Peritoneal Dialysis. Ureter. Prostate

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1 Peritoneal Dialysis Introduction Peritoneal dialysis, or PD for short, is one way to cleanse the blood when the kidneys are no longer able to remove waste. Kidney failure is estimated to be increasing worldwide by 6 to 7% each year. Some people choose peritoneal dialysis because they are able to do it themselves. Also, PD has fewer restrictions than other forms of dialysis. This reference summary will help you better understand peritoneal dialysis, including how it works, the types available, and how to prevent complications. The Kidneys Kidneys are bean-shaped organs located in the middle to lower back, on both sides of the spine. The urine that is formed in the kidneys flows through tubes, called ureters, to be stored in the bladder. When the bladder is full, a person feels the urge to urinate. Urine is emptied through the urethra. Ureter Kidney The main purpose of the kidneys is to make urine. Urine is made when the kidneys filter harmful chemicals, called toxins, out of the blood. The kidneys also help keep necessary chemical substances in the blood, such as sodium, proteins, and sugars. Prostate Bladder Urethra The kidneys control the amount of fluid we keep in our bodies. For example, when we drink more fluids than we need, the kidneys secrete extra urine. On the other hand, when we do not drink as much fluid as we need, the kidneys make less urine. 1

2 The kidneys help regulate hormones that strengthen our bones and produce red blood cells. Since the kidneys constantly filter the blood, they are very sensitive to anything we eat or drink, or to any medications we take. The kidneys also help keep our blood pressure regular. This is why many kidney diseases result in high blood pressure. Damage to only 1 kidney is not usually a major problem because the other kidney can take over. However, if both kidneys get damaged, a person will die within a few days unless they get dialysis. Kidney function usually decreases over time if you have kidney failure. Your doctor may recommend dialysis if he or she believes your kidney is unable to adequately filter toxins out of the blood. How PD Works Peritoneal dialysis may be used to treat kidney failure. This is when the kidneys can no longer remove waste products from the blood. Kidney failure is usually the result of a chronic kidney disease. Diseases that can lead to kidney failure include: Diabetes High blood pressure Kidney or blood vessel inflammation Polycystic kidney disease Harmful wastes can build up in the body if the kidneys are not working. Dialysis is used to do the work of the kidneys. Peritoneal dialysis is one type of dialysis. An operation to insert a catheter is needed before you can begin peritoneal dialysis. The catheter is placed in the abdomen, inside the peritoneal cavity. The peritoneal cavity is the cavity in the abdomen where the stomach and intestines are. The catheter is a small, soft tube that will carry the dialysis solution in and out of your abdomen. Catheter 2

3 Dialysis usually begins 2 to 3 weeks after the catheter is placed. This type of dialysis works by placing a solution in the peritoneal cavity. This cavity is lined with a membrane called the peritoneum. Tiny blood vessels in the peritoneum cleanse the blood with the help of the dialysis solution. The dialysis solution has dextrose in it. Dextrose is a sugar that will pull the waste from your blood into the abdominal cavity. After the dialysis solution pulls waste from the blood, it is drained out of the abdomen, taking the toxins with it. The wastes leave your body when the used dialysis solution is drained from the abdomen through the catheter. Each cycle of draining and refilling is called an exchange. The time the solution remains in the abdomen between exchanges is called the dwell time. The schedule for how many exchanges you have each day depends on your body and the type of peritoneal dialysis you have. Types of PD There are two types of peritoneal dialysis: continuous ambulatory peritoneal dialysis (CAPD) and continuous cycling peritoneal dialysis (CCPD). These types may be used in combination. You can also switch from one type to the other. CAPD typically involves 3 or 4 exchanges during the day, each with a 4 to 6 hour dwell time. One evening exchange allows a dwell time that lasts overnight while you sleep. No machine is needed for CAPD. Gravity moves the liquid in and out of your abdomen. You begin a cycle of CAPD by filling your abdomen with a bag of dialysis solution. After 4 to 6 hours, the fluid contains waste and is drained out of your abdomen. These exchanges can be done any place that is clean. During the dwell time, you can go about your regular activities. CAPD 3

4 CCPD uses an automated cycler machine. The machine does 3 to 4 exchanges at night during a 10 to 12 hour period. There is one exchange in the morning with a dwell time that lasts the entire day. The machine automatically fills and drains your abdomen with the dialysis solution while you sleep. You are not connected to the machine during the day. CCPD With the help of your doctor, a combination of CAPD and CCPD can be customized to your lifestyle. Testing the Effectiveness Kidney function usually decreases over time after kidney failure. This means that the number of exchanges or amount of dialysis solution may have to change. Your doctor will test the effectiveness of the treatment to see if changes need to be made. Peritoneal equilibration test, or PET for short, is one test used to measure the effectiveness of the dialysis. PET measures how much sugar your body absorbs from the dialysis solution. It also measures how much waste has entered the solution during a 4 hour period. The clearance test is another test that measures the effectiveness of the dialysis. The clearance test measures the amount of waste in samples of used solution drained over a 24-hour period. A blood sample is also taken for a clearance test to measure how much waste is left in the blood. Urine may also be collected and tested. Doctors can then determine if waste is being successfully removed from the blood. Changes may be made to the amount of exchanges, the amount of solution used, or the amount of dextrose in the solution. Your doctor will continue to monitor the effectiveness of the treatment schedule over time. It is important that you follow your doctor s recommendations and perform every exchange. Skipping exchanges increases the risk of complications, including death. 4

5 Complications and Prevention The most common problem for people who use peritoneal dialysis is an infection called peritonitis. Peritonitis is an infection of the peritoneum. To prevent infection you should: Check for signs of contamination in the solution bag before using it Perform exchanges and store supplies in a clean, dry place Other ways to prevent infection include: Cleaning the site with antiseptic every day Washing your hands every time you touch the catheter Wearing a surgical mask while performing exchanges The following signs of infection should be reported to your doctor: Cloudiness or an unusual color in the dialysis solution Fever Nausea or vomiting Redness or pain around the catheter Another possible complication is a weakening of the abdominal muscles. During the dwell time, fluid is held in the abdomen. This may strain the muscles in the abdomen and cause a hernia. A hernia is a bulging of an internal organ through a weak area in the muscle. Long dwell time may also cause a problem with weight gain for some people. Some of the dextrose from the dialysis solution can be absorbed into the body and converted to glucose. Long dwell time may also cause some of the waste to go back into the body. A minicycler machine may be used during the night if you use CAPD. A minicycler is a smaller machine similar to the one used for CCPD. It will exchange the solution one or more times during the night to prevent dextrose absorption. An additional exchange in the middle of the afternoon can help people that have chosen CCPD avoid dextrose absorption. Minicycler 5

6 Working with a dietician can also help you get the most out of your dialysis. Dialysis is less effective than working kidneys, but with changes to your diet you can help make it more effective and prevent further complications. Taking all medications as prescribed is also important in preventing complications of peritoneal dialysis. Summary Peritoneal dialysis, or PD for short, is one way to cleanse the blood when the kidneys are no longer able to remove waste. Some people choose peritoneal dialysis because they are able to treat themselves. Also, peritoneal dialysis has fewer restrictions than other forms of dialysis. There are two types of peritoneal dialysis: continuous ambulatory peritoneal dialysis (CAPD) and continuous cycling peritoneal dialysis (CCPD). No machine is needed for CAPD. CCPD uses a machine to cleanse the blood at night while you sleep. These types may be used in combination. You can also switch from one to the other. It is important that you do not skip any scheduled treatments. Doing so raises the risk of complications, including death. By working with your healthcare team, you can figure out which type of peritoneal dialysis fits best with your lifestyle. PD allows patients the freedom to keep up with their regular activities while treating kidney failure. 6

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