5th July 2024

Peritoneal Dialysis

Overview

Peritoneal dialysis (PD) uses a catheter in the abdominal cavity for dialysis. It is a home based therapy. Patients usually carry out the treatment themselves or have carers for support. Almost all patients have residual kidney function, i.e. are not anuric.

Maintenance Treatment

There are 2 ways of administering PD treatment.

1. Continuous Ambulatory peritoneal dialysis (CAPD). Dialysis prescriptions are individualised and usually, patients have 2-3 exchanges a day, 5-6 days a week. 1.5- 2 litres of fluid is infused into the peritoneal cavity, then drained out 30-90 mins later. This is 1 exchange. When a carer administers this treatment, it is called assisted-CAPD (aCAPD)
2. Automated PD(APD)- A machine is used to administer 6-8 exchanges over 10-12 hours. Most patients on APD will dialyse overnight

Some patients may also use a combination of CAPD and APD for a short duration for symptom control, e.g., Fluid overload.

Missed Treatment

Patients on peritoneal dialysis admitted to hospital should be discussed with the local nephrology team for support.

Complications

• PD Peritonitis – Usually associated with exit site infections but can occur without this too. Patients report abdominal pain and discomfort. Gram positive organisms are most commonly isolated from fluid cultures. Treatment is intraperitoneal antibiotics, via PD fluid and/or oral antibiotics. Parenteral antibiotics are generally not required, unless there are concomitant systemic infections.
• PD catheter issues – inform the nephrology team ASAP.
  • Exit site infection
  • Catheter dislodged
  • Catheter cut accidentally