Dialysis treatment for advanced kidney disease doesn’t have to mean going into a center three times a week or trying to find an accessible facility when you travel. A treatment called peritoneal dialysis — named for the peritoneum, a thin membrane that lines the abdominal cavity and the organs in the abdomen — allows patients to perform the procedure at home or from a hotel room when on the go.
“In peritoneal dialysis, we insert a catheter into the abdomen, and patients do dialysis at home,” says Peter Kennealey, MD, FACS, professor of transplant surgery at the University of Colorado. “They have certain fluid solutions in various bags, and they attach those to a machine that runs fluid in, percolates it around, and all the toxins from the bloodstream leak into this fluid.”
The catheter insertion is an operative procedure that is done laparoscopically. It generally takes between 45 minutes and one hour to complete. After surgery, patients are trained in the use of a machine, called a cycler, that they connect to at night to perform dialysis. The cycler can travel on airplanes, and supplies can be shipped in advance when patients travel.
“Say you’re going to stay for a week at a motel in Arizona. They ship a week's worth of supplies to the motel, your cycler comes with you, you unpack, and you're good to go,” Kennealey says. “It can be a lot more difficult to travel to Arizona and find a hemodialysis unit that can fit you in.”
The benefits of peritoneal dialysis when compared to hemodialysis — which is usually performed at a dialysis center — are multifactorial, Kennealey says. Patients can do it on their own schedule, they don’t have to worry about driving to a center if the weather is bad or they are too frail to travel, and the procedure is gentler on the body.
“With hemodialysis, which most people do three times a week, the blood is pulled out and runs through a machine, and it goes back into them,” he says. “But when you pull out a large amount of the blood volume, then the blood pressure goes down and the patients feel lousy. When you have ups and downs in your blood pressure, your native kidney function goes away quicker, because the kidneys don't like this up and down blood pressure. Someone who's on peritoneal dialysis doesn't have those big changes in their blood pressure when they're doing dialysis. They maintain what we call residual renal function for much longer.”
Kennealey, who performs the peritoneal dialysis operation at UCHealth University Hospital and the UCHealth Cherry Creek North Surgery Center, has seen many patients enjoy a better quality of life once they began the in-home dialysis treatment.
“It allows patients to maintain autonomy far better than in-center hemodialysis,” he says. “With in-center hemodialysis, the schedule is not their own. If you have to dialyze at noon on Tuesday, Thursday, and Saturday and you work, that can cause problems. There are a lot of advantages, both medically and emotionally, to being able to maintain the autonomy you had prior to renal failure.”