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Peritoneal Dialysis Provision and Support

PERITONEAL DIALYSIS PROVISION AND SUPPORT

Peritoneal dialysis (PD) is a treatment option for individuals with kidney failure or end-stage renal disease (ESRD). It involves the use of the patient’s own peritoneal membrane, which is a thin lining in the abdominal cavity, as a natural filter to remove waste products and excess fluid from the body.

Here's an overview of peritoneal dialysis in kidney failure:
CATHETER PLACEMENT

To perform peritoneal dialysis, a catheter is surgically inserted into the abdominal cavity. This catheter serves as the access point for the introduction and removal of dialysis fluid.  With advancement in technology, some kidney specialists and surgeons are able to insert this tube with minimally invasive procedure, with rapid healing times and ability to use the tube almost immediately.

DIALYSIS FLUID EXCHANGE

The dialysis process involves exchanging dialysis fluid, also known as dialysate, into and out of the peritoneal cavity (patient’s belly). The dialysate is a sterile solution containing a specific concentration of electrolytes, such as glucose.

Filling (Inflow): The patient uses the catheter to fill the peritoneal cavity with a prescribed amount of dialysate. The dialysate remains in the abdomen for a specified dwell time, allowing waste products, toxins, and excess fluid to diffuse from the blood vessels into the dialysate through the peritoneal membrane.

Dwell Time: The dwell time can vary, but it usually lasts a few hours. The length of the dwell time depends on the prescribed treatment plan, which is determined by the Nephrologist (kidney specialist). During this time, the patient can continue with their daily activities.

Draining (Outflow): After the dwell time, the patient drains the used dialysate, now containing waste products and excess fluid, from the peritoneal cavity using gravity. The drained fluid is discarded, and the process is repeated with fresh dialysate.

EXCHANGE CYCLES

Peritoneal dialysis is typically performed in cycles, which include multiple exchanges throughout the day. The number of exchanges and their frequency can vary depending on the patient's needs and the specific treatment plan.  The patient can perform these manually through a portion of the day (CAPD: Continuous Ambulatory Peritoneal Dialysis) or with the help of a machine at night while the patient sleeps (APD: Automated Peritoneal Dialysis).

BENEFITS OF PERITONEAL DIALYSIS

Flexibility and Independence

Peritoneal dialysis can be performed at home, allowing individuals to have more control over their treatment schedule and reducing the need for frequent visits to a dialysis centre. It offers greater flexibility and independence compared to in-centre hemodialysis.

Infection control

Patients are not exposed to other patients at the dialysis centre, as peritoneal dialysis can be done at home.  This reduces the risk of acquiring infections, such as respiratory or skin infections.  Peritoneal dialysis itself leads to a much lower rate of blood infections and bodily infections as compared to hemodialysis, if done properly with the necessary precautions.

Continuous Dialysis

Since peritoneal dialysis is performed daily, it provides continuous clearance of waste products and excess fluid from the body, contributing to more stable fluid and electrolyte balance.  It therefore mimics the patient’s own kidney function much more closely.

Gentle on the Body

Peritoneal dialysis is generally considered a gentler form of dialysis compared to hemodialysis. The gradual and continuous process may cause fewer fluctuations in blood pressure and is generally better tolerated by some individuals.

Preserved Residual Kidney Function

Peritoneal dialysis may help preserve residual kidney function to some extent. The continuous nature of the treatment can support the remaining kidney function, allowing it to continue removing waste products and maintaining electrolyte balance.

PATIENT CONSIDERATIONS

Lifestyle Changes

Peritoneal dialysis requires individuals to perform exchanges daily, following strict hygiene practices. It may involve adjustments to daily activities, such as work or travel plans, but these adjustments are usually less than those for hemodialysis.  Compliance to healthcare team’s recommendation is vital for the treatment to work properly in the long run and to provide the intended benefits for the patient.

Infection Risk

The catheter exit-site and the peritoneal cavity are at risk of infection. Proper care, including regular cleaning and sterile techniques, is essential to minimise the risk of infection.  However, the overall risk of infection is far lesser than that with a catheter in the blood stream, as may be required for those who choose hemodialysis.

Fluid Balance

It is important to monitor fluid intake and follow the prescribed dialysis fluid exchange regimen to maintain fluid balance.

Training and Support

Individuals who choose peritoneal dialysis receive training from healthcare providers to learn the technique and proper handling of the equipment. Ongoing support is provided by a healthcare team to ensure the success and safety of peritoneal dialysis.

Peritoneal dialysis can be a suitable treatment for those who wish to preserve their daily routines, employment and personal freedom.  It is important for individuals with kidney failure to work closely with their healthcare team to determine the most appropriate treatment plan, including the type and frequency of dialysis, based on their specific condition and medical history.

At RHS, we provide comprehensive Clinical Governance programs for Peritoneal Dialysis with our team of specialists that have decades of experience and expertise.  RHS has a model of collaboration where the provision of such quality and evidence-based dialysis care is done at either RHS facilities or those of our dialysis-provision partners.  Please contact us for further information on how to enrol in such programs if you have kidney failure.
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