How does it work?
Waste products are removed across the natural membrane which lines the inside of the abdomen. This lining is called the peritoneum . The membrane is bathed in a special fluid passed into the abdomen through a small plastic tube. After a few hours this fluid is drained away and replaced by new fluid.
APD , or Automated Peritoneal Dialysis involves the use of a small simple machine. Most of your dialysis happens over approximately 8-9 hours at night. You are attached to the machine for the duration of your treatment, most people find it convenient and manage to sleep quite well once they are used to it. A small amount of involvement is required during the day but this is kept to the minimum and fits in with your plans. However, it may not offer the best treatment for everyone and it is something that will be discussed with your healthcare professionals.
CAPD , or Continuous Ambulatory Peritoneal Dialysis involves carrying out 4 fluid exchanges daily. They are usually 4-6 hours apart with a longer gap overnight. The time taken is usually 30-40 minutes and can be timed to fit in with your daily activities.
Basically all that is needed from you is a clean working surface and nearby handwashing facilities (not in the kitchen).
How is the tube put in?
This requires a small operation, usually under a general anaesthetic. You are usually discharged home 1-2 days after your operation.
Generally after 2 or more weeks you will begin training in how to carry out the procedure. We find this usually takes around 6 days but this will depend on how you get on.
Does the tube remain in place?
Yes, the tube is securely fixed in place and remains there as long as it is required, months or even years, if necessary.
When dressed, it is virtually impossible to detect any visible sign the treatment is taking place although we find that some patients feel more comfortable wearing loose-fitting clothing.
What sort of problems can arise?
The main problem which can occur is peritonitis (inflammation of the peritoneum) and is easily recognised when the fluid draining out becomes cloudy. This is serious, but usually resolves with early treatment by antibiotics.
Other problems can occur, but they can usually be resolved. Remember, help is always at hand. The risk of developing an infection can be minimised by adhering to the simple procedures you will be shown while you are learning to do PD.
What about my diet on peritoneal dialysis?
When PD was first developed, it was felt that one of the main advantages over haemodialysis was the ability to have unrestricted diet and fluids. In time, it has become obvious that fluid restriction would be necessary. This avoids the need for hypertonic (“strong”) bags which damage the peritoneum if used long-term. It is safer to restrict your fluid intake and use weaker bags. The amount of fluid you can tolerate is not dependent on urine output, as with haemodialysis. Your fluid allowance will be worked out during your training period on the basis of how well or otherwise you can clear fiuid through the PD bags.
It is important to take enough protein in your diet since the treatment involves an unavoidable loss of protein each time you drain out. You should compensate for this by eating lots of high protein foods such as meat, fish, chicken, eggs etc.
A lot of salty foods should be avoided, otherwise you will become too thirsty and unable to adhere to the fluid restrictions.
Potassium rich foods, however, are not normally restricted on PD – in fact you may be actively encouraged to eat extra amounts of them.
Phosphate is usually better controlled on PD and there is less need for medication that binds phosphate.
Please be aware that while we have made all effort to ensure that this brief information is accurate, we cannot guarantee that there are no mistakes. Also that the best management for individual patients may differ from that outlined here. Only the doctors caring for the patient will be able to advise on this.