Peritoneal Dialysis

One method of purifying the blood in cases of kidney failure is peritoneal dialysis. Peritoneal dialysis is completely different from hemodialysis. This treatment involves periodically putting a special solution directly into your abdomen through a soft plastic tube, which has been surgically implanted. The fluid bathes the intestines and the lining of the abdomen, and absorbs the waste products and excess fluid from your bloodstream. The fluid is then allowed to run back out through the tube, and is discarded. This treatment is repeated three times a day, and only takes a few minutes each time. The advantage of peritoneal dialysis is that no machine is necessary, so that the treatments can be done at home or anywhere else. Most people are able to do the treatments themselves, or with the help of a family member. Also, since blood is not put through a machine, there is less damage to the blood cells, and less anemia. The risk of serious infections is also lower.

In order to perform peritoneal dialysis, a catheter or tube must be placed into the abdomen with an operation. The operation is usually done under local anesthesia with some sedation but can also be done under general anesthesia if necessary. A small incision is made in the lower part of the abdomen, and the tube is placed through the skin into the pelvic cavity. It is important for the tip of the tube to remain in the pelvis, because this is the lowest point in the abdomen, and the fluid naturally drains there by gravity. To make sure that the tube is in the right position, we sometimes use a laparoscope (a small video telescope which is inserted through a small incision below the belly button). After the operation, we usually wait a few weeks before starting dialysis in order to allow the incisions to heal. Most people are able to go home within 24 hours of the operation. There will be some discomfort for a few days, but it is not usually severe.

When dialysis is started, it is usually done in the hospital for the first few days. Once the tube is functioning well, home dialysis can be started. Your nephrologist (kidney doctor) will arrange for you to be instructed in the care of the tube. The dialysis treatment involves running the special dialysis fluid (like iv. solution) into the tube, allowing it to sit in your belly for a short time, and then letting it run out again.. This treatment is repeated several times a day, but does not interfere with your usual activities.

After a short time, it is often possible to begin using a "cycler," which is a machine which does the fluid exchanges for you. This machine is usually connected at night, and makes it unnecessary to do exchanges during the day.
It will be important to take special precautions in caring for the peritoneal dialysis catheter and in doing the exchanges, in order to avoid infection of the catheter. The dialysis nurses and your nephrologist will instruct you in these precautions.

Possible problems with the peritoneal dialysis catheter include: malfunction of the catheter; this may be due to a change in the position of the catheter, or to scarring around the tip of the tube. Replacement of the catheter may be necessary. Infection of the catheter is a serious problem, but sometimes can be treated with antibiotics. If the infection does not improve with antibiotics, the catheter may need to be removed.

Occasionally, problems with peritoneal dialysis make it necessary to switch to hemodialysis instead; for this reason, anybody who is on dialysis should have a dialysis fistula placed if possible so that it can be used for hemodialysis if necessary.