Peritoneal Dialysis
   
 
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Peritoneal dialysis (PD) uses the natural filtering ability of the peritoneum - the internal lining of the abdomen. The membrane has tiny holes that allow waste products and fluid to filter from your blood. In other words, peritoneal dialysis uses the lining of the abdomen as a filter of waste products from the blood.
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Bags of dialysis fluid (dialysate) are attached to your body with a small, soft plastic tube, called a PD catheter.
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Approximately 18cm of the catheter remain outside your body allowing you to easily change your dialysate as often as your doctor prescribes.
 
  A Kidney failure patient undergoing peritoneal dialysis
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A sterile (dialysate) solution rich in minerals and glucose is run through the tube into the peritoneal cavity, the abdominal body cavity around the intestine, where the peritoneal membrane acts as a semi-permeable membrane.
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The abdomen is the area between the chest and hips - it contains the stomach, small intestine, large intestine, liver, gallbladder, pancreas and spleen.
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During the dwell phase (the time dialysate remains in the abdomen) excess water and waste products from the blood are drawn across your peritoneal membrane into the dialysate, so that it can absorb waste products. Then it is drained out through a tube and discarded.
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This exchange, or cycle, is generally repeated several times during the day - with an automated system it is often done overnight.
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The process of waste removal, as in haemodialysis, is called diffusion. The removal of excess water, osmosis, is aided by another substance within the dialysis fluid, usually glucose.
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The elimination of unwanted water (ultrafiltration) occurs through osmosis - as the dialysis solution has a high concentration of glucose, it results in osmotic pressure which causes the fluid to move from the blood into the dialysate. Consequently, a larger quantity of fluid is drained than introduced.
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Although peritoneal dialysis is not as efficient as haemodialysis, it is carried out for longer periods. The net effect in terms of total waste product and salt and water removal is about the same as haemodialysis.
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Peritoneal dialysis is done at home by the patient; by a willing and motivated patient. It gives the patient a greater amount of freedom and independence because he/she does not have to come in to the clinic at multiple times each week. It can also be done while traveling with a minimum of specialized equipment. Peritoneal dialysis is said to 'save lives and save money'.
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Before having peritoneal dialysis, the patient needs to have a small surgical procedure to insert a catheter into the abdomen. This is kept closed off, except when fluid is being introduced or taken out of the abdomen.
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Your doctor will prescribe the number of exchanges to be performed each day and the amount and type of dialysate to be used.
   
  There are two principal types of peritoneal dialysis:
 
1. Continuous ambulatory peritoneal dialysis (CAPD) - this requires no machinery and can be done by the patient or a caregiver. The dialysate is left in the abdomen for up to eight hours. It is then replaced with a fresh solution straight away. This happens every day, about four to five times per day.
 
2. Continuous cyclic peritoneal dialysis (CCPD) - a machine does the dialysis fluid exchanges. It is generally done during the night while the patient sleeps. This needs to be done every night. Each session lasts from ten to twelve hours. After spending the night attached to the machine, the majority of people keep fluid inside their abdomen during the day. Some patients may require another exchange during the day.
 
Both types of PD allow you to be relatively independent and manage your own care at home. For now, Peritoneal Dialysis is not widely available in Nigeria.