What is the difference between continuous ambulatory peritoneal dialysis?

Before dialysis was available, total kidney failure meant death. Today, people with kidney failure can live because of treatments such as dialysis and kidney transplant.

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In this video, from our Dialysis Essentials course, you'll discover the differences between two types of dialysis, how they both work, and how to adjust dialysis prescriptions.

Peritoneal dialysis can be performed in two ways—continuous ambulatory peritoneal dialysis (CAPD) or automated peritoneal dialysis (APD). In this video, from our Dialysis Essentials course, you'll discover the differences between these two types of dialysis, how they both work, and how to adjust dialysis prescriptions.

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Peritoneal dialysis can be performed two ways. Continuous ambulatory peritoneal dialysis or CIPD uses manual exchanges. Automated peritoneal dialysis or APD is performed overnight using an automated cycler. Continuous ambulatory peritoneal dialysis uses gravity to instill and drain fluid. One manual exchange, which means draining and instilling dialysis fluid takes 30 minutes.

A typical prescription might require three to six exchanges in a 24-hour period. These exchanges are usually done during the day and allow for a longer dwell at night about eight hours so the patient can sleep. The cycler is used in automated peritoneal dialysis, which is typically done only at night over eight to ten hours.

This takes all the day exchanges and does them at night with shorter times between the exchanges because it uses a pump to push dialysis fluid in and stuff the fluid out after is sat in the abdomen for a specific period of time. A common automated peritoneal dialysis prescription is for exchanges with two liter fills over eight to ten hours at night, so a total of eight liters per day.

With automated peritoneal dialysis, the abdomen can remain filled during the day with one to two manual exchanges or remain dry without any fluid. This will depend on the results of the peritoneal membrane test for individual patients. A typical prescription with both night and day exchanges would be for exchanges with two liter fills over eight to ten hours at night with a two liter day exchange so ten liters per day.

If the patient has significant residual kidney function, then they might need less dialysis such as fewer exchanges or lower volume. The peritoneal equilibration test will determine the salt transport type and will help with making adjustments to the prescription.

There are 2 types of peritoneal dialysis (PD): continuous ambulatory peritoneal dialysis (CAPD) and automated peritoneal dialysis (APD). Both types of PD have slightly different advantages, so it really comes down to your personal preference and schedule along with your nephrologist’s recommendation.

You do treatments continuously, without a machine, 3 to 5 times each day in any clean environment—at home, at work or while traveling. That’s why it’s called “ambulatory.” You’re not attached to a machine of any kind. You’re able to be on the move—wherever, whenever.

You place about 2 quarts of cleansing fluid into your abdomen and, later, drain it. This is done by connecting a plastic bag of the fluid, called dialysate, to the soft tube (PD catheter) in your abdomen.
By raising the plastic bag to shoulder level, gravity pulls the fluid into your abdomen. This is called “filling.” When empty, the plastic bag is removed and thrown away.
The cleansing fluid (dialysate) stays inside your abdomen for several hours. This is called “dwelling.” During this time, the waste products and extra fluid move out of your blood through the peritoneum membrane and into the dialysate.
When it’s finished, the dialysate is drained from your abdomen through the PD catheter into a plastic bag, which can be secured and thrown away. This is called “draining.”
The process of these 3 steps—filling, dwelling and draining—is called “an exchange.”
The actual time for filling or draining takes about 30 minutes. It’s done during your regular daily activities. Because you do an exchange 3, 4 or 5 times in a 24-hour period, some people like to do their exchanges around mealtimes and at bedtime.

Peritoneal dialysis (PD) can easily be done at home. Home PD can mean fewer food restrictions and less medication.

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When flying, it may be possible to bring some of your medications, syringes and supplies on board. Some other supplies may need to be shipped to your destination. For details, check ahead with your airline or call Patient Travel Services at 1-866-434-2597 (option 1).

Tip: All medications must be in their original packaging and clearly marked.

What is APD? APD is an automated process that uses a machine called a “cycler” to perform your exchanges. With APD (sometimes known as CCPD or continuous cycling peritoneal dialysis), you can choose between a variety of different times and places for dialysis sessions. APD can be done as a longer single session while you sleep, as multiple shorter sessions during the day or night or as a combination of these options. Everyone’s treatment is different, so talk to your nephrologist about what works best for you.

You will learn to do manual CAPD exchanges first, which will make your APD training easier. And, if for any reason your cycler is not working—or in case of a power failure—you will be able to manage your treatments by knowing how to do CAPD.

By law, your cycler is considered an essential medical device. You cannot be charged a fee for checking your cycler as baggage.

Your doctor will prescribe a cycler for you. They are compact and fit easily on your bedside table. Your cycler is also portable—it can go anywhere you go.

PD becomes routine. Just like brushing your teeth or making coffee, doing PD will become part of your daily routine and start to feel normal.
Traveling and keeping up with PD is easy. Whether you take your portable cycler or do manual treatments throughout the day, just work PD into your schedule like you do at home. Travel Services can even have supplies shipped to your destination.
Using the portal is a great way to stay connected. You can send treatment data, see lab results and communicate with your nurse—all in real time. It's fast, easy and convenient.
There are strategies for dressing with a catheter. Your nurses—and other people on PD—are great resources for learning how to look good while taking care of your catheter. Tape or PD catheter belts can help you stay comfortable and feel great.
Storing supplies is easier with expert help. Tap your nurse for storage ideas—he or she knows great tips for fitting supplies in your living space.

People doing PD may experience some side effects as a result of treatment.

Feeling overly full—Because the belly is always full of fluid on PD, there may be some discomfort, especially when eating. Timing your treatments around meals may help.
Weight gain—Some weight gain may come from fluid retention. The dialysate used in PD also contains sugar, which could lead to weight gain as it's absorbed by the body over time.

When considering your treatment options for dialysis, it’s important to be as informed as possible. Also, share the decision making with your doctor and immediate loved ones. Be honest about any concerns and bring up questions. Talking it through can help you make the best decision.

You'll have 24/7 access to on-call home PD nurses by phone. That means you get the benefits of home and the comfort of knowing help is there if you need it.