Dialysis is done when kidney failure is in the advanced stage – be it temporary or permanent. In hemodialysis, the blood is removed from the patient’s body and purified by passing it through a semi-permeable membrane (dialyzer).
The peritoneum is a layer that covers the intestines. The space between the two layers is called the peritoneal cavity. Peritoneal dialysis involves instilling the purifying liquid inside the peritoneal cavity and cleaning the blood.
A dialysis catheter is inserted into the abdominal cavity (under local anaesthesia) and secured. The catheter is placed externally in a pouch so that it will not hang outside. We normally wait for two weeks for the wound to heal and to start using the abdomen for dialysis. Normally, 2 litres of fluid is instilled into the peritoneal cavity using the catheter and it is made to stay for a period of 6-8 hours.
The blood that flows along the peritoneal membrane has metabolic wastes and the dialysis fluid inside the peritoneal cavity doesn’t have these wastes. These metabolic wastes like urea, creatinine, extra water, etc. that accumulate in the blood due to kidney failure will be removed during the time when the fluid stays inside during dialysis.
Advantages of CAPD
- Whatever kidney function remains at the initiation of dialysis called residual kidney function, is preserved better.
- It is a continuous dialysis where the treatment is done 24 hours a day so that the levels of metabolic wastes remain constant. This is unlike hemodialysis where the dialysis is intermittent.
- Since dialysis does not involve removing the blood, CAPD is safe for patients with heart diseases.
- Ideal for children, the elderly who are not ambulant, and those who lack access to dialysis.
- Less chances of infections.
- Allows patients to consume near-normal diet.
- Dependency on the hospital is avoided and patients can travel and can lead a normal social/professional life.
Manual vs. Automated Dialysis (APD)
The process of filling the dialysis fluid in the abdomen and changing the fluid after a few hours is called an EXCHANGE. The patient or one of his/her family members is trained to do the dialysis procedure at home. The exchange procedure needs only a clean room at home and not an operation theater environment and it normally takes 30 minutes to perform.
There is also a machine called CYCLER that can be used to perform the exchanges. This is a machine that can be programmed to deliver a fixed volume of fluid to stay in the abdomen for a fixed period of time, and at the end, the machine automatically removes and replaces the fluid.
Patients can connect themselves before they go to sleep in the night and finish their dialysis when they wake up. So, through the night the dialysis is done automatically by the machine and the patient is free to do his/her routine uninterrupted in the daytime.
Dr. R. Balasubramaniyam
Chief of Nephrology,
Kauvery Hospital, Chennai
Images Courtesy – National Kidney Center- Nepal, Wikipedia, Wepmeds Care, Cycler – Nephron Plus & researchgate.net/journal
With Deep Gratitude for Your Healing Touch
Our hearts are brimming with ecstasy as we complete 1 year of my new LIFE post my ROBOTIC RENAL TRANSPLANT 😍. All divine blessings and GOD’s benevolent and unimaginable GRACE have made this MIRACLE happen – I was lucky that my husband could be my donor ❤️.
No combination of alphabets will suffice to express our humble gratitude to the medical team of Kauvery Hospital under the compassionate, holistic and expert guidance of my super hero Doctorji R. Balasubramaniam 🙏🏻. Apart from being an empathetic human being, Doctorji’s exceptional care, meticulous attention to detail and commitment to excellence are truly inspiring and has actually accelerated my recovery to lead a normal life. Thank you for giving me a second chance at health and happiness 🤩.
Post-surgery care also was so very seamless and highly commendable. This would not have been possible without the humongous dedication of Dr Balaji, Dr. Swaminathan, Dr. Jeevagan and Dr Anu to whom we could reach out 24/7. They always stood by us like our pillars of support. Our whole family is ever indebted to the whole nephrology team, including the dialysis team, especially Nivasan Sir who sensitised us about the legal format and ensured a hassle-free procedure.
Kauvery Hospital offers the best state-of-the-art technology combined with accomplished doctors and a considerate support staff.
Really, I am living a DREAM 😍
