This is how peritoneal dialysis (PD) works
Peritoneal dialysis, or simply PD, is very similar to what your kidney used to do when it was still working. It runs 24 hours a day in your body. That means that it can happen at home, at your work, or at a dialysis center. Almost any clean place in the world is suitable.
How does peritoneal dialysis work?
In this treatment, a tube (=catheter) is inserted into your abdominal cavity through surgery. You can think of the catheter as a straw into your stomach. The surgery for this is normally done in half an hour. Through this tube, 2-3 litres of irrigation solution (dialysate) are exchanged several times a day. This step is also called a bag exchange.
Since you have a catheter on your abdomen, you must be aware that careful hygiene is a top priority with PD. Any infection could mean that PD is no longer possible and you will have to switch to haemodialysis.
But what exactly is happening now?
You heard me: With peritoneal dialysis (PD) everything that usually happens during hemodialysis in the dialyzer, happens in your abdominal cavity. Since the walls of your abdominal cavity are very finely perfused with blood, urinary substances and water can easily get into the irrigation solution.
What PD procedures are there?
Regardless of the function of your peritoneum, there are different methods to dialyze through your peritoneum:
Stand-alone PD with manual bag exchanges: this usually happens four times a day, or every 6 hours. In between, the solution stays in your abdomen. It is also known under the technical term "independent ambulatory peritoneal dialysis" (CAPD).
## Automated PD: In this type of PD, the bag exchange is done by a machine called a cycler. The cycler changes the fluid every 1-2 hours. Most PD patients do this at night in order to be able to work without restrictions during the day, for example. This type of PD is also known as appliance-based PD (APD).
Who can do peritoneal dialysis?
It is important for PD that access to the abdominal cavity is possible. For some people, this might not be possible due to abdominal inflammation, adhesions after major abdominal surgery, or severe mental or physical disabilities. One prerequisite for PD is that you still have your own urine output. However, it is not always absolutely necessary, so it is best to talk to your nephrologist about your suitability. Also, an inguinal hernia or any kind of soft tissue hernia of the abdomen must be treated before you start PD.
Am I on my own during PD?
As you can see, this type of therapy requires you to work regularly and on your own. But it doesn't require you to go to the dialysis center three times a week, for example. And don't worry - your dialysis team will train and support you until you can safely handle PD on your own. Plus, you'll still have regular visits to the dialysis center. During these visits, the staff will check that you are still doing everything correctly. In this way, the center avoids the possibility of incorrect handling steps creeping in.
As mentioned in the beginning, there is also the possibility to do PD in the center.
Advantages of peritoneal dialysis
PD has many advantages. First of all, you have more responsibility for the treatment of your kidney disease into your own hands, which for many people is no problem at all. By not needing to come to the centre 3 times a week for a long HD session, you may be able to maintain your daily routine a better.
You will also have fewer cardiovascular problems and often times, the residual function of your kidney will be preserved for longer. Additionally, your blood vessels are also spared because you do not need vascular access.
Disadvantages of peritoneal dialysis
If you do PD at home, one of the disadvantages is that the dialysis solution requires space for storage. However, the logistics of common suppliers are now so sophisticated that they can reliably deliver the necessary materials at shorter intervals. This reduces the space requirement a little. The material can also be delivered to your dream holiday destination. Just check this with your nephrology team beforehand.
Another minor challenge is calculating the target weight correctly. This is a bit more difficult for people undergoing PD. You should weigh yourself multiple times daily to avoid fluid overloads.
Overall, however, you simply live more independently with PD.
How long can I do peritoneal dialysis?
Over the years, the filtering capacity of your peritoneum decreases. If your peritoneum can no longer do dialysis, then you can still easily switch to hemodialysis.
What else do I have to watch out for with peritoneal dialysis?
You should keep a close eye on your body and actively learn about your wellbeing along the way. It is very important that you handle your catheter carefully, weigh yourself regularly and also check and document your bag exchanges. This will help you and your dialysis team to identify potential problems early on. For example, if you have cloudy dialysis fluid, abdominal pain or fever, talk to your nephrologist immediately. They will treat you immediately as needed, especially in case of peritonitis.
With PD, your blood is cleansed through your abdominal cavity: a dialysis fluid is put into it through a catheter, which can remove water and other important substances in your body
Compared to hemodialysis, peritoneal dialysis makes you more independent in your everyday life, because you can easily do your treatment at home
If PD does not work sufficiently at some point, you can still switch to haemodialysis without any problems