Pediatric Nephrology Clinical Services : Conditions & Procedures

Peritoneal Dialysis

With peritoneal dialysis (PD), you have some choices in treating advanced and permanent kidney failure. Since the 1980s, when PD first became a practical and widespread treatment for kidney failure, much has been learned about how to make PD more effective and minimize side effects. Since you don’t have to schedule dialysis sessions at a center, PD gives you more control. You can give yourself treatments at home, at work or on trips. But this independence makes it especially important that you work closely with your health care team: your nephrologist, dialysis nurse, dialysis technician, dietitian and social worker. But the most important members of your health care team are you and your family. By learning about the treatment, you can work with your health care team to get the best possible results, and lead a full, active life.

Whether you choose an ambulatory or automated form of PD, you’ll need to have a soft catheter placed in your abdomen. The catheter is the tube that carries the dialysis solution into and out of your abdomen. If your doctor uses open surgery to insert your catheter, you will be placed under general anesthesia. Another technique requires only local anesthetic. Your doctor will make a small cut, often below and a little to the side of your navel (belly button), and then guide the catheter through the slit into the peritoneal cavity. As soon as the catheter is in place, you can start to receive solution through it, although you probably won’t begin a full schedule of exchanges for 2 to 3 weeks. This break-in period lets you build up scar tissue that will hold the catheter in place.

The standard catheter for PD is made of soft tubing for comfort. It has cuffs made of a polyester material, called Dacron, that merge with your scar tissue to keep it in place. The end of the tubing that is inside your abdomen has many holes to allow the free flow of solution in and out.

Types of Peritoneal Dialysis

The two types of peritoneal dialysis differ mainly in the schedule of exchanges. In continuous ambulatory peritoneal dialysis (CAPD), the patient empties a fresh bag of dialysis solution into the abdomen. After 4 to 6 hours of dwell time, the patient returns the solution containing wastes to the bag. The patient then repeats the cycle with a fresh bag of solution. CAPD does not require a machine; the process uses gravity to fill and empty the abdomen. A typical prescription for CAPD requires three or four exchanges during the day and one long—usually 8 to 10 hours—overnight dwell time as the patient sleeps. The dialysis solution used for the overnight dwell time may have a higher concentration of dextrose so that it removes wastes and fluid for a longer time.