By Maya Doyle, MSW

Many patients choose peritoneal dialysis (PD) because of the flexibility it allows; patients do not have to make frequent trips to the hospital, treatments can be done at home and diet and fluid intakes are more liberal. This does not mean, however, that there are not substantial adjustments that must be made for this treatment option.

Patients who choose PD must adapt to the presence of a catheter in the abdomen and to the necessity of daily treatments. The discomfort of the catheter and the feeling of fluid in the abdomen may change the way and the position in which one sleeps (for continuous cycling peritoneal dialysis, CCPD). It may also impact how comfortable one feels during daily activities (for continuous ambulatory peritoneal dialysis, CAPD patients). With time and experience, these discomforts should be minimized for most patients.

Depending upon their age, patients may feel differently about their appearance and body image, although an increased sense of physical wellness resulting from adequate dialysis may be ample reward for tolerating a catheter. Sexually active adults need to be able to communicate openly with their partners about physical and emotional changes that may affect their ability to enjoy intimacy. Young children on PD may need constant instruction to prevent them from touching and contaminating their catheter, although many parents have devised creative solutions with dressings and/or clothing to prevent this.

Within the home, space must be allocated near the bedside for a cycler (for CCPD) and for the many boxes of supplies and fluids that will be delivered monthly. Due to a risk of infection, patients must strive to keep the environment clean and to maintain a high level of personal hygiene. Patients using CAPD must be able to set aside "exchange time" in a private, clean space during their day. 

Patients can hook up their cycler or perform exchanges independently once their technique is proficient, but it is recommended that a family member or other "partner" be available to help. Patients may feel they are placing a burden on this partner and it is vital that both people receive support from their dialysis team. Being able to perform treatments independently makes it easier for PD patients to work, attend school and to travel, since they are not committed to in-center dialysis and equipment and supplies are relatively portable. However, it is important that good communication is maintained with the dialysis team, even if visits are fewer, so that infections and other problems can be addressed promptly.

Maya Doyle is a social worker at Montefiore Medical Center at the Albert Einstein College of Medicine in Bronx, NY.

This article originally appeared aakpRENALIFE, Vol. 17, No. 1, July 2001.

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