Peritoneal Dialysis is also called “PD” for short for Dialysis using Peritoneal. The peritoneum is the membrane that covers the liver, stomach, intestines, and the inner surface of the abdominal wall. The space surrounded by this membrane is called the abdominal cavity. When dialysate is placed in the abdominal cavity for a certain period, waste products, salt, and excess water in the blood move to the dialysate side in the abdominal cavity through the peritoneum. Blood is cleaned by removing the dialysate from the body when waste products and water are sufficiently transferred to the dialysate.
Types of peritoneal dialysis
- CAPD
- APD
What is CAPD (Continuous Carrying Peritoneal Dialysis)?
Change the dialysate (bag change) 3 to 5 times a day. It takes about 30 minutes for one exchange. The patient and their family exchange the dialysate according to the rhythm of life, such as morning, noon, evening, and before bedtime.
What is APD (Automatic Peritoneal Dialysis)?
The dialysate is automatically replaced during sleeping hours. It is a treatment method developed to secure a lot of free time during the day. About40% of peritoneal dialysis patients, mainly children, students, working adults, etc., need to commute to school or work every day treated by this method.
About the mechanism and principle of Peritoneal Dialysis (PD)
There is a space called the abdominal cavity in the abdomen. These organs and their surroundings are covered with the peritoneum. A thin, soft silicone tube (peritoneal dialysis catheter) is implanted here.
Peritoneal dialysate is injected into the abdominal cavity through this tube, and then the dialysate is stored for a certain period (usually about 6 to 12 hours). The accumulated toxins and excess water and salt are discharged into the dialysate. After that, the dialysate with accumulated waste products is discarded, and then a new dialysate is injected into the abdominal cavity again. This process is called bag replacement, and by repeating bag replacement 3 to 4 times a day, toxins and water accumulated in the body can be removed. Each bag change takes about 30 minutes and can be done at home or at work, so you should go to the hospital once a month.
Mechanism of Peritoneal Dialysis
Thin serosa
- Many capillaries run, and the surface layer is lined with more peritoneal mesothelial cells.
- Almost the same area as the body surface area (1.7-2.0 m 2 for adults)
- Females are partially trafficked at the fallopian tube opening
Working
- Fixation and protection of internal organs
- Physiological effects such as leaching, leakage, absorption, and secretion
- There are 50 to 100 ml of serous fluid, and it works as a lubricant and infection protection
What is bagexchange?
Replacing the bag for Peritoneal Dialysis is the work required to inject new dialysate into the abdomen and remove the dialysate containing waste products and water from the abdomen (drainage). To replace the bag, connect the catheter coming out of the abdomen, the bag containing the new dialysate, and the empty bag for drainage, drain the drainage in the abdomen, and then put the new dialysate in the abdomen increase. Then remove the empty dialysate bag and the drainage-filled bag from the catheter out of the abdomen.
This connection/disconnection work can be done manually or automatically using an instrument. About 30% are manually connected, and about 70% are automatically connected. Many of the instruments that connect automatically are equipped with voice guidance, making it easy for people who are not good at operating the instruments or who are hard to see.
Bagexchange schedule
CAPD: Standard peritoneal dialysis that changes dialysate by yourself 3 to 4 times a day.
APD: Connects catheter and machine at night to bed and automatically replaces dialysate. Peritoneal dialysis
Bag replacement time depends on lifestyle. It is possible to adjust. In addition, peritoneal dialysis is a dialysis therapy that can flexibly respond to the patient’s lifestyle and condition, just as a dialysis method that combines the above two and a combination therapy when the urine volume decreases.
CAPD: Continuous portable peritoneal Dialysis
CAPD treatment is one of the dialysis treatment methods used for chronic renal failure. In dialysis that uses the peritoneum as a dialysis membrane, sterile dialysate (PD solution) is injected and stored in the abdominal cavity through a catheter (tube) implanted in the abdominal cavity. Uremia and excess water in the blood move through the peritoneum to the PD fluid during storage. Uremia and excess water are removed by draining the PD fluid in the abdominal cavity through a catheter. Since it is continuously dialyzed, and it is less burdensome to the body than hemodialysis, and it is possible to maintain residual renal function (urine) for a long period of time.
You can do it at home or at work according to the rhythm, and you can freely work while storing.
- C: Continuous = Continuous
- A: Ambulatory = portable (walkable)
- P: Peritoneal = peritoneum
- D: dialysis = dialysis
Cycle of the day at CAPD
CAPD is a treatment in which the bag is changed 3 to 5 times a day, every 4 to 8 hours (about 30minutes). Dialysis is performed continuously for 24 hours. You can work freely while the PD fluid is being stored. You can plan the bag exchange time according to your daily life, such as work or school. One bag replacement operation takes about 30 minutes. If you prepare an appropriate environment, you can change bags at home or travel destinations. In the self-management notebook, write down the status of daily bag replacement (injection/drainage volume, drainage volume, drainage properties, time, etc.), body weight, blood pressure, etc.
The number of bag replacements is determined by the patient’s physical condition and peritoneal function. The replacement time will be adjusted according to the rhythm of life. There is also a method of automatically changing the dialysate several times while sleeping with an automatic peritoneal dialysis device called APD (automated peritoneal dialysis) at night.
