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Peritoneal Dialysis: A treatment Methods for Kidney Failure

When Your Kidneys Fail

How PD Works

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Peritoneal dialysis
The most common form of PD, continuous ambulatory peritoneal dialysis (CAPD), doesn't require a machine. As the word ambulatory suggests, you can walk around with the dialysis solution in your abdomen. Other forms of PD require a machine called a cycler to fill and drain your abdomen, usually while you sleep. The different types of cycler-assisted PD are sometimes called automated peritoneal dialysis, or APD.

Getting Ready for PD
Whether you choose an ambulatory or automated form of PD, you'll need to have a soft catheter placed in your abdomen. The catheter is the tube that carries the dialysis solution into and out of your abdomen. After giving you a local anesthetic to minimize any pain, your doctor will make a small cut, often below and a little to the side of your navel (belly button), and then guide the catheter through the slit into the peritoneal cavity. As soon as the catheter is in place, you can start to receive solution through it, although you probably won't begin a full schedule of exchanges for 2 to 3 weeks. This break-in period lets you build up scar tissue that will hold the catheter in place.

The standard catheter for PD is made of soft tubing for comfort. It has Dacron cuffs that merge with your scar tissue to keep it in place. (Dacron is a polyester fabric.) The end of the tubing that is inside your abdomen has many holes to allow the free flow of solution in and out.  There are two types of Tenckhoff peritoneal catheters, a standard (A) and a curled (B).

Types of PD

Continuous Ambulatory Peritoneal Dialysis (CAPD)
If you choose CAPD, you'll drain a fresh bag of dialysis solution into your abdomen. After 4 to 6 or more hours of dwell time, you'll drain the solution, which now contains wastes, into the bag. You then repeat the cycle with a fresh bag of solution. You don't need a machine for CAPD; all you need is gravity to fill and empty your abdomen. Your doctor will prescribe the number of exchanges you'll need, typically three or four exchanges during the day and one evening exchange with a long overnight dwell time while you sleep.

Continuous Cycler-Assisted Peritoneal Dialysis (CCPD)

Nocturnal Intermittent Peritoneal Dialysis (NIPD)
NIPD is like CCPD, only the number of overnight exchanges is greater (six or more), and you don't perform an exchange during the day. NIPD is usually reserved for patients whose peritoneum is able to transport waste products very rapidly or for patients who still have substantial remaining kidney function.

Customizing Your PD
If you've chosen CAPD, you may have a problem with the long overnight dwell time. It's normal for some of the dextrose in the solution


Preventing Problems

* Store supplies in a cool, clean, dry place.
* Inspect each bag of solution for signs of contamination before you use it.
* Find a clean, dry, well-lit space to perform your exchanges.
* Wear sterile gloves to perform exchanges.
* Wash your hands every time you need to handle your catheter.
* Clean the exit site with antiseptic every day.
* Wear a surgical mask when performing exchanges if you have a cold.


* Fever
* Nausea or vomiting
* Redness or pain around the catheter
* Unusual color or cloudiness in used dialysis solution
* A catheter cuff that has been pushed out

Equipment and Supplies for PD
Transfer Set: A transfer set is tubing that connects the bag of dialysis solution to the catheter. Two types of transfer sets are available.

* A straight transfer set is a straight piece of tubing that stays connected to your catheter. To begin each exchange, you connect the free end to a fresh bag of solution and hang the bag higher than the catheter, usually attaching it to a special stand, so that gravity pulls the solution into your abdomen. While the solution is in your abdomen, you can roll up the bag and wear it under your clothes. When you've finished your dwell time, you take the bag out and place it near the floor so that gravity pushes the used solution down into the bag. When the bag is full, you disconnect it from the straight transfer set and connect a fresh bag of solution to start the next exchange.
* A Y-set is a Y-shaped piece of tubing that can be disconnected between exchanges. To start, you connect the base of the Y to your catheter. You then connect one branch of the Y to a fresh bag of solution and the other to an empty bag. To flush away any bacteria that might be in the transfer set, you close off the base of the Y and drain a small amount of solution from the full bag into the empty one. Then you close the branch that leads to the empty bag and let the solution flow into your abdomen. Once the bag has emptied, you can disconnect the Y-set from your catheter so you won't need to conceal a bag or extra tubing under your clothes. When it's time to empty the used solution, you reconnect the catheter to the Y-set and drain the solution into an empty bag to discard. Then you connect a fresh bag and begin the process again.

Dialysis Solution

You'll need a clean space to store your bags of solution and other supplies. You may also need a special heating device to warm each bag of solution to body temperature before use. Manufacturers do not recommend using microwave ovens to warm solution because they change its chemical makeup.

The cycler, which automatically fills and drains your abdomen, usually at night while you sleep, can be programmed to deliver specified volumes of dialysis solution on a specified schedule. Most systems include the following components:


* Pump. The pump sends the solution from the storage bags to the heater bag before it enters the body and then sends it from the weigh bag to the disposal container after it's been used. The pump doesn't fill and drain your abdomen; gravity performs that job more safely.


* Weigh bag. The cycler's timer releases a clamp to let the used dialysis solution drain from your abdomen into a weigh bag that measures and records how much solution has been removed. Some systems compare the amount of solution inserted with the amount drained and display the net difference between the two volumes. This lets you know whether the treatment is removing enough fluid from your body.

* Disposal container. After the used solution is weighed, it's pumped to a disposal container that you can throw away in the morning.

* Alarms. Sensors will trigger an alarm and shut off the machine if there's a problem with inflow or outflow.

Testing the Effectiveness of Your Dialysis
To see if the exchanges are removing enough waste products, such as urea, your health care team must perform several tests. These tests are especially important during the first weeks of dialysis to determine whether you're receiving an adequate amount, or dose, of dialysis.





* increasing the number of exchanges per day for patients treated with CAPD or per night for patients treated with CCPD or NIPD

* increasing the volume of each exchange (amount of solution in the bag) in CAPD


* adding an extra middle-of-the-day exchange to the CCPD schedule

For more information about testing the effectiveness of your dialysis, click here:

One of the big problems with PD is that patients sometimes don't perform all of the exchanges prescribed by their medical team. They either skip exchanges or sometimes skip entire treatment days when using CCPD or NIPD. Skipping PD treatments has been shown to increase the risk of hospitalization and death.


The doctor should determine your PD dose on the basis of practice standards established by the National Kidney Foundation Dialysis Outcomes Quality Initiative (NKF- DOQI). Work closely with your health care team to ensure that you get the proper dose, and follow instructions carefully to make sure you get the most out of your dialysis exchanges.

(Adapted from NIDDK)