This information leaflet will explain the option of Peritoneal Dialysis (PD) the differing ways in which it can be performed, the benefits and the potential issues of treatment.
What is PD?
Peritoneal dialysis (PD) is a method of gently removing waste and excess water from the blood. This becomes required when the renal function becomes severely impaired and without treatment is likely to cause symptoms such as nausea or vomiting.
Importantly no blood is removed to achieve the cleansing, instead the blood is cleansed on the inside of the body by use of special fluid placed within your peritoneum.
Renal (CKD Team)
Salford Royal, Hope Building
Telephone: 0161 206 1882
What is the peritoneum?
The peritoneum is a natural membrane, it lines the inside of your abdomen and covers all the internal organs see Figure 1.
It is a 2 layered membrane that creates a natural cavity. The membrane itself contains many tiny pores, it is these pores that allow us the opportunity to use the peritoneum to perform PD.
How does PD work?
For PD to work the patient is required to have a special PD catheter inserted into their lower abdomen. This catheter lies deep within the abdomen and it allows for the patient to administer the special dialysis fluid into the cavity, see Figure 2.
The fluid once in the cavity is allowed to dwell, whilst is does so it draws waste from the blood supply. After a given time period this fluid is removed and replaced with fresh fluid, this process is termed “an exchange”.
Repeated exchanges of old for new fluid provides ongoing cleansing of the blood and removal of water. This process can be done in different ways (see options 1 and 2).
How often is PD performed?
This will depend on the choice you make. As PD gives you the options of performing your treatment at home, and can be done in 2 differing ways, therefore the time spent performing your treatment will be dependent upon your choice.
Your CKD nurse will help you to understand these options and help you in considering which method best suits your lifestyle.
A typical 1 month supply average
30 boxes
APD 5L boxes: 29cm wide, 38cm long, 16cm high
CAPD 2L x4 boxes: 28.8cm wide, 38cm long, 23cm high
Fresenius boxes: 29cm wide, 48cm long, 17.5cm high
What is needed?
In order to perform peritoneal dialysis, you will need a clean home environment and area to perform your dialysis.
This is important to minimise your risk of catching peritonitis. (Peritonitis is inflammation of the peritoneal space and is treated with antibiotics).
Your peritoneal dialysis nurse as part of your training will train you so that your risks of catching peritonitis is minimised.
This will include teaching you how to wash your hands effectively and how to prepare the area you will be performing your dialysis.
The work area where you will perform your dialysis ideally needs to be:
- Be away from any drafts
- Be free of clutter
- Be clean
- Not have pets in the area/room while you are preforming your dialysis and making key connections
- You will also need to have space in your home to store the medical supplies required to perform the therapy
- Usually a one month supply is delivered, and can be stored in various areas of the home
Option 1
Continuous Ambulatory Peritoneal Dialysis (CAPD)
Breaking this down helps to understand the nature of CAPD. CAPD is carried out every day, most patients will perform 4 exchanges each day, commonly this takes place morning, mid- day, early evening and bed time. Each exchange will take approximately 30 minutes to perform.
Looking at a single exchange will help you to understand the process a little more. For example, a patient on CAPD will have slept through the night with dialysis fluid in their PD cavity this fluid will have drawn waste into the cavity along with some water.
Remember this process is now repeated 4 times each day.
Stages of a single CAPD exchange(removal of old fluid replacement of new fluid)
Option 2
Automated Peritoneal Dialysis (APD)
APD is generally performed every night (it can be performed during the day if required for example if you work night shift).
The community peritoneal dialysis nursing team will demonstrate and teach you how to set your APD machine up for use and how to connect and disconnect yourself using your PD catheter, and the APD machine will be by your bedside.
The APD machine will warm the dialysis fluid and perform waves of exchanges whilst you sleep.
It will drain out the used fluid sending it to your toilet or to a drainage bag, it will then administer fresh warm fluid to begin the cleansing process again.
You will need to be on the dialysis machine every night for a period of approximately 8 hours, this enables the APD machine to perform several exchanges of dialysis fluid each night.
After spending the night on the machine, most people on APD will keep the last fill of fluid inside their peritoneum during the day without needing to change it.
Assisted Automated Peritoneal Dialysis (AAPD)
AAPD is suitable for some elderly patients but is not limited to the elderly.
It may be used for patients who are unable to perform their own peritoneal dialysis themselves.
This can be short or long term, short term may include early discharge from hospital, and long term may include for example: frail, physical disabilities, terminal ill and people with learning disabilities for example.
Some people can start with Aapd then graduate to self-care. It can be used in a number of settings but mainly in the home in the bedroom and performed overnight.
Daily access will be needed to your home from either the hospital staff or an outside agency that has been approved and used by the hospital, helping to clear away and set up the automated peritoneal dialysis machine.
You, a relative or a carer will be taught by the peritoneal dialysis community nursing team on how to safely connect and disconnect from the automated peritoneal dialysis machine.
Regular support will be given either by telephone or by home visits from the peritoneal dialysis community nursing team as required.
Planning your access for PD
When your kidney function declines to between 8% and 9% you will be seen by the PD nurses in a special appointment called preparation for dialysis.
The CKD team will ring you and advise you that you are being sent an appointment, to help you prepare for this appointment.
This appointment allows you the chance to meet the PD team who will take over your care from the CKD team once you start PD.
It also allows for the insertion of your PD catheter to be planned carefully.
Catheter insertion is usually done at Salford Royal as a day case. You will need someone to drive you home after the procedure.
Catheter insertion can be done in 2 ways
- Medical (the most common way of catheter insertion)
- Surgical
Your renal consultant and the CKD team will help you understand which type of catheter insertion you will need and why.
At this appointment you may be consented for your PD catheter to be inserted at a later date which will be mutual agreed with you.
You may also be given a bowel prep which you will need to take the day before your planned catheter insertion.
Will there be any changes to my day to day life?
It is important to note that patients on PD need to be having their bowels open every day.
This should be a normal stool motion, not difficult to pass or diarrhoea.
Most patients on PD need to take regular laxatives in order to prevent constipation and to keep the dialysis working effectively.
The frequency of laxatives required will be individual to you and your PD nurse will discuss this with you during your training.
Day to day commitments from you
Doing a home dialysis requires a degree of commitment from patients, in order to keep the dialysis working.
You will need to be responsible for the following:
- Weighing yourself daily
- Monitoring your blood pressure
- Stock balance
- Accepting deliveries
- Dealing with waste
The PD team will continue to support you once you have been trained on PD. This will be through phone calls and home visits if required.
It is important to note that doing any home therapy gives you responsibility to contact the team if things go wrong, and ensuring you are taking your medications as prescribed.
Is everyone suitable for PD?
Unfortunately no, some reasons where PD may not be promoted would be.
- Where surgery has been performed that may have damaged or impaired the peritoneum.
- Obesity may in some cases give concern that the therapy may not be adequate for body size.
- The home environment may be unsuitable.
Summary
All dialysis therapies have their own advantages and potential disadvantages. The CKD team’s role is to discuss and explain these choices further.
The choice of treatment is yours, but the PD team will always initially train you on CAPD (Option 1) first, even when your choice is for APD once done you will then train you for APD.
For both these types of peritoneal dialysis the community team will teach you how to perform CAPD and APD treatment safety and independently at your home.
For both therapies, the flow of dialysis fluid can be affected by constipation. Some patients may need regular laxatives to address this problem.
Date of Review: January 2025
Date of Next Review: January 2027
Ref No: PI_M_1617 (Salford)