Peritoneal dialysis

Treatment Overview

Peritoneal dialysis uses a membrane inside your body (peritoneal membrane) as a filter to clear wastes and extra fluid from your body and to return electrolyte levels to normal. Unlike with hemodialysis, you do not need to travel to a dialysis center for your treatment. Instead, after being trained at a dialysis center, you will do your treatment at home, on your own schedule. Peritoneal dialysis can often be done at night, while you are sleeping.

You will need to have a catheter placed in your belly (dialysis access) before you begin dialysis. Placement is usually done 10 to 14 days before dialysis starts. Some peritoneal dialysis catheters may be used immediately (acute-use catheters). But because of a high risk of complications, these catheters are not commonly used.

The process of doing peritoneal dialysis is called an exchange. You will usually complete 4 to 6 exchanges each day using the following steps:

1. Fill: Dialysis fluid enters your peritoneal cavity.
2. Dwell: While the fluid is in your peritoneal cavity, extra fluid and waste travel across the peritoneal membrane into the dialysis fluid.
3. Drain: After a few hours, the dialysis fluid is drained and replaced with new fluid.

There are three types of peritoneal dialysis. Discuss these treatment methods with your doctor to decide which one might work best for you.

• Continuous ambulatory peritoneal dialysis (CAPD). During CAPD, the dialysate solution stays in your belly for about 4 to 6 hours. After this time, the solution is drained out of your belly. Your belly is then refilled with fresh solution. You need to change the solution about 4 times a day. This is the most commonly used form of peritoneal dialysis.
• Continuous cycling peritoneal dialysis (CCPD). During CCPD, a machine automatically fills and drains the dialysate from your belly. This process takes about 10 to 12 hours, so you can perform CCPD at night while you sleep.
• Intermittent peritoneal dialysis (IPD). IPD is much like CCPD but is usually performed in a hospital. Treatment sessions may last up to 24 hours and are done several times a week. IPD is rarely done anymore.

What To Expect After Treatment

Mild back pain or abdominal fullness may sometimes occur during peritoneal dialysis.

Why It Is Done

Peritoneal dialysis replaces the work of the kidneys after complications of kidney failure develop.

How Well It Works

Peritoneal dialysis provides approximately 10% of normal kidney function. It does not reverse chronic kidney disease or kidney failure.

Risks

The most common complications from peritoneal dialysis include infection around the catheter site or infection of the lining of the abdominal wall (peritonitis). Less commonly, there may be problems related to the catheter. But most complications can be managed or prevented.

Peritoneal dialysis is not recommended when any of the following conditions are present:

• Scarring of the lining of the abdominal wall (peritoneal membrane)
• Leaks in the lining of the abdominal wall
• Active inflammatory bowel disease (Crohn's disease, ulcerative colitis)

What To Think About

Peritoneal dialysis is a good treatment option for people with kidney failure. Advantages include:

• Few dietary or fluid restrictions.
• Absence of needle sticks.
• Independence and ability to normalize daily routines.
• The ability to perform the dialysis at home.
• Decreased dependence on blood pressure medicine.
• Fewer problems with anemia.

Peritoneal dialysis does not cost as much as hemodialysis, because you can do it at home. Quality of life is also thought to be improved when less time is spent in dialysis centers.

In the United States, peritoneal dialysis is not used as frequently as hemodialysis for long-term treatment of adults. Peritoneal dialysis is more common in other countries.

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Author:	Jeannette Curtis	Last Updated: November 13, 2007
Medical Review:	E. Gregory Thompson, MD - Internal Medicine D.C. Mendelssohn, MD, FRCPC - Nephrology
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