What to expect with Peritoneal Dialysis and In-center Hemodialysis

In this section, you can get a better understanding of what to expect with each type of dialysis. You can also learn about the benefits and drawbacks of each option and consider which type of dialysis is best for you.

PD is a treatment that you can do at home. Doing your own treatment allows you some control over your kidney disease. PD can be done in two ways: Continuous Ambulatory Peritoneal Dialysis (CAPD) or Automated Peritoneal Dialysis (APD).

CAPD is the manual exchange of old solution for new solution multiple times a day by gravity. There are three steps to do an exchange:

Drain:

The used/old dialysis solution inside the abdomen is drained. This dialysis solution contains waste and excess fluid.

Fill:

After the abdomen is completely drained of the old solution, new dialysis solution is placed into the abdomen.

Dwell:

When the new solution has been placed, the tubing and bags are disconnected. During the dwell is when the dialysis occurs in the forms of osmosis and diffusion. During this time, the dialysis solution collects waste and excess fluid from your body while you are disconnected from the dialysis supplies and doing your daily activities.

APD is an automated form of PD. APD completes PD exchanges (drain, fill, dwell) using a machine, typically while you sleep at night. During the day, you are free to go anywhere and be involved in your normal activities. If you require an additional exchange during the day, your nurse will advise you.

You can be trained by your healthcare provider to do PD on your own. You do not need to insert needles for the delivery of peritoneal dialysis.

In most cases, you and your caregiver can learn it in a week or two. Your healthcare team will schedule training for you and it includes:

• Setting up an exchange area
• Hand washing
• Catheter and exit-site care
• Doing an exchange
• Choosing which solution to use
• Storing and ordering supplies
• Keeping treatment logs
• Taking your blood pressure, pulse, temperature and weight
• Diet and fluid limits
• Recognizing and reporting problems

Osmosis and diffusion in PD treatment happens continuously. PD solution dwells in your abdomen, continuously collecting waste from your body, while you continue your daily activities. When starting treatment, you may feel full when you put fluid in. Your body will get used to this over the first few weeks.

PD may help you keep your remaining kidney function longer. However, it is important to do PD exactly how you are taught to avoid infections. Since PD is done at home, you can schedule treatment around your lifestyle and have flexibility for your daily activities. PD is portable, so you can still travel and perform your treatment elsewhere.

You, your family member, or caregiver will perform PD at home on a daily basis. You will not do exchanges alone until both you and your nurse are confident in your training that you can do all the steps safely. You will still have appointments with your nephrologist. And if you have questions, or need help with your equipment and supplies, your social worker, nurse, dietitian and technical support will always be just a phone call away.

For CAPD, you do not need a dialysis machine and only require storage space at home for solution and ancillary supplies. The manufacturer of PD supplies will deliver boxes of dialysis solutions to your home every month.

In-center hemodialysis (ICHD): Conventional ICHD is always an option and is a backup for other types of treatment. You have to go to your clinic at a scheduled time for ICHD treatment.

If you are on ICHD, arrive early for your treatment time, wear comfortable clothes and bring something to pass the time. A physical assessment is performed and your weight is measured before the treatment to assess how much water to remove during the HD treatment. Connecting to the dialysis machine requires your access site to be cleaned, needles inserted and/or tubing connected. After your prescribed treatment, you are disconnected from the machine and, once your blood pressure meets clinic standards, you can go.

Medical staff is present and will connect you to the machine. ICHD requires a large time commitment. Treatment happens 3 times a week and 4-5 hours are needed for each treatment. With travel time and preparation, this may take much longer. Feeling in control of your treatment can be difficult with ICHD when you are dependent on others or if life changes limit your choices.

You may feel tired or experience discomfort such as nausea, leg cramps, etc. during or after the treatment. Be sure to talk to your medical staff about these symptoms.

Reference:

Adapted from Schatell, Dori MS, and Agar, John MD. Help, I Need Dialysis! How to have a good future with kidney disease. Madison, WI: Medical Education Institute, Inc.; 2012. P. 64.