CAPD (continuous ambulatory peritoneal dialysis) is the method of dialysis performed past stomach. MThis method utilizes membrane in the abdominal cavity (peritoneum) which has large surface area and lots of vascular tissue as a natural filter when passed by waste.
Dialysis is useful for cleaning the blood of metabolic waste substances, electrolytes, minerals, and excess fluids due to decreased kidney function. In addition, dialysis can also help control blood pressure.
Preparation Before CAPD
The patient is required to undergo surgical insertion of a catheter into the abdominal cavity first. This catheter will later be useful as a place for the entry and exit of dialysis fluid, which is a sterile fluid to attract metabolic waste substances, minerals, electrolytes, and water from the body.
In catheter insertion surgery, the surgeon will make a small incision (usually on the side below 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, the patient may be required to stay overnight. However, most were able to go straight home.
Although dialysis can be done immediately after the catheter is inserted, 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 the nurse on how to properly exchange fluids and how to avoid infection. After 1-2 weeks of undergoing CAPD with the help of a nurse, patients are usually able to do it themselves at home.
How is CAPD Done?
First of all, the patient needs to place the bag filled with dialysis fluid at shoulder level. The fluid is then inserted into the abdominal cavity with the help of gravity.
After the dialysis fluid has completely entered the abdominal cavity, the catheter should be closed and the patient can move and carry out their normal daily activities.
After 4-6 hours, dialysis fluid containing residual substances can be drained out of the abdominal cavity, to then be discharged into the toilet or bathroom. CAPD can be done 3-6 times a day, with one fluid filling before bed.
Advantages of CAPD
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.
- Use less drugs.
- More flexible 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 fluid exchange is not long, so you can still carry out your usual activities, 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 patients undergoing hemodialysis, because the process of dialysis through the stomach can be done more often.
- Kidney function may be maintained longer.
- There is no need to receive a needle stick or injection needle.
- Less problems for patients with anemia.
- Lower death rate.
- The risk of developing dementia is lower.
Lack of CAPD
CAPD is not necessarily appropriate for all patients with kidney failure. Conditions that make dialysis through the stomach difficult or impossible are:
- Obesity or overweight.
- Have had stomach surgery several times or have a large surgical scar on the stomach.
- Hernia disease, Crohn's disease, ulcerative colitis, bacterial infections Clostridium difficile, colon cancer, and end-stage liver disease with ascites.
- The presence of a hole or stoma in the abdomen (ileostomy or colostomy).
- Inability to care for oneself or limited assistance from others.
CAPD risk
Although actually all dialysis methods have risks or side effects, there are some conditions that are more prone to occur due to CAPD, such as:
1. Hernia
The presence of holes in the abdominal muscles where the catheter is inserted and pressure from the abdominal cavity due to dialysis fluids can cause a hernia to appear near the navel, groin, or near the catheter insertion site.
2. Weight gain and blood sugar levels
Dialysis fluids contain sugar that can be absorbed by the body, putting patients at risk for weight gain and diabetes.
3. Enlarged belly
As long as the dialysis fluid is in the stomach, the stomach may enlarge and feel like it is bloated or full. However, generally not to the point of causing pain.
4. Digestive problems
Patients undergoing CAPD are more likely to experience digestive problems, such as acid reflux disease (GERD), heartburn (dyspepsia), intestinal obstruction (bowel blockage), or intestinal adhesions, than patients undergoing hemodialysis.
5. Infection
The most serious complication is infection. Infection can occur in the skin around the catheter insertion site or in the abdominal cavity (peritonitis) due to the entry of germs through the catheter.
Symptoms of a skin infection include redness, pus, swelling, and tenderness at the insertion site. While peritonitis can cause symptoms such as:
- Stomach pain
- Fever
- Nausea and vomiting
- The used dialysis fluid is cloudy
- The catheter is like being pushed out of the stomach
Dialysis can help reduce complaints and prolong life expectancy, but cannot treat kidney failure. Consult with an internal medicine specialist about choosing the right dialysis method for you, including CAPD, taking into account the advantages and disadvantages.
Written by:
dr. Michael Kevin Robby Setyana