Peritoneal dialysis utilizes the lining membrane (peritoneum) of the abdomen as a filter to clean blood and remove excess fluid.
Peritoneal dialysis may be performed manually (continuous ambulatory peritoneal dialysis) or by using a machine to perform the dialysis at night (automated peritoneal dialysis).
About 2 to 3 liters of dialysis fluid are infused into the abdominal cavity through the access catheter. This fluid contains substances that pull wastes and excess water out of neighboring tissues.
The fluid is allowed to dwell for two to several hours before being drained, taking the unwanted wastes and water with it.
The fluid typically needs to be exchanged four to five times a day or done by a machine called a cycler during the night.
Peritoneal dialysis offers much more freedom compared to hemodialysis since patients do not need to come to a dialysis center for their treatment.
Peritoneal dialysis can preserve residual renal function better than hemodialysis.In other words, patients keep the urine production longer, which allows for less fluid restriction; it also allows a liberalized potassium diet.
You can carry out many of your usual activities while undergoing this treatment. This may be the preferable therapy for children.
Peritoneal dialysis requires the patient to play a more active role in their dialysis treatment. Of primary importance is the patient’s responsibility for maintaining a clean surface on the abdomen, where treatment is administered, in order to prevent infection.
As an alternative to this treatment, some patients on peritoneal dialysis use a machine called a “cycler.” This cycler is used every night. Two to three bags of dialysis fluid areused on the cycler, and the machine automatically changes the fluid while the patient sleeps.
Peritoneal access (for peritoneal dialysis): A catheter is implanted into the abdominal cavity (lined by the peritoneum) during a minor surgical procedure. This catheter is a thin tube made of a soft flexible material, usually silicone or polyurethane. The catheter usually has one or two cuffs that help hold it in place.
The tip of the catheter may be straight or coiled and has multiple holes to allow the fluid to exit and then return. Though the catheter can be used immediately after implantation, it is usually recommended to delay peritoneal dialysis for at least two weeks to allow healing and decrease the risk of developing leaks.
Instead of having to go to a dialysis center three times a week for treatments that are about four hours long, a person does his or her hemodialysis treatments at home. There are different types and schedules of home hemodialysis, but the most common is daily, more frequent home hemodialysis in which the patient does shorter treatments (about 2.5 to 3 hours) more often (five or six days per week) at home.
Daily, more frequent dialysis keeps the amount of toxin and water build-up to a minimum, which makes the treatment shorter and may reduce or eliminate many side effects patients experience. The patient and a care partner (usually a family member or friend) are trained by the RMA staff to do their treatments safely at home.
Doing dialysis more often is closer to how healthy kidneys work. Many patients report – and various studies have confirmed – that compared to three-times-weekly in-center hemodialysis, daily, more frequent home hemodialysis may offer the following health and quality of life benefits:
Lower risk of death
Less stress on the heart
Better blood pressure control with fewer medications
Much quicker recovery time after treatment
Improved appetite and the ability to drink more
Fewer depressive symptoms
Better mental and physical health
More energy and vitality
Feeling of being in control of treatment and life
Ability to travel
Despite the health benefits that daily, more frequent home hemodialysis may provide to those with chronic kidney disease “CKD,” this form of therapy is not for everyone. The reported benefits of daily, more frequent home hemodialysis may not be experienced by all patients.
The risks associated with hemodialysis treatments in any environment include, but are not limited to, high blood pressure, fluid overload, low blood pressure, heart-related issues, and vascular access complications. The medical devices used in hemodialysis therapies may add additional risks including air entering the bloodstream, and blood loss due to clotting or accidental disconnection of the blood tubing set.
Certain risks are unique to the home. Treatments at home are done without the presence of medical personnel and on-site technical support.
Patients and their partners must be trained on what to do and how to get medical or technical help if needed.
Based on these benefits of home hemodialysis, we at Renal Medicine Associates, with the assistance of Fresenius, created the Home Hemodialysis and Peritoneal Dialysis program at North Rio Rancho (NRR) Dialysis Center.
NRR Dialysis Center received medicare certification in December 2008 and shortly thereafter began home dialysis training. This was the first NM center to train home hemodialysis patients.
This clinic has a 30 patient census for home hemodialysis and peritoneal dialysis and provides 24 hour coverage for these patients. This is one of the larger home hemodialysis clinics in the US.
Here’s How Daily, More Frequent Home Hemodialysis is Different:
For daily, more frequent home hemodialysis patients, dialysis is performed five or six times a week instead of the standard three-times-weekly schedule for in-center dialysis.
That means less time for fluid to build up between treatments, so less fluid needs to be removed during each treatment. More frequent treatments mean fewer ups and downs in fluid levels, which studies have shown may reduce stress on the heart.
Here’s How Daily, More Frequent Home Hemodialysis May Help:
Doing dialysis more often allows for more frequent removal of fluid from the body. Patients can experience a nearly 50 percent reduction in the number of blood pressure medications prescribed after switching to daily, more frequent home hemodialysis, plus a significant increase in the number of patients using no blood pressure medications at all. Fewer medications mean fewer side effects – and fewer out-of-pocket costs.
What Are the Advantages of the Different Types of Dialysis?
Each of the two types of dialysis, hemodialysis and peritoneal dialysis, has advantages and disadvantages. It is up to the patient to decide which of these procedures is best by considering her/his life style, other medical conditions, support systems, and how much responsibility and participation in the treatment program he/she desires. Each patient must view the two types of dialysis procedures from her/his own perspective.
Regardless of which type of dialysis is chosen, patients have certain responsibilities, such as following a diet program, watching their fluid intake, and taking special vitamins and other medicines to control blood pressure and calcium and phosphorus balances.
For many patients, the major advantage of in-center hemodialysis is minimal participation in the treatment. However, patients are required to adhere to a specific schedule and travel to the dialysis unit. Hemodialysis also requires stricter diet control and fluid control than peritoneal dialysis.
For those patients preferring more independence, peritoneal dialysis allows for more flexible scheduling and can be performed at home. The patient still must undergo a certain amount of dialysis each day but can alter the exact timing of the procedure.
On the other hand, peritoneal dialysis must be done every day of the week.
The major problem with peritoneal dialysis is infection. The patient has a plastic tube that goes from the peritoneal cavity to the outside of the body, and this is a potential entry site for bacteria. Great emphasis is placed on cleanliness and technique during the training sessions.
Home Dialysis of New Mexico:
700 Lomas Blvd NE,
Woodward Center, Building #3
Albuquerque, NM 87102
Home Dialysis of New Mexico (HDNM) provides courteous in-depth education to patients faced with choosing which type of dialysis best fits their needs. The clinic has two very experienced and knowledgeable nurses (Elsa Gomez and Tina Lopez) that provide one-on-one education and training. They provide 24-hour coverage.
All supplies needed to provide your care at home are supplied by the clinic and the vendor used in your choice of treatment.
HDNM provides services on peritoneal dialysis and home hemodialysis with NxStage modality.
The NxStage System One is the only truly portable hemodialysis system cleared for home use by the U.S. Food & Drug Administration (FDA). It is the smallest commercially-available hemodialysis system.
Its simplicity and compact size are intended to allow easy use in patient’s homes and give patients the opportunity to travel with their therapy. It plugs into standard electrical outlets and, unlike conventional hemodialysis systems, requires no special infrastructure to operate.
Under the guidance of their physicians, patients can use the NxStage System One with their trained partners where, how, and when it best meets their needs, at home or on vacation.
To learn more about kidney function replacement with Home Dialysis of New Mexico, contact Tina Lopez or Elsa Gomez at (505) 842-5272.