There are a few types of peritoneal dialysis, which depend on when the exchanges take place.
Your child’s healthcare team will speak to you about the best type for your child. This may depend on your preferences, but some children do better on certain types of peritoneal dialysis.
Continuous ambulatory peritoneal dialysis (CAPD)
In CAPD, exchanges usually take place four times a day, which you or your child – or another parent/carer who is trained – will need to do. There is no machine.
- Fill: you will put the contents of a new bag of dialysate (dialysis fluid) through your child’s catheter. This is done by gravity.
- Dwell: the dialysate stays in the abdomen for about 4 hours. Your child can walk around and do activities as normal, such as go to school or play.
- Drain: you will need to drain the used dialysate out through the catheter.
Automated peritoneal dialysis (APD) or continuous cycling peritoneal dialysis (CCPD)
In APD, exchanges take place overnight – usually for about 9-12 hours. A machine, which can sit next to the bed, automatically and continuously moves dialysate into and out of the abdomen. You will be given one or more cards that are programmed especially for your child.
For each dialysis session you may need to use a particular card depending on your child’s weight that day. You will need to insert the right card into the machine.
Some children finish each night-time cycle with fresh dialysate that dwells in the peritoneal cavity all day. This gives an extra cycle of dialysis and may help protect your child against any discomfort.
The machine, can sit on top of a table or desk at home. APD may be a better option for smaller children.
Assisted automated peritoneal dialysis (aAPD)
If you need more support, you may be able to have assisted APD. A healthcare assistant who specialises in dialysis can come to your home.
Changing dialysis
It may be possible – or sometimes necessary – to change the type of dialysis your child has. This may depend on your child’s health and complications of dialysis, how he or she is responding to dialysis, or your family’s situation. Speak with your child’s healthcare team for more information.
Risks
Your child’s healthcare team will teach you how to manage peritoneal dialysis and care for your child’s exit site. They will also give you information about what to look for so any complications can be treated quickly.
Poor drainage
Sometimes fluid does not properly drain out of the peritoneal cavity. This may happen for different reasons.
- The PD catheter may become kinked or blocked, such as when a child lies on it (for example, rolling over at night) – this can usually be easily corrected.
- Blood or fibrin (a protein) from the body can get stuck in or around the catheter. A medicine called heparin can be added to the dialysate (dialysis fluid) to help prevent this.
- Occasionally, the poor drainage keeps happening. This may be because the catheter gets displaced, or omentum (a fold of tissue in the abdomen) gets wrapped around the catheter.
- Sometimes, the omentum can be removed in surgery – this is called an omentectomy – leaving the catheter in place. Or, the catheter may need to be replaced. Some children who have previously had surgery in their abdomen may have adhesions. If this happens, peritoneal dialysis may need to be stopped.
Infection
Infection is a serious risk that is caused by germs entering the body. The infection may be at the site where the catheter enters the skin (exit site infection) or inside the peritoneal cavity (peritonitis). Keeping the exit site clean will reduce this risk.
Most infections can be treated with antibiotic medicines, which kill the germs. If the infection is more serious, the catheter will need to be removed, and a new catheter placed after the infection is gone.
Very serious infections can cause damage to the peritoneum which cannot be repaired.
Other risks
- Hernias happen when an internal part of the body pushes through the wall around it and a lump in the tummy can be seen.
- Leakage of the dialysis fluid may happen. This is more likely in babies because they have less muscle, or when the catheter has not rested for long enough.
Supporting your child
PD can be a difficult and stressful experience for your child and the whole family, including other children. You and your child will learn more over time about how to help live with dialysis.
Your child’s healthcare team is there to help you. They can provide support with your child’s education, accessing financial benefits and doing PD outside your home – for example, at your child’s school, other family members’ homes or while on holiday. There may also be help available from a team social worker and/or psychologist.
Speaking with other families of children on this type of dialysis can also be a huge support.
If you have any concerns or need additional support, speak with your doctor or nurse.
More information about supporting your child and the future in Dialysis – an introduction