Peritoneal Dialysis (PD) is a form of dialysis that filters the blood using the blood vessels found in the lining of the abdomen. These specific blood vessels are called the peritoneum. In this form of dialysis, there are no needles or blood required. This opens up many options for where PD can take place. PD can be done anywhere sterile and sanitary. This dialysis creates more freedom to be social and work freely without the interruptions of multiple clinic visits throughout the week. However, clinic visits will still be necessary but only 1-2 times a month for your specific nurse to ensure PD is doing its job properly and correctly fitting your needs as well as your kidney's needs.

There are two types of at home PD.

Continuous Ambulatory Peritoneal Dialysis (CAPD) is the continuous draining and filling of fluids used to clean the kidney performed throughout the day. This treatment is machine-free and uses gravity. In order to participate in any PD a catheter must be placed within the body. This is used as a port to put fluid into the body and then used to pull fluid from the body. Since this method is gravity-based, the 2-quart bag of cleaning fluid must be attached to the port and placed above shoulder height for the fluid to be pulled into the port and enter the body. Once the bag is emptied, disconnect it from the port safely and discard the bag. For draining, an empty bag is attached and should be placed lower than your abdomen (around the knees or below). Once the empty bag is filled with waste and extra fluids, disconnect and discard the bag. On average this method takes 30-40 minutes for each exchange. This is normally done 3-5 times in a 24-hour period, while awake. Most people do the exchange at mealtimes and right before bed. 

• This method gains you control over extra fluids easier.
• Can decrease stress on the heart.
• Can decrease stress on blood vessels.
• Eat more freely.
• Less medication needed for High Blood Pressure.
• Daily activities, work, and travel easier due to the easier mobility.

Automated Peritoneal Dialysis (APD) uses a cycler machine which your care team can provide more details on usage of the machine. The machine delivers and removes fluids for you. This treatment is normally done at night and can be done while sleeping. Most commonly machines are placed on bedside tables with the solution, while the tube for waste is placed in a toilet, sink or shower/bath nearby for an easy clean up in the morning. Once attached to the machine movement will be limited. The solution bags are shipped to your door, with unloading and stocking. You must have a safe location to store the solution bags. You or a caretaker must be properly trained to use this method. Training can take one to a few weeks. 

Treatment days are specific to everyone but with APD and CAPD it is commonly used every day. 

Benefits

• Creates a more natural kidney function making every day feel a little more normal. 
• Expands your pallet by having less food and drink restrictions throughout the day. 
• At home PD helps regulate blood pressure, making it easier to control and can reduce the medications needed. 
• Can decrease stress on the heart.
• Can decrease stress on blood vessels.
• More free time to do what you love and spend time with the people you love.

Surgery

These at-home PD techniques are created through a minor surgery putting in a peritoneal catheter in the abdomen. The average surgery takes less than an hour using anesthesia and usually results in going home the same day. Post-op, th catheter may not get wet, meaning avoid swimming, bathing, and showering for two weeks. Sponge baths or using wash cloth to clean the other parts of the body is allowed but make sure the incision area does not get wet in order to reduce the chances of infection called peritonitis.

Risks

Even though the catheter is known as a minor surgery, complications can occur. Be aware of potential infection, high blood pressure, weight gain, hernias, and ineffective dialysis.

Post operation, light duty for 6 weeks is required. Light duty entails no movement that strains the abdomen including climbing stairs and heavy lifting. 

If you have diabetes, talk to your doctor about your current insulin dosage. PD uses solution bags to clean the peritoneum. The solution bags use an ingredient known as Dextrose which is a form of sugar. This may cause higher blood sugar levels as well as weight gain.

If there is any current damage or past surgeries on the abdomen at-home PD may not be right for you. 

If the peritoneal lining is not intact, it may not be possible to move to at-home dialysis.

Type of treatment is a big decision, disclose all your past surgery information as well as any other information that may affect your options when talking to your doctor. 

This information is not a medical diagnosis or used for medical purposes but only for education purposes.

Dialyzers/artificial kidney have two main parts.

1. A tube that takes small amounts of blood at a time to go through the machine/cycler. 
2. The machine has a small membrane that separates the washing fluid known as dialysate. 

• Blood cells, proteins, and other important things needed in blood are not able to pass through the membrane. 
• Urea, creatine, potassium, and extra fluids can pass through the membrane and are washed away with the dialysate. 

This type of dialysis is usually done at a hospital or dialysis center. It is possible to do this treatment at home, however, it can be a long process to be certified for at-home care. You and your care partner will have to go through a few weeks to months worth of training, it does vary based on the method chosen for you. The more knowledge you have on your dialysis the easier it will be to move to at-home treatment. 

Treatment at a center or hospital is done on average 3 times a week in 3-to-4-hour prescheduled sessions. 

At-home treatment is commonly done 4-7 times a week with the session time decreasing each time. 

You and your doctor can discuss what method works best for you and how much treatment is needed for you to feel as normal as possible. The amount of dialysis is incredibly important. The correct amount of Dialysis can decrease the amount of hospital stays, improve your overall health, and may enable you to live a longer life. 

Correct dosage to look out for 

• Urea reduction ratio (URR) 65%
• Kt/V at least a 1.2 

This information is not a medical diagnosis or used for medical purposes but only for education purposes.

Types of at home hemodialysis

Conventional Home Dialysis

• 3 time a week with 3-4 hours a session
• Training with you and a care partner is required for a few weeks to a few months.

 Short Daily Home Hemodialysis 

• 5-7 times a week (new machines) with 2 hours sessions
• Less fluid generally needs to be removed over time.
• Fewer symptoms (i.e. headaches, nausea, cramping, and feeling worn out after treatment) 
• Training with you and a care partner is required for several weeks. 

Nocturnal Home Hemodialysis

• Long slow treatment done at night while you sleep, 6 times a week or every other night depending on what the Doctor recommends for 6-8 hours a night. 
• Some centers can receive information through the telephone or the internet from your machine. 
• Since you spend more hours attached to the machine, more waste removal is done during that time. 
• You can combine daily hemodialysis and nocturnal dialysis.
• Training with you and a care partner is required for several weeks.

Short Daily and Nocturnal Hemodialysis Benefits

• Less medication is needed in order to control high blood pressure and anemia.
• Less medication is needed to keep phosphorous under control to help prevent bone disease.
• Less neuropathy (nerve damage) and restless leg syndrome.
• Feeling better before and after treatment.
• Higher energy throughout the day.
• Better sleep.
• Less and shorter hospitalization.
• Better quality of life.
• Live a longer and fuller life.

However, it may take a while to learn all the information in order to do at-home care. You and your care partner must pass the training before you can begin any of the at-home treatments listed above. Discuss with your doctor what you believe might be the best course of action for you.

In some cases of sudden or acute kidney failure, a short amount of time on Dialysis can heal the kidneys enough for normal function. However, Chronic Kidney Disease (CKD) is not as simple of a fix. 

CKD is a disease that progresses over time. Your kidneys will not heal from the dialysis but rather the dialysis will act as your kidneys to keep you alive. Dialysis is needed until a transplant is received.