What to expect with Peritoneal Dialysis and In-center Hemodialysis

In this section, you can get a better understanding of what to expect with each type of dialysis. You can also learn about the benefits and drawbacks of each option and consider which type of dialysis is best for you.

PD is a treatment that you can do at home. Doing your own treatment allows you some control over your kidney disease. PD can be done in 2 ways: continuous ambulatory peritoneal dialysis (CAPD) or automated peritoneal dialysis (APD).

CAPD does not require a dialysis machine. It uses gravity to exchange the fluid several times a day.

To do this, a bag of dialysis solution is connected to a tube that goes into your abdomen. The exchange starts by placing the drain bag portion of the system on the floor and draining out the used solution in your peritoneal cavity (effluent). The new solution bag is hung on an intravenous (IV) pole, at shoulder level, and then gravity is used to pull the fresh solution into your abdomen. Once this is completed, the system is disconnected from your catheter and you are free to move about until your next exchange. Each of these exchanges lasts about 20 minutes. 

If you are on CAPD, your abdomen will always contain dialysis solution, and each time it is exchanged, you’ll go through the following steps:

1. Connect

You will connect a new bag of dialysis solution to your catheter using a “non-touch” technique, which your clinician will teach you.

2. Drain

The existing dialysis solution inside your abdomen is drained out, removing the waste and excess fluid from your body.

3. Flush

Your catheter is flushed with new dialysis solution to wash away any germs that may have gotten onto the end of it during connection.

4. Fill

Once your abdomen has been completely drained of the old dialysis solution and the flush is complete, your abdomen is filled with fresh dialysis solution.

5. Disconnect

When the new solution has filled your abdomen, the tubing and bags are disconnected using the “non-touch” technique. The fluid is thrown away and the empty bags are discarded. Your PD catheter will remain in place and be protected with a sterile cap, or it may be tucked away when the exchange is complete. Between now and the next exchange, dialysis is cleaning your blood. This is known as the “dwell” period. You are free to move around and be involved in normal activities until your solution needs to be replaced again.

This CAPD exchange process takes place between 1 and 4 times per day, depending on your dialysis requirements. Each exchange takes about 20 minutes to perform. Your clinicians will discuss your medical and lifestyle needs with you in order to determine your individual dialysis prescription.

CAPD is termed a “continuous” therapy. This has several benefits in comparison to other types of dialysis. Waste products and excess fluid can be controlled more easily during the treatment process, which may reduce stress on your body. If you’re doing CAPD, you might be able to eat more of the foods you enjoy and take fewer medications than if you were doing HD. CAPD equipment is also more portable than other types of dialysis equipment, so it’s possible for you to continue doing normal daily activities while you’re performing treatment, and it is easier for you to do your dialysis in other places, such as a workplace or a relative’s home.

APD is an automated form of PD. APD completes PD exchanges (drain, fill, dwell) using a machine (referred to as a cycler), typically while you sleep at night. During the day, you are free to go anywhere and be involved in your normal activities. If you require an additional exchange during the day, your nurse will advise you.

Before each treatment, your APD cycler is set up with tubing that connects it to 10–15 L of clean dialysis solution. A cycler tube is then connected to your catheter. The APD cycler is programmed to control the movement of clean dialysis solution into your abdomen by the machine. It drains the used dialysis solution from your body and replaces it with new solution at regular intervals throughout the therapy. You will have to set up the dialysis machine with fresh equipment and dialysis fluid every time you do your APD therapy. Since every patient needs a different amount of dialysis, your APD cycler’s program will be customized to your specific needs.

During each APD treatment, the cycler will automatically perform your therapy, made up of the following steps:

1. Drain

The cycler drains the used dialysis solution from your abdomen, removing the waste and excess fluid from your body.

2. Fill

Once the cycler has completely drained your abdomen of the old solution, it fills it with fresh dialysis solution.

3. Dwell

When the new solution has filled your abdomen, your cycler will leave the new solution in your peritoneal cavity for a set time period. After this time has finished, the cycler will repeat these 3 steps again. These 3 steps are called an exchange or cycle. The dialysis machine will perform several exchanges throughout the prescribed treatment time.

APD treatment usually lasts between 8 and 12 hours, depending on your medical and lifestyle requirements. It is typically done while you sleep, giving you the freedom to carry on your normal activities during the day. For the treatment to be completed, you need to be connected to your APD cycler. However, it is possible to temporarily disconnect from the machine if necessary. There is also sometimes longer tubing that allows you more freedom to move around while you’re connected to the machine. Sometimes patients may need to do extra daytime dialysis exchanges. Your clinician will advise you if this is necessary for you.

APD helps control the excess waste and fluid during treatment, which can help reduce the stress on your body. It may also give you increased flexibility with your diet and the number of medications you need to take while on dialysis. Your treatments will normally happen at night, which may make it easier for you to continue working, studying, or socializing during the day. You will need to prepare your cycler each day and discard the used equipment after your treatment has finished.

You can be trained by your healthcare provider to do PD on your own. You do not need to insert needles for the delivery of PD.

In most cases, you and your caregiver can learn how to do PD in a week or two. Your healthcare team will schedule training for you that includes:

• Setting up an exchange area
• Handwashing
• Catheter and exit-site care
• Doing an exchange
• Choosing which solution to use
• Storing and ordering supplies
• Keeping treatment logs
• Taking your blood pressure, pulse, temperature, and weight
• Diet and fluid limits
• Recognizing and reporting problems

Osmosis and diffusion in PD treatment happens continuously. PD solution dwells in your abdomen, continuously collecting waste from your body, while you continue your daily activities. When you are first getting used to PD, you may feel full when you fill your abdomen with new PD solution. Your body will get accustomed to this over the first few weeks.

PD may help you keep your remaining kidney function longer. However, it is important to do PD exactly how you are taught to avoid infections. Since PD is done at home, you can schedule treatment around your lifestyle and have flexibility for your daily activities. PD is portable, so you can still travel and perform your treatment elsewhere.

You, your family member, or your caregiver will perform PD at home on a daily basis. You will not do exchanges alone until both you and your nurse are confident in your training that you can do all the steps safely. You will still have appointments with your nephrologist. And if you have questions or need help with your equipment and supplies, your social worker, nurse, dietitian, and technical support will always be just a phone call away.

Given that for CAPD you do not need a dialysis machine/cycler, you will only require storage space at home for solution and ancillary supplies. The manufacturer of PD supplies will deliver boxes of dialysis solutions to your home every month.

In-center HD, often referred to as conventional in-center HD (performed 3 times per week), is always an option and is a backup for other types of treatment. You have to go to your clinic at a scheduled time for in-center HD treatment.

If you are on in-center HD, arrive early for your treatment time, wear comfortable clothes, and bring something to pass the time. A physical assessment is performed and your weight is measured before the treatment to assess how much fluid needs to be removed during the HD treatment. Connecting to the dialysis machine requires that your access site be cleaned, needles be inserted, and/or tubing be connected. After your prescribed treatment, you are disconnected from the HD machine and, once your blood pressure meets clinic standards, you can go.

Medical staff are present and will connect you to the machine. In-center HD requires a large time commitment. Treatments are delivered 3 times a week and are 3–5 hours long. With travel time and preparation, this may take much longer. Feeling in control of your treatment can be difficult with in-center HD when you are dependent on others or if life changes limit your choices.

You may feel tired or experience discomfort such as nausea, leg cramps, etc. during or after the treatment. Be sure to talk to your medical staff about these symptoms.