloaded, if you're euvolemic, meaning you have a pretty close to a normal amount of fluid in your body, then we'll use a lower percentage concentration of the dextrose or the sugar solution, like a 1.5%, and that way it won't pull as much fluid from your body because we have to be careful. If you are volume overloaded, and we use too low of a concentration, then we won't pull enough fluid and you'll still have too much fluid on your body. But then if you are at a pretty good place if you're euvolemic with a nice amount of fluid in your body and a nice balance already, if we use a high concentration, then we could mess around and make you have too little fluid. So it's a delicate process, but again, we're very careful in training you and you'll definitely pick up on it.
6. Complications of Peritoneal Dialysis
What are the possible complications of PD? Now we talked about the many, many benefits of PD, but of course, you also want to know about potential complications. And one of the most important potential complications is infection or peritonitis. But again, your dialysis team will be sure to train you on sterile techniques and so that you try to prevent infection. And certainly, you will also be trained on how to recognize infection if it occurs.
Dialysis Can Be A Bridge To Life
In all honesty, no one is ever really excited about having to do dialysis. It's nothing that most people will volunteer for, or do cartwheels about. No, but the truth of the matter is that if your kidneys stop working, then unless you do dialysis or have a kidney transplant, you cannot live. And so dialysis does give us an option. It can be a bridge to life, or a bridge until you're able to get that life-saving transplant. And knowing about peritoneal dialysis, this PD that you can do in the comfort of your own home, well, it's just one more option that can help to make life a little better under the circumstances. If you are in a position where you can prevent kidney failure, of course, that is the most optimal choice. Be sure to watch my YouTube video on the stages of CKD and my video on how to keep your kidneys healthy, after you finish reading this.
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