Peritoneal Dialysis 101

We have had a lot of questions about what this is and what Lot is going through. First off, he is not constantly tired. That is hemo dialysis where the blood is cleaned outside the body and put back in. Around 12 pounds of fluid is taken off each time that happens. That is one reason why people on hemo are tired all the time. That is not to say that every person on hemo is always tired; just making a generalization. Lot actually has a little more energy now. I am the one that is going to bed by 10 every night.

We have been inundated with information that last 2 weeks. In fact, I have 1 binder and an accordion file folder full of information that has been given and explained well to us. I will try to condense it down for you.


Here is a very short version of what happens. An initial drain has to occur so that the peritoneum does not over fill. This drain is the most painful (at least it is only 2 minutes long). At the end of the catheter, there are numerous holes that the fluid goes in and out of. When it can't suck up anymore dialysate (the fluid being put in that attracts waste products), the end of the catheter sucks itself to whatever organ is closest, which is usually the bladder and most recently, the lower end of the colon. Not fun at all.

So, after the initial drain (I Drain) the peritoneum begins to fill with the dialysate. Oh, by the way, the peritoneum is a sack that surrounds all your organs in the abdomen. Right now, Lot is being filled with 1000mL of fluid. That will go up to 1500 on Friday, 2000 on Monday, and finally, the end amount of 2500mL on Wednesday. This is the fill. It is fairly fast. Once he is finished filling up, it is dwell time. This is the amount of time that the dialysate is in the peritoneum. It can be either 1.5 or 2.5 hours. It all depends on if the waste products are attracted slow or fast to the fluid. We found out at the 6 week mark what Lot is. This involves a blood test, urine test and a test of the dialysate fluid once it has been drained. If Lot is a fast waste mover, he will dwell for and hour and a half. If not, 2.5 hours. Once the dwell time is up, the fluid drains and it starts all over again for a total of 4 sessions.

Lot can stay on the machine the whole time, but if he needs to get off to use the restroom, get a drink, eat, anything, he can. He just needs to be hooked back up before the dwell time is up. Otherwise, the machine will alarm and not stop until he is hooked up and draining. The machine is programed with how much fluid to put in and when the last drain occurs, it will just sit there until we wake up to get him off the machine.

When Lot is hooking himself up, everyone in the room MUST wear a mask and sanitize their hands. No fans are to be on, windows and doors have to be closed, no pets allowed, and absolutely NO touching of anything that is not to used in the process. Once the exchange is finished, a new cap is placed onto the end of the catheter in Lot.

The picture below is the transfer set. The part on the left is what gets hooked to the dialyzer. The other end is connected to another tube that goes into the body. It cannot be pulled out, but if it gets tugged on, irritation can occur at the site.



The end of that cap is not not to be touched. If any bacteria get into the peritoneum, it results in peritonitis, an infection of the peritoneum. He will be put on antibiotics until it clears up. It can be very serious and we take it very seriously. If an infection goes untreated, it could mean death. One big indicator that there is an infection is cloudy dialysate in the gas can. We have a 5 gallon, new gas can that the fluid is drained into. Before it is dumped down a toilet, tub, or sink, a portion is poured into a clear cup so that we can see if it is cloudy and yellow. That cup is ONLY used for that purpose and not drinking will EVER take place with that cup.

The waste is essentially pee. It is all the waste products that a normal kidney would filter out through your pee. It is not yellow. The waste contains excess potassium, phosphorus, protein, creatinin, among other vital nutrients that are replenished through a renal vitamin.

Drinking more water WILL NOT help any. Lot is on fluid restrictions of 34 ounces of fluid a day. This includes fluids that are in foods. He is (as are all of us) on a low sodium, phosphorus, potassium, and high protein diet. So that means virtually no fast food, processed (boxed) foods, no potatoes, tomatoes, bananas, avocados, mushrooms, very little milk, no processed cheeses, no watermelon or jello and only clear sodas,. A normal person needs 2-3 servings of protein a day; Lot needs at least 5. He is taking a non-potassium containing whey protein powder to help with that. He is also on 2 blood pressure medications, a renal vitamin (that replaces vital nutrients lost during dialysis) vitamin D3, sodium bicarbonate, fish oil with 900 IU of omega 3's, tums every time he eats (to attract phosphorus) and a few things to keep him regular (if anything pinches the catheter, we get alarms from the machine that is can't drain/fill properly and the culprit is usually waste in the colon). He also applies a topical antibacterial cream to the exit site (place where the catheter comes out of his abdomen) daily.

This is what the machine looks like:


 The bags of fluid are placed on the top and are warmed up by the machine. We are told that cats are very attracted to them because as long as the machine is on, the top is warm.

If you would like more in depth info, you can visit these websites:

The National Kidney Foundation

If you would like to go to Kidney School, you can go here. This site is a good resource to get a basic knowledge of the kidneys, how they work, the different types of treatment for kidney failure, and how to cope with CKD (Chronic Kidney Disease)

If you would like to read about transplants, you can go to the InterMountain Medical Center website. This is where we will go when we get "the call." There is also good information about being a living donor.

As always, if you have any questions about the process, you can call, email, or comment here. All comments are sent to my inbox, so I can see them sooner.