By: Geraldus Sigap
Chronic kidney disease (CKD) is a condition that affects millions of people worldwide, leading to the gradual loss of kidney function. When the kidneys can no longer filter blood effectively, waste products and excess fluids build up in the body, necessitating dialysis—a life-saving procedure that mimics the filtering function of healthy kidneys. Continuous Ambulatory Peritoneal Dialysis (CAPD) is one of the key dialysis methods available, offering patients greater flexibility and independence compared to traditional hemodialysis. This article explores the science behind CAPD, its indications, preparation, what patients can expect, and the procedure itself, highlighting why it remains an effective option for dialysis patients.
CAPD is typically indicated for patients with end-stage renal disease (ESRD) who require long-term dialysis. It is particularly suitable for patients who prefer to manage their dialysis at home and wish to maintain a more normal lifestyle, as it does not require visits to a dialysis center multiple times a week. CAPD is also an option for patients who may have difficulties with vascular access, which is required for hemodialysis. Additionally, CAPD may be chosen for patients who have residual kidney function, as it can help preserve this function longer compared to hemodialysis.
Figure 1. Illustration of CAPD
CAPD is often recommended for younger patients who are active and have busy schedules, as well as for elderly patients who may find the less invasive nature of CAPD more tolerable. It is also a viable option for patients with certain cardiovascular conditions, as the continuous nature of peritoneal dialysis is gentler on the heart than the rapid fluid shifts associated with hemodialysis. Before starting CAPD, patients undergo a thorough evaluation to determine if they are suitable candidates for the procedure. This includes assessments of their overall health, the condition of their peritoneum (the lining of the abdominal cavity), and their ability to manage the procedure independently. Once deemed suitable, patients receive education and training on how to perform CAPD, including how to maintain a sterile environment to prevent infections.
The first step in preparation is the surgical insertion of a catheter into the patient’s abdomen. This catheter allows the dialysis solution to be infused into and drained from the peritoneal cavity. The procedure is usually done under local anesthesia and may require a few days of recovery before the patient can begin CAPD. For patients starting CAPD, it’s important to know what to expect during the process. Unlike hemodialysis, which typically occurs three times a week for several hours at a time, CAPD is done every day. However, it is performed in cycles, with each cycle lasting around 4 to 6 hours. During each cycle, a dialysis solution is infused into the peritoneal cavity through the catheter. The solution remains in the cavity for several hours, during which it absorbs waste products and excess fluids from the blood. The solution is then drained, and the process is repeated.
CAPD is typically done in the comfort of the patient’s home, and because it doesn’t require machines, it offers more freedom and flexibility. Patients can carry out their normal daily activities while the dialysis solution is in their abdomen, although some may choose to perform the exchanges at night while they sleep.
Patients are trained to recognize signs of potential complications, such as infections or issues with the catheter. Peritonitis, an infection of the peritoneum, is a common concern, so maintaining strict hygiene and sterile techniques during exchanges is crucial.
The CAPD procedure itself is relatively simple, but it requires attention to detail and strict adherence to sterile techniques. Here’s a brief overview of what the process involves:
- Infusion: The patient connects a bag of sterile dialysis solution to the catheter and allows the solution to flow into the peritoneal cavity. This process takes about 10-15 minutes.
- Dwell Time: Once the solution is in the peritoneal cavity, the patient disconnects the bag and continues with their daily activities. The solution stays in the abdomen for 4-6 hours, during which it absorbs waste products and excess fluids.
- Drainage: After the dwell time, the patient connects an empty bag to the catheter and allows the used dialysis solution to drain out of the peritoneal cavity. This process also takes about 10-15 minutes.
- Repeat: The cycle is repeated multiple times a day, depending on the prescribed treatment plan.
CAPD is designed to be as non-disruptive as possible, allowing patients to integrate the treatment into their daily lives with minimal interference. While CAPD is highly effective for managing kidney failure, it’s important to recognize its role in broader health, particularly in patients with cardiovascular conditions. For many patients with kidney disease, cardiovascular health is a major concern. The continuous nature of peritoneal dialysis, such as CAPD, places less strain on the heart compared to the rapid fluid shifts of hemodialysis, making it a gentler option for those with cardiovascular risks.
However, it’s important to note that while CAPD offers many benefits, some patients with severe or complex cardiovascular conditions may still require additional treatments, such as Coronary Artery Bypass Grafting (CABG). CABG is often more effective than stenting when dealing with extensive or hard plaques in the coronary arteries. While stents are commonly prioritized for less severe blockages, CABG remains the gold standard for patients with multiple or calcified plaques, as it provides a more comprehensive solution by bypassing the blocked arteries altogether.
At Abdi Waluyo Hospital, we pride ourselves on offering personalized, comprehensive care for patients requiring CAPD and other dialysis treatments. Our team of experienced nephrologists and nurses are dedicated to helping patients manage their condition effectively, ensuring that they receive the best possible care tailored to their unique needs. Additionally, we offer specialized cardiovascular care, including advanced imaging and surgical options such as CABG, for patients with complex cardiovascular conditions. Our multidisciplinary approach ensures that patients receive the highest level of care for both kidney disease and heart health.
Resources
- Key points: About Dialysis for Kidney Failure | National Kidney Foundation [Homepage on the Internet]. [cited 2024 Aug 28];Available from: https://www.kidney.org/key-points-about-dialysis-kidney-failure
- Murdeshwar HN, Anjum F. Hemodialysis [Homepage on the Internet]. In: StatPearls. Treasure Island (FL): StatPearls Publishing, 2024 [cited 2024 Aug 28]; Available from: http://www.ncbi.nlm.nih.gov/books/NBK563296/
- Putri S, Nugraha RR, Pujiyanti E, et al. Supporting dialysis policy for end stage renal disease (ESRD) in Indonesia: an updated cost-effectiveness model. BMC Res Notes 2022;15:359.
