Peritoneal Dialysis What is Peritoneal Dialysis? Dialysis is a treatment for people in the later stage of chronic renal insufficiency (kidney failure). This treatment cleans the blood and removes wastes and excess water from the body. Normally, healthy kidneys do this work. Sometimes dialysis is a temporary treatment. However, when the loss of kidney function is permanent (as in end-stage kidney failure), you must continue to have dialysis on a regular basis. The only other treatment for kidney failure is a kidney transplant. There are two types of dialysis: hemodialysis and peritoneal dialysis. In hemodialysis, your blood is passed through an artificial kidney machine to clean it. Peritoneal dialysis uses a filtration process similar to hemodialysis, but the blood is cleaned inside your body rather than in a machine. How Does Peritoneal Dialysis Work?The inside of your abdomen is called the peritoneal cavity and it is lined with a thin membrane called the peritoneum. This membrane surrounds the intestines and other internal organs. In peritoneal dialysis, this cavity is filled with dialysis fluid which enters the body through a permanently implanted catheter. Excess water and wastes pass from the blood through the peritoneum into the dialysis fluid. This fluid is then drained from the body and discarded. In most cases this treatment can be performed without assistance, at home or at work. How is Access to the peritoneal Cavity Established? A tube called a catheter, made of soft, non-irritating plastic, is inserted in your abdomen below and to one side of your navel, and stays there as long as you are using this type of dialysis. The catheter may be inserted at the bedside using local anesthetic, or in the operating room, depending on what is best for you. The dialysis fluid flows into, and is drained out of, the peritoneal cavity through this special tube. The insertion of the catheter may cause discomfort for a brief period, but peritoneal dialysis is not painful. However, care must be taken to avoid infection. What are the types of Peritoneal Dialysis? Peritoneal dialysis is also called continuous peritoneal dialysis (CPD). In CPD you always have dialysis fluid in your peritoneal cavity, so your blood is constantly being cleaned. The fluid is changed at regular intervals throughout the day. There are different types of peritoneal dialysis including:  Continuous ambulatory peritoneal dialysis (CAPD)  Assisted continuous ambulatory peritoneal dialysis (ACAPD)  Automated or cycler peritoneal dialysis (APD) Continuous ambulatory peritoneal dialysis (CAPD) In CAPD, you carry about 2.0 - 2.5 litres of dialysis fluid in your peritoneal cavity all the time. An exchange is usually done four times a day by draining out the old fluid and refilling your peritoneal cavity with fresh fluid. The exchanges are often done early in the morning, lunchtime, late in the afternoon and at bedtime. Each exchange takes about 30 to 45 minutes. Assisted continuous ambulatory peritoneal dialysis (ACAPD) Assisted CAPD involves the use of simple equipment so that an extra exchange can be done while you sleep. Automated or cycler peritoneal dialysis (APD) In APD (previously called Continued Cycling Peritoneal Dialysis), a machine called an automatic cycler performs exchanges every night while you sleep. In the morning, when you come off the machine, about two litres of dialysis fluid are left in your peritoneal cavity for the day. In the evening, you drain this fluid out when you connect yourself to the automatic cycler for the night. While APD allows you to do dialysis at home with no interruptions to your day, it does require that you be attached to the machine every night for eight to ten hours. Some people may also do an additional exchange during the day to provide adequate removal of waste products. A special test called a PET test will help your healthcare team decide which method of peritoneal dialysis is best for you. Since peritoneal dialysis works continuously, you have greater freedom in food choices than with hemodialysis. However, you will need to learn about appropriate food choices to meet your nutritional needs and control the build-up of food wastes and water. Your dietitian will work with you to design an individual eating plan that is healthy and enjoyable. Medications and vitamins may also be prescribed. You will need to plan your week around your peritoneal dialysis schedule. You may have to take time off work or school before you start peritoneal dialysis and when the treatments begin. However, once your health is more stable, you should be able to return to your normal activities. Depending on your energy level, you may have to make some adjustments in your work situation or limit your activities. Travelling is relatively easy on peritoneal dialysis and exchanges can be performed almost anywhere that is clean. All you need to arrange is transportation for your supplies, including dressings and your cycler, if needed. Supplies can be carried with you as luggage, checked with your luggage or shipped ahead as cargo. Some companies which furnish dialysis supplies will arrange to deliver them to your destination. Your healthcare team and local Kidney Foundation office can provide information and advise you about travel costs and arrangements. In general, no one type of dialysis is superior and the type of dialysis treatment you receive depends on what is most appropriate for your particular needs. You can help to make this choice. It may also depend on what is available in your community. Each type of dialysis has strengths and limitations. Your healthcare team can provide information and support to help you understand all the options and answer any questions you or your mily may have.