What is Peritoneal Dialysis? Purpose, Levels/Procedure & Results

Peritoneal dialysis is a gentle way to clean your blood when your kidneys can't do their job properly. Instead of using a machine like traditional dialysis, this treatment uses the natural lining inside your belly called the peritoneum as a filter. A special fluid flows into your abdomen, draws out waste and extra water from your blood, then gets drained away, taking the toxins with it.

What is peritoneal dialysis?

Peritoneal dialysis works by turning your belly into a natural filtering system. Your peritoneum is a thin, smooth membrane that lines your abdominal cavity and covers your organs like a protective blanket. This membrane has tiny blood vessels running through it, making it perfect for filtering waste from your blood.

During treatment, a soft tube called a catheter stays permanently placed in your abdomen. Clean dialysis fluid flows through this catheter into your belly cavity, where it sits for several hours. The fluid acts like a magnet, pulling waste products and excess water from your blood through the peritoneal membrane.

After the cleaning process is complete, you drain the used fluid out through the same catheter. This process is called an exchange, and most people do it 3-4 times daily. Each exchange takes about 30-40 minutes, giving you flexibility to do it at home, work, or wherever feels comfortable.

Why is peritoneal dialysis done?

Peritoneal dialysis becomes necessary when your kidneys lose their ability to filter waste and excess fluid from your blood effectively. This typically happens when kidney function drops below 10-15% of normal capacity. Without this treatment, dangerous toxins and fluid would build up in your body, leading to serious health complications.

Your doctor might recommend peritoneal dialysis if you have end-stage kidney disease caused by diabetes, high blood pressure, or other kidney conditions. It's often chosen by people who want more independence and flexibility in their treatment schedule compared to in-center hemodialysis.

This treatment works especially well for people who still produce some urine, have good manual dexterity, and prefer managing their care at home. Many patients find it fits better with work schedules, family responsibilities, and travel plans since you can do exchanges anywhere with proper supplies.

What is the procedure for peritoneal dialysis?

The peritoneal dialysis process begins with a minor surgical procedure to place your catheter. This tube, about the thickness of a pencil, gets inserted into your abdomen through a small incision. Most people have this done as an outpatient procedure and can go home the same day.

Your catheter needs 2-3 weeks to heal properly before you can start dialysis treatments. During this time, you'll work with a dialysis nurse to learn how to perform exchanges safely and recognize signs of infection or other complications.

Each exchange follows four simple steps that become routine with practice:

1. Drain the used dialysis fluid from your abdomen into a collection bag
2. Fill your belly with fresh, sterile dialysis solution through the catheter
3. Let the fluid dwell in your abdomen for 4-6 hours while it cleans your blood
4. Repeat the process with a new exchange

The entire exchange process takes about 30-40 minutes of hands-on time. Between exchanges, you can go about your normal activities while the fluid does its cleaning work inside your abdomen.

How to prepare for your peritoneal dialysis?

Preparing for peritoneal dialysis involves both physical and educational steps to ensure your safety and success. Your healthcare team will guide you through comprehensive training that typically takes 1-2 weeks to complete.

Before starting treatment, you'll need several medical tests to make sure peritoneal dialysis is right for you. These include blood tests to check your kidney function, imaging studies of your abdomen, and sometimes a small test to see how well your peritoneal membrane filters waste.

Here's what you can expect during your preparation period:

• Learning proper hand washing and sterile technique to prevent infections
• Practicing connecting and disconnecting your catheter safely
• Understanding how to measure and record your fluid removal
• Recognizing warning signs that require immediate medical attention
• Setting up a clean, dedicated space in your home for exchanges

Your dialysis team will also discuss your diet, medications, and lifestyle adjustments. Most people can maintain fairly normal eating habits, though you may need to monitor protein intake and limit certain foods high in phosphorus or potassium.

How to read your peritoneal dialysis results?

Understanding your peritoneal dialysis results helps you stay on track with your treatment goals. Your healthcare team monitors several key measurements to ensure your treatment is working effectively and adjust your prescription if needed.

The most important measurement is your Kt/V ratio, which shows how well your treatment removes waste products. A healthy target is typically 1.7 or higher per week when combining your dialysis clearance with any remaining kidney function you might have.

Your medical team will also track these important indicators:

• Creatinine clearance - measures how well waste products are being removed
• Fluid removal - ensures you're taking off the right amount of excess water
• Peritoneal equilibration test - checks how fast your membrane transports waste
• Blood pressure and weight trends - indicates fluid balance control
• Laboratory values like potassium, phosphorus, and hemoglobin levels

These numbers get reviewed monthly during your clinic visits. Your dialysis prescription might be adjusted based on these results, which could mean changing your solution strength, dwell times, or number of daily exchanges.

How to optimize your peritoneal dialysis treatment?

Getting the most from your peritoneal dialysis treatment involves following your prescribed routine consistently and maintaining good overall health habits. Small daily choices can make a significant difference in how well your treatment works.

Sticking to your exchange schedule is crucial for maintaining steady waste removal. Missing exchanges or cutting dwell times short can lead to toxin buildup and fluid retention. If you need to adjust timing occasionally, work with your healthcare team to modify your schedule safely.

These lifestyle factors can help optimize your treatment effectiveness:

• Maintaining good nutrition with adequate protein intake
Staying physically active within your energy levels
• Managing blood pressure and blood sugar if you have diabetes
• Taking prescribed medications consistently
• Keeping your catheter exit site clean and dry
• Attending all scheduled medical appointments

Your dialysis adequacy can change over time, so regular monitoring helps catch any issues early. Some people eventually need to switch to hemodialysis if their peritoneal membrane becomes less effective at filtering waste.

What are the risk factors for peritoneal dialysis complications?

While peritoneal dialysis is generally safe, certain factors can increase your risk of complications. Understanding these risk factors helps you and your healthcare team take preventive measures and monitor your treatment more closely.

The most significant risk factor is poor sterile technique during exchanges, which can lead to peritonitis - an infection of the peritoneal membrane. This serious complication affects about 1 in 18 patients per year, but proper training and careful technique can greatly reduce this risk.

Several health conditions and lifestyle factors may increase your complication risk:

• Diabetes, especially with poor blood sugar control
• Previous abdominal surgeries that created scar tissue
• Inflammatory bowel disease or frequent constipation
• Weakened immune system from medications or illness
• Poor manual dexterity or vision problems affecting technique
• Living in environments with poor sanitation

Age alone doesn't disqualify you from peritoneal dialysis, but older adults may face additional challenges with manual dexterity or remembering complex procedures. Family support or home care assistance can help overcome these obstacles safely.

What are the possible complications of peritoneal dialysis?

Most people do well with peritoneal dialysis, but like any medical treatment, complications can occur. Being aware of potential problems helps you recognize warning signs early and seek prompt treatment when needed.

Peritonitis is the most serious complication, occurring when bacteria enter your peritoneal cavity and cause infection. Early symptoms include cloudy dialysis fluid, abdominal pain, fever, and nausea. With prompt antibiotic treatment, most cases resolve completely, but severe infections can sometimes damage your peritoneal membrane.

Other complications you should know about include:

• Catheter-related infections around the exit site on your skin
• Catheter blockages from fibrin clots or positioning problems
• Fluid retention if your treatment isn't removing enough excess water
• Hernias from increased abdominal pressure during exchanges
• Lower back pain from the weight of dialysis fluid in your abdomen
• Gradual loss of peritoneal membrane function over time

Most complications are treatable when caught early. Your healthcare team will teach you warning signs to watch for and provide clear instructions about when to call for help. Regular monitoring appointments help detect problems before they become serious.

When should I see a doctor for peritoneal dialysis concerns?

Knowing when to contact your healthcare team can prevent minor issues from becoming serious complications. Your dialysis center should provide you with 24-hour contact information for urgent concerns that can't wait until regular business hours.

Call your doctor immediately if you notice cloudy dialysis fluid coming out during an exchange, as this often indicates peritonitis. Other urgent symptoms include severe abdominal pain, fever above 100.4°F, or signs of catheter infection like redness, swelling, or pus around your exit site.

Contact your healthcare team promptly for these concerning symptoms:

• Difficulty draining dialysis fluid or poor fluid removal
• Unusual abdominal pain or cramping during exchanges
• Sudden weight gain or swelling in your legs or face
• Persistent nausea, vomiting, or loss of appetite
• Shortness of breath or chest pain
• Catheter damage or accidental disconnection

Don't hesitate to call with questions or concerns, even if they seem minor. Your dialysis team would rather address small issues early than deal with serious complications later. Regular communication helps ensure your treatment stays on track.