PD takes place inside your body without any blood manipulation. A sterile dialysis fluid is infused into the abdomen where it remains for a period of time, usually between 4 and 12 hours. It is then drained, bringing out waste products and the excess water from the body. This procedure is either repeated 3-5 times every day (continuous ambulatory peritoneal dialysis (CAPD)) or is performed overnight with the help of a machine (automated peritoneal dialysis (APD)).
How peritoneal dialysis works
Approximately 2 litres of dialysis fluid is infused into the abdomen through a special tube called a PD catheter. This process is called ’infusion’. The cleaning process uses the membrane in your abdomen as a natural filter. Waste products and excess water are removed from your body into the dialysis fluid through the peritoneal membrane. This process is called ’dwell time’. After 4-12 hours, this fluid is drained from your abdomen in a process named ‘drainage’, which takes about 20-30 minutes. After that, new sterile fluid is instilled into your abdomen and the process starts all over again. This process of draining out the old fluid and instilling new fluid is called an ‘exchange’ and is done mainly by gravity. Except for the time spent during these exchanges — on average 30-40 minutes, 3-5 times a day — the rest of the day you are free to do whatever you want (e.g. work, study or even travel).
Inserting the catheter
Peritoneal dialysis requires access to the abdomen. This is done via a PD catheter. It is a thin plastic tube about the size of a pencil that is usually inserted through the abdominal wall into the abdominal cavity. It is usually inserted by a surgeon or a nephrologist under general or local anaesthesia. It is permanently connected into your body, with just a small part of it exiting through the skin for the connection to the transfer set and the PD bags during the exchanges. The PD catheter is the same for CAPD and APD. It is desirable to wait 2 weeks after catheter insertion before PD is started.
Keeping the catheter and the area around it clean is very important. You will be trained on how to achieve this and avoid infections.
Can I live a normal life?
As a peritoneal dialysis patient you can go on doing most of the things you did before you started this treatment and your residual renal function may be preserved for longer allowing for less diet restrictions. You might have to limit how much you drink and how much salt you consume. As part of the process, you will be able to discuss these questions with a dietician.