When you have end stage renal disease, you and your nephrologist will discuss the best treatment options for you and your lifestyle needs.
There are two types of home dialysis treatment, hemodialysis and peritoneal dialysis. In peritoneal dialysis (PD), the filter is the lining of the abdomen, called the peritoneum. In hemodialysis (HD), the filter is a plastic tube filled with millions of hollow fibers, called a dialyzer.
Peritoneal dialysis can be conducted in the patient’s home or in a location which is clean and sanitary.
In peritoneal dialysis, the patient’s peritoneum, or lining of the abdomen, acts as a blood filter. A catheter is surgically inserted into the patient’s abdomen. During treatment, the catheter is used to fill the abdominal cavity with dialysate. Waste products and excess fluids move from the patient’s bloodstream into the dialysate solution. After a waiting period of six to 24 hours, depending on the treatment method used, the waste-filled dialysate is drained from the abdomen and replaced with clean dialysate.
At the onset, a PD nurse will provide extensive training customized to your own special medical needs and learning style. You will learn how to use your equipment, maintain a safe and hygienic environment, manage your supplies, and keep records of your treatments. Most training programs take approximately one to two weeks.
Types of Peritoneal Dialysis
There are three types of peritoneal dialysis:
1. Continuous Ambulatory Peritoneal Dialysis (CAPD)
CAPD requires no machine. It can be done in a sanitary, well-lit place. With CAPD, your blood is always being cleaned. The dialysis solution passes from a plastic bag through the catheter and into your abdomen, where it stays for several hours with the catheter sealed. The time period that dialysis solution is in your abdomen is called the dwell time. You then drain the dialysis solution into an empty bag for disposal. Next you refill your abdomen with fresh dialysis solution so the cleaning process can begin again.
With CAPD, the dialysis solution stays in your abdomen for a dwell time of 4 to 6 hours, or more. The process of draining the used dialysis solution and replacing it with fresh solution takes about 30 to 40 minutes. Most people change the dialysis solution at least four times a day and sleep with solution in their abdomens at night. With CAPD, it’s not 12 necessary to wake up and perform dialysis tasks during the night.
2. Continuous Cycler-assisted Peritoneal Dialysis (CCPD)
CCPD uses a machine called a cycler to fill and empty your abdomen three to five times during the night while you sleep. In the morning, you begin one exchange with a dwell time that lasts the entire day. You may do an additional exchange in the middle of the afternoon without the cycler to increase the amount of waste removed and to reduce the amount of fluid left behind in your body.
3. Combination of CAPD and CCPD
If you weigh more than 175 pounds, or if your peritoneum filters wastes slowly, you may need a combination of CAPD and CCPD to get the right dialysis dose.
For example, some people use a cycler at night but also perform one exchange during the day. Others do four exchanges during the day and use a minicycler to perform one or more exchanges during the night.
You and your healthcare team will determine the best schedule for you.
Reasons why you would prefer Peritoneal Dialysis:
-You can dialyze in your own home
-PD can be done with a machine called a cycler overnight, or manually throughout the day
-You can do your own treatment. You do not need to rely on a care partner
-The shorter treatments allow you to remain active at work, school, or even for travelling
-Your diet is more liberal
– No needles are required
-Supplies are shipped directly to your home or travel destination
-Once you are trained on dialysis, you will generally visit the dialysis unit only once or twice a week for your routine check and to meet with your nephrologist, dietician, and social worker.
-You will have fewer negative side effects because PD more closely follows the kidney’s natural function. It also permits a more continuous fluid balance without the fast fluid removal that may occur with traditional hemodialysis.
-With CCPD, you can do it at night, mainly while you sleep
-With CCPD, you are free from performing exchanges during the day
Cons to Peritoneal Dialysis
–CAPD can disrupt your daily schedule.
–With CAPD, it is a continuous treatment, and all exchanges must be performed 7 days a week.
-With CCPD, you rely on a machine to drain and fill your abdomen
-With CCPD, your movement at night is restricted by because you are connected to the cycler.
HOME HEMODIALYSIS (“HD”)
Treatment for hemodialysis may be administered at home under the right conditions. With home hemodialysis, the treatment is administered with the help of your care partner. The Kidney Treatment Center of South Florida will provide a machine for use in the home or help the patient get a machine from a supplier. The patient does not have to buy the machine. Supplies, such as dialysis solution, will be delivered to the home once or twice a month.
As in PD, a HHD nurse will provide comprehensive training program customized to your specific medical needs and learning style.
During training, you will learn the following:
-How to use your equipment
-How to check blood pressure and pulse
-How to monitor the machine
-How to create a hygienic environment
-How to manage supplies
-How to handle needles
-How to keep an organized log of your treatments
The length of training programs varies, but most people usually learn how to perform HHD safely within three to five weeks.
People who choose HHD will have a dialysis care partner to assist them. This can be a spouse, parent, child, professional caregiver or other responsible person who can be relied upon to provide support. Your care partner will be trained with you.
In recent years, many people have found that doing HD at home has many benefits. Some machines may require special wiring or plumbing changes in the home, but others use standard household outlets. The home must have room for the HD machine, supplies, and in some cases a water purification machine.
Someone from the clinic will be available to answer phone calls 24 hours a day. The patient returns to the clinic once a month to see the nephrologist, dialysis nurse, and dietitian.
A blood sample will be tested at least monthly to ensure the HD treatments are working and to detect any problems, such as anemia or high potassium levels, that should be treated.
What are the risks of home HD?
Home HD has the same risks for complications that exist with in-center HD, including low blood pressure and infection. The most serious risk is the possibility of an air embolism-a condition in which air is introduced into the blood stream accidentally, preventing the heart from adequately pumping blood. Another serious risk is blood loss if a catheter separates. Home HD patients and their helpers learn to watch for these problems and are trained to act quickly if they arise.
What are the advantages of home HD?
-The patient can set their own schedule. The patient can choose treatment times to fit other activities, such as going to work or caring for a family member.
-Better control of fluid buildup in the body. The patient can dialyze more often at home. People who dialyze at a clinic skip 4 days each week, so wastes and fluid buildup in their bodies. Dialyzing at home five to seven times per week means wastes and fluid don’t build up as much in the body. Muscle cramps that are common in people using the standard HD may be less common in those who choose home HD because wastes and fluid are cleared more often.
-Fewer dietary restrictions. Because toxins are removed daily, you’re allowed an increased flexibility in your diet, including having fewer fluid restrictions and the freedom to eat foods that were prohibited when you dialyzed in a center three days a week
-Direct shipment of supplies to your home or travel destination
-Infrequent trips to the dialysis center. You will visit the dialysis center just once or twice per month for a checkup with your home dialysis care team.
What are some barriers to home HD?
– You must have a partner.
– Providing hemodialysis treatments may be stressful to your family
– You and your partner need training.
– You need space for storing the machine and supplies at home.
– You may need to take a leave of absence from work to complete training.
-You will need to learn to put in the dialysis needle
Your nephrologist will discuss all treatment alternatives with you to decide your best choice best on your medical needs and personal lifestyle. Once you have made your choice, the Kidney Treatment Center of South Florida will be available to provide caring and professional support to you in all aspects of your care and treatment. With the Kidney Treatment Center of South Florida, you are not alone in your dialysis care.
For further information, please visit the following National Institute of Health Resource