The RenalTracker Team
February 3, 2021

Have you come across the words “peritoneal dialysis?”

Nearly one in ten people have chronic kidney disease (CKD).

This is according to a report made by The Global Kidney Health Atlas in 2017. And for those who progress to end-stage renal disease, renal replacement therapy is vital. Either a kidney transplant or dialysis is needed to combat the complications of CKD.

Is this true for you?

If it is, then you’re probably looking into treatment options and ways to improve your kidney health.

But what exactly is peritoneal dialysis? And more importantly, is it the right option for you?

We hope you can get closer to the answer by the end of this article.

What is peritoneal dialysis?

Before we get into the specifics, let’s talk a bit about dialysis in general.

Dialysis is a procedure that takes over the jobs that damaged kidneys can no longer perform. This includes filtering out waste products and excess salt and water from your blood.

There are two main types of dialysis:
hemodialysis and peritoneal dialysis.

Hemodialysis is more common. But peritoneal dialysis has its own advantages too. We'll talk about those later in this article.

Peritoneal dialysis uses the inner lining of your abdomen as a natural filter for your blood. This lining is called the peritoneum. Find out more about this process in the next section.

How does peritoneal dialysis work?

Man having Peritoneal dialysis

Before you can begin peritoneal dialysis, your doctor will have to put a catheter in place. A catheter is a soft, flexible tube that is usually made of silicone.

During peritoneal dialysis, a cleansing fluid will flow through the catheter and into your body. This fluid is called the dialysate. The dialysate stays in your abdomen for a set amount of time—your dwell time. Individual dwell times vary, but it is usually around 4 to 6 hours.

During this time, your peritoneum is acting as a filter. Waste materials and excess fluid in your blood pass through the peritoneum and end up in the dialysate.

At the end of your dwell time, the dialysate filled with waste products is drained through the catheter. Then it is replaced with fresh dialysate. This cycle is referred to as an exchange. After each exchange, the filtering process begins again.

What are the types of peritoneal dialysis?

There are two types of peritoneal dialysis. While they work more or less the same way, some differences are worth noting:

1. Continuous Ambulatory Peritoneal Dialysis (CAPD)

CAPD is done 3 to 5 times a day while you are awake. Each exchange takes 30 to 40 minutes. During your dwell time, you are free to walk around and go about your day. Because it does not involve a machine, you can do it from home or any other reasonably clean environment. CAPD involves an overnight dwell. You do an exchange right before bed and again when you wake up. You or a helper will need to receive training to perform CAPD properly.

2. Automated Peritoneal Dialysis (APD)

In APD, a machine at home does the fluid exchange automatically while you’re sleeping. The treatment can take as long as 12 hours, although you'll be asleep through most of it. After that, you will be free to go about your daily routine. APD involves a long dwell time during the day, since exchanges only occur at night. Because it is mostly automated, you won’t need as much training as with CAPD.

The machine used for APD is called a cycler. For this reason, APD is also known as continuous cycling peritoneal dialysis (CCPD).

It is possible to combine these two types. For example, someone doing CAPD may also use a cycler to perform exchanges while they’re asleep. On the other hand, you can also supplement APD with manual exchanges during the daytime.

The longer you do peritoneal dialysis, the more finely tuned the treatment can be. Adjustments in dwell time and the number of exchanges can be made, based on how your body responds.

Why peritoneal Dialysis?

There is no question about it--peritoneal dialysis is not the popular choice.

Hemodialysis is definitely more widely practiced. According to estimates, 90 percent of all dialysis patients are undergoing this treatment. But that doesn't mean hemodialysis is automatically the better option. This articles goes deeper in comparing hemodialysis vs peritoneal dialysis.

Studies prove that peritoneal dialysis can be just as effective as hemodialysis. There are pros and cons to each dialysis type. Before you decide on which might be best for you, it might be helpful to give peritoneal dialysis a closer look.

Here are some advantages to peritoneal dialysis that are worth considering:

1. You can do it at home.

With proper training, you can do CAPD or APD at home. You won’t need to schedule appointments or drive to a hemodialysis center to get treatment.

2. You can go about your daily activities.

APD is only done at night, so it isn’t disruptive to your daytime routine. You are also free to go about your day while undergoing CAPD, as long as you do your exchanges.

3. It makes it easier to travel.

Most APD cyclers are portable, and you can bring them with you in case you have to travel. For CAPD, as long as you have dialysate fluid and the proper equipment, you can do exchanges. Though it may be inconvenient to carry your supplies when traveling.

4. It costs less.

According to the United States Renal Data System, hemodialysis costs each patient an average of $87,000 per year. Peritoneal dialysis only costs around $66,750. Studies in other countries have similar findings, with hemodialysis being more expensive. Even if the cost for dialysis is usually reimbursed, it would be prudent to keep this information in mind.

5. It is more similar to natural kidney function.

Being a daily process, peritoneal dialysis is a lot like your normal kidney function. Because it keeps your body closer to its natural state, this treatment may be gentler on your system. It places less stress on your heart and blood vessels.

6. You have fewer diet restrictions.

Anyone undergoing any form of dialysis will have to make significant dietary changes. But in general, those who do peritoneal dialysis have a less restricted diet. They also tend to use fewer medications.

Final Notes

So now we've talked about what peritoneal dialysis is, how it works, and why you might want to give it some thought. Hopefully, we have given you a better idea of what it’s all about.

While it is not the usual choice, it is at least worth exploring if you’re on the road to renal replacement therapy. And maybe this "road less traveled” is the right one for you!

We know it can be confusing when you're faced with such important decisions. But with enough information - and the advice of your healthcare providers - you can be confident in making the right choice.

Sources:


The Kidney Project: Statistics
https://pharm.ucsf.edu/kidney/need/statistics

Patient education: Peritoneal dialysis (Beyond the Basics)
https://www.uptodate.com/contents/peritoneal-dialysis-beyond-the-basics#H4

Peritoneal Dialysis
https://nephcure.org/peritoneal-dialysis/

Peritoneal dialysis: increasing global utilization as an option for renal replacement therapy
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6790235/

Peritoneal Dialysis: What You Need to Know
https://www.kidney.org/atoz/content/peritoneal