A guide to peritoneal dialysis.

Peritoneal dialysis is a convenient option for kidney patients because it can be done at home.

“Dialysis is a procedure that helps to filter a patient’s blood when their kidney disease has advanced to failure, and the organ is no longer able to perform its usual functions,” explains Dr Geoffery Bihl, a physician and nephrologist at Mediclinic Vergelegen.

There are two types of dialysis – peritoneal and haemodialysis.

Peritoneal dialysis can be conducted at home and the entry point is through the abdomen. Haemodialysis is performed in hospital, and the entry point is through the arm.

How peritoneal dialysis works

In peritoneal dialysis, a dialysis solution comprising water, salt and other additives is placed inside your abdomen. Here, the salt within the solution acts in tandem with the peritoneum (the tissue lining your belly) to draw toxins from your blood.

To prepare for the process, you will undergo a procedure to have a catheter (a tube) inserted into your belly. This allows the solution to pass from a bag into your belly. The insertion of the catheter usually takes place three weeks before treatment starts.

 The convenience of peritoneal dialysis

The fact that peritoneal dialysis takes place at home makes it a convenient option for kidney patients. It also means you must be ready to play a role in your own treatment: you will need to transfer the solution into your belly via the catheter. It must be left there for enough time to absorb excess fluid and waste from your blood. This process takes around four to six hours, and must be repeated between four and six times daily.

This type of peritoneal dialysis, performed manually, is known as Continuous Ambulatory Peritoneal Dialysis (CAPD). Many people feel a little bloated while the solution is inside their bellies; however, the process is not painful.

If CAPD exchanges are scheduled carefully, you may continue to perform your daily activities – working, seeing friends, even playing sport (if your specialist allows) – while the fluid is at work, and the procedure can be carried out in any clean space. That said, it is important to take precautions (like washing your hands and wearing a mask) when doing exchanges to keep the catheter site infection free. You will also have to store your supplies (such as the bags of solution and the transfer set used to perform an exchange) in a clean place, and check each bag for contamination (a cloudy appearance) before using it.

Possible complications of peritoneal dialysis

If you notice any signs of infection, such as redness, pus, or swelling, contact your healthcare practitioner. It’s also important to look out for signs of peritonitis (inflammation of the peritoneum, a membrane that lines the inside of your abdomen and pelvis). These include nausea, vomiting, fever and pain in the abdomen. Your healthcare practitioner will provide training to help you make sure you are aware of these signs, and know how to care for your equipment properly.

A new normal

Patients undergoing peritoneal dialysis may need to change their diet to include less sodium and phosphorus and additional protein. Your specialist will also advise how much fluid and potassium you should consume, and which supplements you should take.

Your specialist will also take blood and urine monthly, to assess whether the exchanges are efficient. If they are not removing enough waste, you may need to have a different schedule or solution.

Remember that although you will feel better with peritoneal dialysis, it is not a cure for kidney failure. Peritoneal dialysis is not suited for all patients and criteria need to be closely discussed with your doctor.