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Peritoneal Dialysis

Peritoneal dialysis and at-home hemodialysis are the two forms of dialysis that can be conducted outside of the dialysis center and at home. Whereas at-home hemodialysis requires a significant unit of equipment (the home dialysis machine), peritoneal dialysis does not have to involve equipment, just special supplies.  The medical team places a catheter (tube) into the patient’s abdomen.  Patients use this implanted catheter to instill a fluid (dialysate) in their abdominal cavity. (No needles are involved in this form of dialysis.) The peritoneal membrane in the patient’s abdomen allows wastes to pass into the dialysis solution, which “pulls” these wastes out (across a concentration gradient). Thus the fluid absorbs the body’s waste products, and the patient then drains this solution from the belly.

Virtua’s nephrology and surgical staffs are experienced in establishing this form of therapy for patients. While the dialysis catheter in the patient’s belly is stabilizing and healing (approximately two weeks), the patient undergoes instruction on how to conduct peritoneal dialysis.  While the training is easier than learning home hemodialysis, the patient, and preferably a helping family member, will need to understand how to:

  • order and use the dialysis supplies;
  • cool store and warm up the dialysis solution bags;
  • perform an exchange, removing indwelling dialysate and instilling a new bag of solution;
  • maintain clean peritoneal technique and sterile connection of the disposable transfer set;
  • and use preventive techniques to safeguard against infection at the catheter site.

This form of dialysis is not for everyone. It requires competence, confidence, and dexterity with the techniques, or a capable caregiver to assist with them.  However, performing an exchange is not complicated once the patient has learned the steps.  In addition, this form of home dialysis does not require a partner for assistance, as at-home hemodialysis does.

Peritoneal dialysis has been in wide, successful use for more than two decades and has significantly improved as a technique during that time. Patients may use one or both of two forms of this therapy:

Continuous ambulatory peritoneal dialysis (CAPD). With this approach, draining the fluid and refilling it takes about a half hour and needs to be done several times per day, including once overnight, so that dialysis is taking place nearly all of the time, 24 hours per day. Patients first empty the abdomen of solution, allowing gravity to drain the dialysate through the transfer tube.  Then, with the dialysate bag hung on an I.V. pole so that gravity allows the solution to flow into the abdomen, they add fresh solution to the peritoneal cavity.  For several hours at a time, while the fluid is indwelling, patients can move about independently. The tubing remains hidden under their clothing.  This is called ambulatory peritoneal dialysis, and it can be done in many locations, making work and travel easier for the patient.

Continuous cycling peritoneal dialysis (CCPD).
 Patients may want to accomplish most of their peritioneal dialysis overnight. This requires a cycler device, which performs several exchanges (removal and instillation) of the dialysis solution while the patient sleeps.  One additional dwell time lasts throughout the day.  Because it takes advantage of a cycler machine, this approach is sometimes referred to as automated peritoneal dialysis.  Patients must receive training in how to operate the cycler, which is a portable device that can fit on a bedstand or side table and is about the size of an average travel bag.

With these methods, the volume of the dialysate instilled, the dwell time, and the number of exchanges determines the amount of dialysis that takes place. Patients may elect to use whatever combination of the two approaches to peritoneal dialysis works best for them.

Patients must undergo testing by their medical team in the first few weeks of home dialysis, and must visit the their nephrologist at the dialysis center periodically thereafter, to assure that they are receiving adequate dialysis and to check on the status of their catheter.  Particularly with peritoneal dialysis, the team must determine what amount, combination, and schedule of dialysis is best for the patient.

Benefits of Home Dialysis

Home dialysis gives the patient more flexibility in his or her dialysis schedule.

The equipment or supplies required are not inexpensive, but neither is care at a dialysis center several times per week. Home dialysis can improve lifestyle by sparing patients a dominating commitment to care at the dialysis center.

With home hemodialysis, patients can vary the length and number of sessions per week, and arrange the timing of their dialysis around other activities.  Under normal circumstances, though, they must dialyze on a regular schedule.

Researchers are exploring whether shorter daily dialysis sessions, or longer sessions performed overnight while the patient sleeps, are easier for the body to tolerate and more effective in removing urinary wastes than the conventional regimen of three longer sessions per week at a dialysis center.  (The Federal Government has not yet established a policy to pay for more than three sessions at a hemodialysis center per week.  As a result, payments from Medicare may not fully cover the costs of at-home hemodialysis.)

Home hemodialysis may result in larger amounts of total dialysis per week and reduce variation in kidney failure symptoms (compared to care at the hemodialysis center) because this approach to dialysis can be more continuous in nature. Partly as a result, home dialysis may help patients better control blood pressure and wastes in the blood, and provide them with greater lattitude in diet and fluids.  Many patients who switch to home hemodialysis report improved quality of life.

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