Peritoneal Dialysis: An Overview of a Life-Saving Treatment

Andrew Kowalski, MD, FASN

Chronic kidney disease (CKD) affects millions worldwide, and for those whose kidneys are no longer functioning properly, dialysis becomes a critical component of treatment. While hemodialysis (HD) is the more commonly known form of dialysis, peritoneal dialysis (PD) offers an alternative that can be more flexible and better suited for some patients. In this blog post, we’ll dive into what peritoneal dialysis is, how it works, its advantages, and considerations for patients choosing this treatment.

What is Peritoneal Dialysis?

Peritoneal dialysis is a form of dialysis that uses the lining of the abdomen, called the peritoneum, as a natural filter to remove waste products and excess fluids from the blood. Unlike hemodialysis, which requires a machine and an artificial filter, PD can often be done at home with relatively simple equipment, offering greater independence for patients.

How Does Peritoneal Dialysis Work?

The process of PD involves inserting a catheter into the patient’s abdomen. A dialysis solution, often a sugar-based fluid called dialysate, is infused into the abdominal cavity through this catheter. The peritoneal membrane, which lines the cavity, acts as a filter. As the blood flows through the small vessels of the peritoneum, waste products and excess fluid pass from the blood into the dialysate. After a set period, the used solution, now containing waste products, is drained from the abdomen and replaced with fresh dialysate.

This process can be done in different ways:

1. Continuous Ambulatory Peritoneal Dialysis (CAPD): This is a manual driven process where the patient performs several exchanges, usually three or four times. Each exchange typically takes about 30 minutes, and between exchanges, the patient can continue with their normal activities. .

2. Automated Peritoneal Dialysis (APD): This method uses a machine called a cycler to perform exchanges automatically, usually while the patient sleeps. The cycler controls the timing and flow of the dialysate, making the process more convenient for those who prefer or require overnight treatment.

This tends to be the most common option as these exchanges can be programed to run back to back while the patient sleeps. So a typically night would be:

1. Picking a time to start

2. Hooking up the abdominal catheter to the tubing and preparing the machin

3. If it is too early to go to bed the patient can watch TV or go about their nightly business (the tubing is often long enough to allow a fair amount of mobility, including reaching the bathroom).

4. the machine will run continuous through the cycles and alert the patient when the time is up, which is usually timed for when the wakes up in the morning

Advantages of Peritoneal Dialysis

1. Flexibility and Independence: One of the biggest advantages of PD is that it offers more flexibility than hemodialysis. Patients can perform the treatment at home or even while traveling, making it possible to maintain a more normal lifestyle. For those who value independence, PD is a great option.

This machine is slightly small than a carry-on piece of luggage making travel easier and stress free. The patient will call the dialysis company ahead of time to let them know where they are traveling to, and their supplies are at the location by the time they arrive.

2. Fewer Dietary Restrictions: Because PD is performed more continuously (either several times a day or overnight), waste and fluid are removed more steadily from the blood. This often results in fewer dietary and fluid restrictions compared to patients on hemodialysis.

3. Less Stress on the Heart: PD tends to be gentler on the cardiovascular system since it doesn’t involve the rapid fluid removal that occurs during hemodialysis sessions. This can be particularly beneficial for patients with heart disease or other cardiovascular issues.

4. Greater Convenience for Patients with Difficult Vein Access: For patients who struggle with vascular access (a common issue for long-term HD patients), PD provides an alternative that doesn’t rely on creating access points in the veins.

Considerations and Challenges

While PD offers many advantages, it’s not the right choice for everyone. Here are some factors patients need to consider:

1. Risk of Infection: One of the main risks associated with peritoneal dialysis is peritonitis, an infection of the peritoneum. Patients must be diligent about cleanliness when handling the catheter and performing exchanges. Even with precautions, infections can occur and may require antibiotics or, in some cases, a switch to hemodialysis.

2. Body Image Concerns: The presence of a catheter in the abdomen and the bloating caused by the dialysate solution can affect body image and comfort. Some patients find it difficult to adjust to these changes.

3. Not Suitable for All Patients: PD may not be suitable for individuals with extensive abdominal scarring, a history of severe abdominal surgeries, or certain other medical conditions. A careful assessment by a healthcare provider is essential to determine if PD is a viable option.

4. Daily Responsibility: Unlike hemodialysis, which is usually done in a clinic three times a week, PD is a daily commitment. Patients must be disciplined and take responsibility for their own care, which can feel overwhelming for some.

Conclusion

Peritoneal dialysis is a valuable option for many individuals with chronic kidney disease. It offers flexibility, more control over one’s schedule, and the ability to perform treatment at home. However, it also comes with responsibilities and risks that need to be managed. Choosing between peritoneal dialysis and hemodialysis is a personal decision that should be made in consultation with a healthcare team, considering each patient’s lifestyle, medical history, and personal preferences.

For patients who prioritize independence and wish to avoid the constraints of regular clinic visits, peritoneal dialysis can be a life-changing treatment that fits their lifestyle while managing their condition effectively.

If you or a loved one is facing the need for dialysis, talk to your healthcare provider about whether peritoneal dialysis could be the right choice.