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CONTINUOUS AMBULATORY PERITONEAL DIALYSIS (CAPD)

CAPD is a form of dialysis treatment that is performed at home. Treatments can be done as you go about your regular daily activities. You are not restricted by the use of a machine. CAPD allow you to be independent and to perform treatments on a flexible schedule.

With this type of treatment, body waste products and extra fluid are removed inside your peritoneal cavity ( the area in the abdomen around the organs). A soft silastic tube (catheter) is surgically placed into the peritoneal cavity through your abdominal wall. It stays in place unless surgically removed. It is used to drain dialysate in and out of your peritoneal cavity.

Dialysate stays in your peritoneal cavity 24 hours a day except for the short periods when old dialysate is drained out and fresh dialysate is put in. For most patients, the treatment is carried out 4 to 5 times a day, 7 days a week.

CAPD treatment is relatively simple. CAPD treatment is relatively simple. About two quarts of sterile dialysis solution from a plastic bag runs through the plastic connecting tube and catheter into your peritoneal cavity. The dilaysate remains in the peritoneal cavity for about 3-5 hours. Your peritoneal membrane acts as a filter allowing wastes and extra fluid to be drawn out of your blood. The dialysate and wastes are drained out and thrown away. Fresh dialysate is infused, and you go about your normal activities for another 3-4 hours before "exchanging" fluid again. The last exchange of the day stays in overnight allowing you to sleep without interruption.

CAPD may be the choice for you if you:

  • Live too far from a dialysis center or have no transportation
  • Do not have a good blood access site for hemodialysis
  • Prefer the flexibility of independence that CAPD offers

ADVANTAGES OF CAPD

  • Fewer dietary changes
    Because CAPD is performed 24 hours a day, waste products are cleared continuously allowing you to eat more freely. However, protein is lost in each exchange which means that you must eat a high protein diet to make up for those losses.
  • Easier control of fluid balance.
    Fluid balance is maintained by changing the strength of the dialysis solution. The solutions that are higher in sugar pull out more fluid. You may be asked to limit salt or fluid intake to maintain fluid balance.
  • Blood chemistry values are more steady.
    Waste products are removed at the same time they are being generated.
  • Less anemia ( a higher blood count).
    Blood is not circulated outside the body though a dialyzer, so there is little or no chance of blood loss. Since blood chemistries are steady, the red blood cells may also live longer.
  • A sense of freedom.
    One of the most important advantages of CAPD is the freedom that you are able to enjoy. You can do exchanges or treatments almost anywhere. You dialyze while going about your normal activities and do not have to rely on a machine for treatments.

DISADVANTAGES

  • Peritonitis.
    Peritonitis is an infection of the peritoneal membrane and is a serious medical condition. Peritoneal treatments or exchanges must be done very carefully using sterile procedures to prevent peritonitis. Sterile procedures are an important part of training. Some signs and symptoms of peritonitis are abdominal pain, fever, nausea, and draining out of cloudy dialysis solution ( most important sign).
  • Placement of long term catheter.
    The surgical placement of the catheter may cause some intial pain and discomfort. However, for most patients, the pain is reduced or completely gone after the first 2 or 3 weeks.
  • Feeling full.
    Some patients complain of feeling full because of the dialysis solution in the abdomen. Most patients say this fullness is like having eaten too large a meal. After a few months, most patients say the only discomfort they feel is during those few minutes of the exchange when their abdomens are "empty".
  • Storage space for supplies.
    The exchanges can be done almost anywhere, but storage space is needed for the dialysis solutions and supplies.
  • Possible weight gain from sugar in the dialysate.
    Sugar is in the dialysate to help pull extra fluid out of your body. Some of this sugar is absorbed into the blood and it may cause excess weight gain, high blood sugar, and high triglycerides (blood fat).

CONTINUOUS CYCLIC PERITONEAL DIALYSIS (CCPD), [Also called Automated Peritoneal Dialysis, (APD)]

CCPD exchanges are performed with a cycler machine during the night while you are sleeping. 3-4 exchanges are performed during the night, 6 to 7 nights a week, and your daytime hours are free. Some dialysis solution is usually left in your peritoneal cavity during the day and drained out when you hook up to the cycler machine at night.

The cycler machine measures and warms each exchange. It delivers warm solution or "fills" the peritoneum. Dialysis takes place while the solution "dwells" in your peritoneal cavity for specified period of time. The solution is then drained from your peritoneal cavity, taking waste products and extra fluid with it. This whole process is called a " cycle". CCPD is safe a nighttime procedure even for patients who do not have a helper present.

ADVANTAGES OF CCPD

  • Same as for CAPD
  • Daytime hours free. Exchanges are done at night.
  • Less risk of developing peritonitis (fewer connections)

DISADVANTAGES OF CCPD

  • High dextrose (sugar) solutions may be needed to keep fluid balance in your body.
  • Fluid may not drain as well when you are lying down, so fluid intake may need to be restricted.
  • You must remain in bed for at least 8 hours of treatment