Like hemodialysis, peritoneal dialysis allows substances normally removed by the kidneys to be removed from the body, but it is done inside your body.
Peritoneal dialysis requires access, usually by means of a plastic tube, to the peritoneal (abdominal) cavity. The peritoneal cavity is lined by a membrane, called the peritoneum, that surrounds the organs and intestines in the abdomen. Tubes called catheters can be inserted under local anesthetic. For dialysis, fluid is fed through the catheter into the peritoneal cavity, where it is left for a time to allow excess water and waste to pass from the blood into the peritoneal cavity. The fluid is then drained off and replaced (see figure 1).
There are two types of peritoneal dialysis: continuous ambulatory peritoneal dialysis (CAPD) and automated or continuous cycler peritoneal dialysis (APD or CCPD). In CAPD, 4 exchanges are usually undertaken per day: 3 exchanges during daytime, and one at night, with the fluid left in the abdomen for 4 to 8 hours and then drained off and replaced.
APD or CCPD uses a machine to perform regular peritoneal exchanges at night. For this type of dialysis, you are connected to the automatic cycler at bedtime and disconnected, generally with the abdomen full of fresh dialysis fluid, in the morning. This fluid exchanges slowly during the daytime hours and is drained off at the beginning of the next night.
Each of these techniques has similar overall effectiveness and any treatment preference depends primarily on your lifestyle.
The main risk of peritoneal dialysis is infection. Because the peritoneal fluid is supplied in plastic bags, connection of these bags to the peritoneal catheter can introduce bacteria into the peritoneal cavity unless it is done with proper technique in order to minimize infection.
If you are receiving peritoneal dialysis you must be on a special diet, especially with respect to salt, water, and potassium.
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