What is it?
Our kidneys usually filter and remove waste products and excess fluid from the blood. Ambulatory peritoneal dialysis (APD) is a way of replacing your kidney function, if your kidneys have failed.
Working in the same way as continuous ambulatory peritoneal dialysis (CAPD), APD uses the membrane covering your internal organs (the peritoneum) to filter out waste and excess water. But this form of dialysis is usually done overnight with the help of a machine.
The peritoneum is a natural filter, with a rich supply of tiny blood vessels (capillaries), which lines a space in your body called the peritoneal (or abdominal) cavity. During APD a machine pumps carefully measured amounts of fluid into the space through a catheter (a permanent soft, flexible plastic tube) attached to your abdomen. The fluid (known as dialysate fluid) stays in the cavity for most of the night whilst waste products pass from the capillaries into the liquid. It is then automatically drained out into an empty bag for you to thrown away.
The process of adding fresh liquid and draining out used liquid is called a dialysis ‘session’. Between three to 12 exchanges are usually carried out in each overnight session, while you are asleep– leaving the daytime free.
Watch this animation, from the Kidney Patient Guide, to see how peritoneal dialysis work.
How do I get a catheter?
A specialist will put the catheter in your abdomen, just below your belly button. The procedure will be done under local or general anaesthetic and you may be required to stay in hospital for 24-48 hours afterwards.
About a week to ten days later, a nurse will take out your stitches and you should be able to start APD shortly afterwards.
Can I do APD myself?
Yes. Your kidney team, GP and District Nurse will work together to help you. You will be:
- supported by a dialysis nurse who will work closely with you. They will advise you on how best to arrange your bedroom for your nightly dialysis session and teach you how to connect and disconnect yourself from the machine, take care of your catheter and exit site and cope with any potential problems. They can also help you if you have any worries about how you will cope with your APD.
- given equipment, including the machine (which is usually the size of a small suitcase) and fluid bags, together with advice on where to store things. You will also be shown how to re-order supplies and arrange deliveries to your home.
- given advice about doing ADP on holiday – and help with making any arrangements (including arranging the delivery of supplies to your or holiday destination).
A family member, friend or nursing assistant can also be trained to help you with your APD and your kidney doctors will give you regular check-ups to see how you and your kidneys are doing.
Depending on where you live, you may be able to access an Assisted APD service. This is where a fully trained healthcare assistant is contracted by your local NHS trust to come to your home to clear away equipment from your overnight treatment and then set up your dialysis machine for your next treatment. They can also order supplies for you and contact your kidney unit if you are experiencing any problems.
This service can be especially helpful for people who may want some extra short-term support while they get used to using the machine at home or for frail, older people who want long-term support to enable them to receive their dialysis treatment at home. However this service is quite expensive and isn’t yet available everywhere so speak to your kidney unit to find out if Assisted APD is available in your area.
Will I need a special diet and medications?
Your kidney dietitian will help you to maintain a healthy, balanced diet. You may be required to restrict certain foods (for example those containing potassium, phosphates and high levels of salt) but you should only restrict your diet if your kidney dietitian has advised you to do so.
Your kidney doctor may prescribe:
What are the benefits of having my dialysis at home?
Many people like the independence it brings. You don’t need to travel to hospital or a dialysis unit for your treatment – you can do it yourself in the comfort of your own home and while on holiday too.
Are there any potential problems?
The most common potential complication of APD is infection – of the exit site or of the peritoneum (peritonitis).
But your dialysis nurse will work closely with you to help you avoid infection by showing you how to care for your exit site and keep your catheter free from bacteria. If problems do occur, contact your GP or kidney unit straightaway. The sooner an infection is treated, the less likely it is to affect your APD or require your admission to hospital.
Other possible problems could include:
- blockages in the catheter
- hernias (a lump in the abdomen) which can be caused by an internal part of the body (such as an organ) pushing through weakened stomach muscles.
But your medical team will be able to help you if these do occur.
[ML1]Article is about APD.
[ML2]I’m not sure why this suggests hernias cause drainage problems. They are associated with leaks, which will cause a slight reduction in the volume drained, but it’s not really a drainage problem. Maybe something more like ‘Hernias can also cause problems’, possibly with ‘with small volumes of fluid slowly leaking out’.
[ML3]I’d suggest removing the visible, as not every hernia is always visible
How will APD make me feel?
APD is not generally painful but some people find it uncomfortable to have fluid in their abdomen.
You may feel anxious, angry and upset about the prospect of nightly APD sessions and how this may affect you and your family personally and socially. This is all perfectly normal so talk to your kidney doctor or nurse about any concerns that may be affecting you physically and psychologically. They may also be able to put you in touch with a counsellor who can help you with your mental wellbeing.
Take a look at our Dialysis Decision Aid booklet for more information about APD and other types of treatments generally available to people with kidney failure.
The booklet has space for your own notes and some suggested prompts to help you raise any issues that may be concerning you.
You can also find further advice and helpful tips in our How can I help myself? section.
Reviewed April 2019
The need for more research
We know there are significant variations between kidney units in the chances of a patient starting APD, and in the number of patients who have to switch to haemodialysis. Research is needed to understand and resolve these differences. We also need to investigate ways to improve mortality rates and quality of life for people on dialysis.
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