UNDERSTANDINGUnderstanding Your YOURHemodialysis PERITONEAL DIALYSISAccess Options OPTIONS HOW THE KIDNEYS WORK Inside each nephron, a special blood vessel called a glomerulus works like a strainer to keep blood cells and needed substances in while letting extra fluid and wastes out. Blood enters the kidney here, through the renal artery. Each kidney contains about one million nephrons - tiny filtering centers that clean the blood. Drop by drop, urine is produced and travels to the bladder through this tube, called a ureter. UNDERSTANDING YOUR PERITONEAL DIALYSIS OPTIONS The kidneys are two bean-shaped There are two types of dialysis organs, each about the size of a options: Hemodialysis and fist. They are located just below Peritoneal Dialysis. This brochure the rib cage, one on each side of is focusing on peritoneal dialysis the spine. To locate your kidneys, (PD). There are two different put your hands on your hips, and types of PD. This brochure then slide your hands up until you will describe the strength and can feel your ribs. Now if you put weakness of each. AAKP hopes your thumbs on your back, you the brochure will help you will know where your kidneys are. understand more about the You can’t feel them, but they are different kinds of dialysis options. there. After learning about your dialysis options, you can help your doctor WHAT DO THE decide what therapy is right for you. KIDNEYS DO? • Regulate your blood pressure HOW DOES PD WORK? • Make red blood cells PD is one of the available • Keep your bones strong treatment options to remove waste • Make urine products and extra fluid from the blood when the kidneys are • Remove waste and extra fluid no longer working properly. PD The kidneys filter about 120 to uses your own peritoneum – a 150 quarts of blood each day to natural membrane that covers the produce about 4 to 8 cups of urine. abdominal organs and lines the The urine is made-up of waste and abdominal wall. This membrane other fluids you consumed. acts as a filter. The peritoneum is a porous or sponge-like membrane When your kidney function starts that allows toxins and fluid to be to fail, harmful toxins build up in filtered from the blood. your body, your blood pressure may rise, you may not be able to In order to perform PD, a surgeon get rid of excess salt and water, will need to create a dialysis and and your body may not make access to the peritoneal cavity. A enough red blood cells. When dialysis access is an entranceway this happens, you need treatment into your abdomen that lies to replace the work of your beneath your skin and is easy failing kidneys. The two types of to use. To create an access, the treatment for kidney failure are doctor will insert a small, soft dialysis or transplantation. tube, known as a catheter. The American Association of Kidney Patients: Understanding Your Peritoenal Dialysis Options 4 catheter is usually about 12 inches When receiving a PD treatment, long and as wide as a pencil. This dialysate will flow into the procedure is usually done in an peritoneal cavity through the outpatient center. The surgeon catheter. The solution will remain will give you a medicine to numb in the cavity for several hours. the skin where the catheter is During this time, waste products placed and medicines to relax you. and excess fluid pass from the During your procedure, a catheter blood into the peritoneal cavity. is placed through the abdominal After the complete dwell time wall and into the peritoneal cavity. (period the dialysis solution is in The catheter will travel from the your abdomen), the solution will peritoneal cavity under the skin be drained from the cavity. You (the tunnel) to a place where it will then fill the cavity with fresh comes out of the body. The place solution and the process begins where the catheter comes out of again. The process is called an the body is called the exit site. exchange. It will take about two to three There is potential for infection weeks for the exit site to heal, but with any surgical or invasive you will be able to walk around procedure; therefore, you will normally after your surgery. The need to follow proper techniques only thing to be aware of is that for performing your treatments. you will need to keep the dressing Different types of PD have dry and undisturbed. Sponge different schedules of exchanges. baths are okay but no showers Some PD treatments are done or baths until you see your PD during the day while others can nurse, usually one week after your be done overnight during sleep. surgery. Your doctor will prescribe how A portion of the catheter remains many exchanges you will do each outside the abdomen and under day, as well as the amount and your clothing. When the dialysis is type of dialysis fluid you will use. performed the catheter is used to It is important to follow your PD connect to the dialysis fluid bags prescription and do all of the (dialy(dialysate). Your PD nurse exchanges as instructed. will teach you a simple routine Storage space is needed at for cleaning and taking care of home for PD supplies. Delivery the catheter exit site. Daily care of of solution bags is typically the exit site is critical to prevent scheduled once each month. infections. These supplies must be stored in a clean, dry area. 5 American Association of Kidney Patients: Understanding Your Peritoneal Dialysis Options TYPES OF PERITONEAL DIALYSIS Since you don’t have to go to a the membrane into the dialysis dialysis center for treatment, PD solution. They are removed from gives you more control. You can the body when the dialysis solution do treatments at home, at work or is drained during an exchange into on vacation. This independence a pre-attached drainage bag. makes it especially important to CAPD requires that you have work closely with your healthcare dialysis solution in your abdomen. team: your nephrologist, dialysis The amount of dialysate will vary nurse, dietitian, and social worker. depending on your specific needs. The most important member(s) of Exchanges are usually performed your healthcare team is you and every four to six hours during your support team. the day. After a specified time, the solution, which now contains CONTINUOUS toxins, is drained into the drainage bag. You then repeat the cycle with AMBULATORY a fresh bag of solution. PERITONEAL DIALYSIS An exchange of dialysis fluid in (CAPD) CAPD is simple. You will be able to do it yourself once you have CAPD does not require a machine. been trained by a specialized CAPD It can be done in most places nurse. This training usually takes that are clean and well lit. The one to two weeks. only equipment you need is a bag full of dialysate fluid and The solution bag is hung on the plastic tubing that comes an IV pole, using gravity to attached to the bag. A mask is allow dialysate to flow into the strongly recommended to prevent peritoneal cavity. First, empty the the risk of infection. As the word abdomen of the old fluid, then ambulatory suggests, you can add fresh solution. Once you have walk around with the dialysis filled your peritoneal cavity with solution in your abdomen. CAPD the clean dialysate solution, you is performed manually and can be can detach the tubing and empty done almost anywhere. the used dialysate into the toilet. The clean fluid then sits in the With CAPD, dialysis takes place peritoneal cavity until your next 24 hours a day, seven days a exchange. During this time, you week. The peritoneal membrane are free to go about your regular acts as a filter, removing toxins activities. Each exchange takes and excess fluid from the blood. about 30 minutes to complete. The toxins and excess fluid cross Your doctor will prescribe the American Association of Kidney Patients: Understanding Your Peritoneal Dialysis Options 6 PROS POTENTIAL CHALLENGES • Can be done in many locations, making Treatments are usually performed four it easier to travel and work. • times per day. • Unlike home hemodialysis, a partner is Not all dialysis facilities offer CAPD (You not required. • have the right to request a transfer to a • No needles. doctor/facility that prescribes CAPD). • Flexible schedule and increased • Your abdomen is always full of fluid, independence. which may increase the size of your • Fewer fluid and diet restrictions than waist. hemodialysis. • The dialysate is glucose-based and • No machine is necessary. insulin requirements will change in diabetics. Some patients gain weight. • Often provides better blood pressure control. • Requires the insertion of a permanent catheter. • Prolongs remaining kidney function. • Procedures must be closely followed to reduce the risk of infection in the peritoneal cavity or at the exit site. • Storage space needed in your home for supplies. number of exchanges you’ll your catheter connected to the need, typically three exchanges cycler machine. during the day and one evening CCPD is a simple procedure. The exchange. A usual prescription machine automatically controls will have you performing the timing of exchanges, drains exchanges when you wake, at the used solution, and fills the lunchtime, at dinnertime and at peritoneal cavity with new bedtime. solution. This machine is designed and prescribed to be used at night CONTINUOUS CYCLING while you sleep. The machines are PERITONEAL DIALYSIS easy to operate and have built-in safety devices. CCPD machines are (CCPD) portable and about the size of a Sometimes called automated small suitcase.