Dialysis treats end-stage kidney failure. It removes harmful substances from the blood when the kidneys cannot.
This article focuses on peritoneal dialysis.
Your kidneys are in charge of filtering wastes out of your blood. But, if your kidneys don't work as well as they should, you may need a procedure called dialysis, a process that removes wastes in place of your kidneys. Let's talk about dialysis.Your kidneys have several important jobs. In addition to filtering your blood, they help maintain just the right balance of water, acids, and minerals in your body. The also function as part of the endocrine system producing hormones. If you've had kidney disease for many years, or your kidneys have suddenly failed because of disease or injury, your doctor may recommend that you have dialysis, a treatment that replaces some of what the kidneys do, removing waste and excess fluid from your blood. It is sometimes used as a holding treatment while awaiting a kidney transplant.Here's how dialysis works. First, your doctor will need to create an access to reach your blood vessels. If you need dialysis only for a short period of time, that access will be made using a hollow tube, called a catheter. Usually the catheter is placed into a large vein in your neck, chest, or leg near your groin. If you're having dialysis for a longer period of time, you'll need a more permanent access. To create this access, your doctor will connect one of your arteries to one of your veins. Then whenever you have dialysis, a needle is simply placed into this access area.During each dialysis session, your blood is removed from your body through the needle. It's sent across a special filter, which removes harmful substances from your blood. Then, your clean blood is sent back into your body. Often, you'll visit a special center for dialysis about three times a week. Each session lasts three to four hours. Or, you may be able to do dialysis right at home three times a week or even daily. Home sessions are shorter, about 2 to 3 hours, and they're easier for your body to tolerate. Before you perform dialysis at home, a nurse will teach you how to place the needle, how to clean the machine, and monitor your blood pressure during treatment.It's important when you're having dialysis that you do all of your scheduled sessions. Also, call your doctor right away if you have any problems, like swelling, redness, fever, a drop in blood pressure, or bleeding. These could be signs that you've developed an infection or other complication from your dialysis, and need medical attention.
Your kidneys' main job is to remove toxins and extra fluid from your blood. If waste products build up in your body, it can be dangerous and even cause death.
Kidney dialysis (peritoneal dialysis and other types of dialysis) does some of the job of the kidneys when they stop working well. This process:
WHAT IS PERITONEAL DIALYSIS?
Peritoneal dialysis (PD) removes waste and extra fluid through the blood vessels that line the walls of your abdomen. A membrane called the peritoneum covers the walls of your abdomen.
PD involves putting a soft, hollow tube (catheter) into your abdominal cavity and filling it with a cleansing fluid (dialysis solution). The solution contains a type of sugar that draws out waste and extra fluid. The waste and fluid passes from your blood vessels through the peritoneum and into the solution. After a set amount of time, the solution and waste is drained and thrown away.
The process of filling and draining your abdomen is called an exchange. The length of time the cleansing fluid remains in your body is called the dwell time. The number of exchanges and amount of dwell time depends on the method of PD you use and other factors.
Your doctor will perform surgery to place the catheter in your abdomen where it will stay. It is usually near your bellybutton.
PD may be a good option if you want more independence and are able to learn to treat yourself. You will have a lot to learn and need to be responsible for your care. You and your caregivers must learn how to:
With PD, it is important not to skip exchanges. Doing so can be dangerous to your health.
Some people feel more comfortable having a health care provider handle their treatment. You and your provider can decide what is best for you.
TYPES OF PERITONEAL DIALYSIS
PD gives you more flexibility because you do not have to go to a dialysis center. You can have treatments:
There are two types of PD:
Continuous ambulatory peritoneal dialysis (CAPD). For this method, you fill your abdomen with fluid, then go about your daily routine until it is time to drain the fluid. You are not hooked up to anything during the dwell period, and you do not need a machine. You use gravity to drain the fluid. The dwell time is usually about 4 to 6 hours, and you will need 3 to 4 exchanges each day. You will have a longer dwell time at night while you sleep.
Continuous cycling peritoneal dialysis (CCPD). With CCPD, you are connected to a machine that cycles through 3 to 5 exchanges at night while you sleep. You must be attached to the machine for 10 to 12 hours during this time. In the morning, you begin an exchange with a dwell time that lasts all day long. This allows you more time during the day without having to do exchanges.
The method you use depends on your:
You can also use some combination of the two methods. Your provider will help you find the method that works best for you.
Your provider will monitor you to make sure the exchanges are removing enough waste products. You will also be tested to see how much sugar your body absorbs from the cleansing fluid. Depending on the results, you may need to make certain adjustments:
WHEN TO START DIALYSIS
Kidney failure is the last stage of chronic kidney disease. This is when your kidneys can no longer support your body's needs. Your doctor will discuss dialysis with you before you need it. Usually you will go on dialysis when you have only 10 to 15% of your kidney function left.
There is a risk for infection of the peritoneum (peritonitis) or the catheter site with PD. Your health care provider will show you how to clean and care for your catheter and prevent infection. Here are some tips:
Watch the exit site for swelling, bleeding, or signs of infection. Call your provider immediately if you have a fever or other signs of infection.
Call your health care provider right away if you notice:
Also call your doctor if you experience any of the following symptoms severely, or they last more than 2 days:
Correa-Rotter RC, Cueto-Manzano A, Khanna R. Peritoneal Dialysis. In: Taal MW, Chertow GM, Marsden PA, Skorecki K, Yu ASL, Brenner BM. eds. Brenner and Rector's The Kidney, 9th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 65.
Mitch WE. Chronic kidney disease. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 24th ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 132.
Tolkoff-Rubin N. Treatment of irreversible renal failure. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 24th ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 133.
Last reviewed on: 12/30/2014
Reviewed by: Deepak Sudheendra, MD, Assistant Professor of Interventional Radiology & Surgery at the University of Pennsylvania, with an expertise in Vascular Interventional Radiology & Surgical Critical Care, Philadelphia, PA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.