Topic: Kidney Failure: Choosing a Treatment That's Right for You
Question: What is (are) Kidney Failure: Choosing a Treatment That's Right for You ?
Answer: Purpose of Peritoneal Dialysis
                
The purpose of peritoneal dialysis is to filter wastes and extra fluid from your body. This type of dialysis uses the lining of your bellythe space in your body that holds your stomach, bowels, and liverto filter your blood. This lining, called the peritoneum, acts to do the work of your kidneys.
                
How Peritoneal Dialysis Works
                
A doctor will place a soft tube, called a catheter, in your belly a few weeks before you start treatment. The catheter stays in your belly permanently. When you start peritoneal dialysis, you will empty a kind of salty water, called dialysis solution, from a plastic bag through the catheter into your belly. When the bag is empty, you can disconnect your catheter from the bag so you can move around and do your normal activities. While the dialysis solution is inside your belly, it soaks up wastes and extra fluid from your body. After a few hours, you drain the used dialysis solution through another tube into a drain bag. You can throw away the used dialysis solution, now filled with wastes and extra fluid, in a toilet or tub. Then you start over with a fresh bag of dialysis solution. The process of emptying the used dialysis solution and refilling your belly with fresh solution is called an exchange. The process goes on continuously, so you always have dialysis solution in your belly soaking up wastes and extra fluid from your body.
                
Types of Peritoneal Dialysis
                
Two types of peritoneal dialysis are available. After you have learned about the types of peritoneal dialysis, you can choose the type that best fits your life. If one schedule or type of peritoneal dialysis does not suit you, talk with your doctor about trying the other type.
                
- Continuous ambulatory peritoneal dialysis does not require a machine and you can do it in any clean, well-lit place. The time period that the dialysis solution is in your belly is the dwell time. With continuous ambulatory peritoneal dialysis, the dialysis solution stays in your belly for a dwell time of 4 to 6 hours, or more. The process of draining the used dialysis solution and replacing it with fresh solution takes about 30 to 40 minutes. Most people change the dialysis solution at least four times a day and sleep with solution in their belly at night. With continuous ambulatory peritoneal dialysis, you do not have to wake up and perform dialysis tasks during the night.  - Continuous cycler-assisted peritoneal dialysis uses a machine called a cycler to fill and empty your belly three to five times during the night while you sleep. In the morning, you begin one exchange with a dwell time that lasts the entire day. You may do an additional exchange in the middle of the afternoon without the cycler to increase the amount of waste removed and to reduce the amount of fluid left behind in your body.
                
You may need a combination of continuous ambulatory peritoneal dialysis and continuous cycler-assisted peritoneal dialysis if you weigh more than 175 pounds or if your peritoneum filters wastes slowly. For example, some people use a cycler at night and perform one exchange during the day. Others do four exchanges during the day and use a minicycler to perform one or more exchanges during the night. Youll work with your health care team to find the best schedule for you.
                
Pros and Cons of Peritoneal Dialysis
                
Each type of peritoneal dialysis has pros and cons.
                
Continuous Ambulatory Peritoneal Dialysis
                
Pros
                
- You can do continuous ambulatory peritoneal dialysis alone.  - You can do continuous ambulatory peritoneal dialysis at the times you choose, as long as you perform the required number of exchanges each day.  - You can do continuous ambulatory peritoneal dialysis in many locations.  - You can travel as long as you bring dialysis bags with you or have them delivered to your destination.  - You dont need a machine for continuous ambulatory peritoneal dialysis.  - You gain a sense of control over your treatment.
                
Cons
                
- Continuous ambulatory peritoneal dialysis can disrupt your daily schedule.  - Continuous ambulatory peritoneal dialysis is a continuous treatment, and you should do all exchanges 7 days a week.  - Boxes of dialysis solution will take up space in your home.
                
Continuous Cycler-assisted Peritoneal Dialysis
                
Pros
                
- You can do exchanges at night, while you sleep.  - You may not have to perform exchanges during the day.
                
Cons
                
- You need a machine.  - Your connection to the cycler limits your movement at night.
                
Questions to Ask My Doctor
                
- Is peritoneal dialysis the best treatment choice for me? Why? If yes, which type is best?   - What type of training do I need, and how long will it take?  - What does peritoneal dialysis feel like?   - How will peritoneal dialysis affect my ____ [blood pressure, diabetes, other conditions]?   - Will I be able to keep working? Will I be able to care for my children?   - How much should I exercise?   - Where do I store supplies?   - How often do I see my doctor?   - Who will be on my health care team? How can the members of my health care team help me?   - Whom do I contact if I have problems?   - With whom can I talk about finances, sex, or family concerns?   - How/where can I talk with other people who have faced this decision?
                
More information about Peritoneal Dialysis is provided in the NIDDK health topic, Treatment Methods for Kidney Failure: Peritoneal Dialysis. See also the Kidney Failure Treatment Comparison Chart, which compares peritoneal dialysis, hemodialysis, and transplantation.
(Source: NIDDK)