There are two types of dialysis available:

1) Peritoneal dialysis

2) Hemodialysis

Peritoneal dialysis

Peritoneal dialysis is a procedure in which one or two litres of dialysis solution is instilled into abdominal cavity through peritoneal catheter. It is a silastic catheter of about 12" size and is put into the abdominal cavity through midline just below umbilicus. About 4" to 6" of catheter is in the abdominal cavity while remaining is lying outside. Dialysis solution (Dialysate) is instilled into the abdominal cavity and is kept there for some time (30 to 40 minutes) and subsequently drained out. Diffusion of waste product occurs from the blood passing through abdominal cavity into the dialysis solution through peritoneal membrane. This is a very selective semipermeable membrane and is much more effective than synthetic semipermeable membrane used in Hemodialysis solution. After fluid is removed fresh solution is instilled again and procedure is repeated till desirable effect is obtained.

Initially peritoneal dialysis was used in acute cases only. But since last ten years or so long term peritoneal dialysis is also done. This is commonly known as CAPD (Continuous Ambulatory Peritoneal Dialysis) through permanently inserted peritoneal dialysis catheter in the peritoneal cavity. This is very effective procedure and does not require any complicated and expensive machine to do this procedure. This can be done by patient themselves at any place once they are fully trained to do the procedure. It is cheaper than Hemodialysis. Only problems encountered with CAPD are - Peritonitis or Infection of cavity through catheter by faulty technique. This (peritonitis) can be life threatening. Unfortunately this is still not done in India as proper supplies are not available.

CAPD - Procedure

CAPD is a much simpler dialysis as explained above. It is safe too with an experienced hand. It does not require sophisticated equipment for the procedure and can be done anywhere by patient themselves. In this permanent peritoneal dialysis catheter is inserted surgically below unbilicus and sutured in place. Through this two litres of dialysis fluid (available in disposable plastic bag) is inserted in the peritoneal cavity. After instillation of fluid, bag is folded and kept under the belt. Fluid is kept in abdominal cavity for four to six hours and then it is drained out into the bag. After all fluid is drained, fresh solution is instilled again and procedure is repeated three to four times a day. Utmost care should be taken when bag is changed so that infection does not occur. Promising results have been obtained so far from CAPD in USA & Europe.

Advantages of peritoneal dialysis

It is a simple procedure and can be done even in a smaller places where only limited help is available. Critically ill patients tolerate this better than regular hemodialysis. No blood thinning medicine is required in this. It is much more effective in removal of excess body fluids. Peritoneal dialysis does not require routine any vascular access (A.V. Fistula or Shunt) and has greatly reduced dietary restrictions. It is easily tolerated by even small children and infants where Hemodialysis is difficult.

Disadvantage o peritoneal dialysis

It is a slow procedure and not as effective as Hemodialysis. It requires hospitalization and so becomes more expensive. Infection is most dreaded complication and can be fatal unless treated aggressively early.

In India, PERITONAL DIALYSIS is used to treat patients with acute and chronic renal failure in INITIAL STAGES till patient is switched over to regular hemodialysis.