CAPD (continuous ambulatory peritoneal dialysis) is a method of dialysis carried out through the stomach. This method utilizes a membrane in the abdominal cavity (peritoneum) that has a large surface and a lot of blood vessel tissue as a natural filter when it is passed by residual substances.
Dialysis is useful for cleaning blood from metabolic waste, electrolytes, minerals, and excessive fluids due to decreased kidney function. In addition, dialysis can also help control blood pressure.
Preparation Before CAPD
Patients are required to undergo catheter insertion surgery first. This catheter will be useful as a place for the entry and exit of dialysis fluid, which is a sterile liquid to attract metabolic waste, minerals, electrolytes, and water from the body.
In a catheter surgery, the surgeon will make a small incision (usually next to the underside of the navel), after the patient is given general or local anesthesia. From the incision, a catheter is inserted until it reaches the abdominal cavity (peritoneal cavity).
After the operation is complete, patients may be required to undergo overnight stays. However, most can go straight home.
Although dialysis can be done immediately after the catheter is installed, the catheter will work better if the surgical wound heals first, which is within 10-14 days or up to 1 month.
You will be taught by nurses about how to properly exchange fluids and how to avoid infection. After 1-2 weeks undergoing CAPD with the help of nurses, patients are usually able to do it themselves at home.
How is the CAPD done?
First of all, the patient needs to place a bag filled with dialysis fluid at shoulder height. The liquid is then put into the abdominal cavity with the help of gravity.
After the dialysis fluid has completely entered the abdominal cavity, the catheter must be closed and the patient can move and go about his normal daily activities.
After 4-6 hours, dialysis fluid containing residual substances can be flowed out of the abdominal cavity, and then discharged into the toilet or bathroom. CAPD can be done 3-6 times a day, with one fluid filling before going to sleep.
CAPD Advantages
CAPD has almost the same effectiveness as hemodialysis (HD). However, there are several advantages of CAPD when compared to HD, including:
- There is no drastic change in blood flow that usually occurs in hemodialysis, so the burden on the heart and blood vessels is lighter.
- Less use of drugs.
- Free and independent. Machine dialysis is generally done in a hospital or hemodialysis center, while CAPD can be done anywhere as long as it's clean. In addition, the time needed for the exchange of fluids is not long, so you can still move as usual, work, or travel. Before leaving for your destination, make sure the equipment needed for fluid exchange is ready.
- Food and drink restrictions are not as strict as those for patients undergoing hemodialysis, because the process of dialysis through the stomach can be done more often.
- Kidney function may be maintained longer.
- No need to receive a needle stick or IV needle.
- Fewer problems for patients with anemia.
- Lower death rate.
- The risk of developing dementia is lower.
Lack of CAPD
CAPD is not necessarily right for all people with kidney failure. Conditions that make dialysis difficult or impossible are:
- Obesity or overweight.
- Have had stomach surgery a number of times or there is a large surgical scar on the stomach.
- Hernia, Crohn's disease, ulcerative colitis, bacterial Clostridium difficile infection, colon cancer, and end-stage liver disease with ascites.
- There is a hole or stoma in the abdomen (ileostomy or colostomy).
- Not able to take care of themselves or limited help from others.
CAPD risk
Even though all dialysis methods have risks or side effects, there are a number of conditions that are more prone to occur due to CAPD, such as:
1. Hernias
The existence of holes in the abdominal muscles where the catheter enters and the pressure from the abdominal cavity due to dialysis fluid can result in the appearance of a hernia near the navel, groin, or near the catheter entry.
2. Increase in body weight and blood sugar levels
Dialysis fluid contains sugar that can be absorbed by the body, so the patient is at risk of gaining weight and diabetes.
3. Stomach enlarges
As long as the dialysis fluid is in the stomach, the stomach may enlarge and feel like bloating or fullness. However, it is generally not to cause pain.
4. Digestive problems
Patients who undergo CAPD are more likely to experience digestive problems, such as stomach acid disease (GERD), heartburn (dyspepsia), intestinal obstruction (intestinal obstruction), or intestinal adhesions, than patients who undergo hemodialysis.
5. Infection
The most serious complication is infection. Infection can occur in the skin around the site of entry of the catheter or in the abdominal cavity (peritonitis) due to the entry of germs through the catheter.
Symptoms of a skin infection include redness, suppuration, swelling and tenderness at the site of the catheter. While peritonitis can cause symptoms such as:
- Stomach ache
- Fever
- Nausea and vomiting
- Dialysis fluid that has been used is turbid
- The catheter is pushed out of the stomach
Dialysis can help reduce complaints and extend life expectancy, but can not treat kidney failure. Consult with a specialist in internal medicine regarding the selection of dialysis methods that are right for you, including CAPD, taking into account the advantages and disadvantages.
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