Continuous Ambulatory Peritoneal Dialysis (CAPD) uses liquid called dialysate, which is contained in prepared sterile bags. The patient attaches tubing in the shape of a Y with two bags attached to his/her catheter. One of the bags is empty; the other contains dialysate. The empty bag is used to drain off used dialysate fluid and waste products. Then the bag containing the fluid is drained into the patient�s peritoneum and left in for three to six hours while the dialysis process takes place. Once the clean fluid has drained into the patient, he/she clamps or caps off the catheter. The bags and Y-tubing are removed and discarded. The patient repeats this process three to five times a day, every day.
This exchange process is completed three to five times per day, every day. At night, the CAPD patient allows the dialysate to remain in the peritoneal cavity for up to eight hours before exchanging bags.
Several companies now have disconnect or �bagless� CAPD systems. This disconnect system has several advantages. The patient no longer wears the tubing and bag used for the exchange. Disconnect systems may decrease peritonitis infection rates.
CCPD (APD) benefits in brief
How CCPD works Continuous cycling peritoneal dialysis or automated peritoneal dialysis replaces your kidney function by using the lining of your abdomen, or peritoneum, to filter your blood.
PD catheter To do PD, you'll have a soft plastic tube (called a catheter) surgically placed in your abdomen. You'll be trained to use a cycler machine and the catheter to fill your peritoneum with 2 liters or so of a special dialysate fluid. Wastes and extra fluid in the blood flow into the dialysate.
You will attach your catheter to the machine each night at bedtime. This takes about 10-20 minutes. When you wake up, you will be done. Disconnecting from the machine takes less than 5 minutes.
Most often, people who do CCPD are first trained to do CAPD, with four manual exchanges each day. Some people choose to do CAPD when they travel, too, so they don't need to bring a cycler on vacation.
PD exchanges Each night, the cycler fills your abdomen with dialysate and drains it out several times while you relax or sleep. At the end of the treatment, you disconnect and go about your day. Depending on how much dialysis you need, you may also need to do a daytime exchange—often at lunchtime. To see cyclers, visit our section on dialysis equipment.
Ask your surgeon to put a “transfer set” onto your catheter in the operating room. This tubing extension has a valve that lets the catheter open and close, and will make it easier for you to get started. And, ask the surgeon to make sure the catheter won't exit at your belt-line or under a skin fold.
Your PD training nurse will check your catheter, flush it with fluid, and change the dressings weekly until it heals.
Training After your catheter is placed, you'll have a week or more of training. Your PD training nurse will teach you how to:
When you first begin to put fluid in, you are likely to feel very full and even stretched. After a week or two, you'll get used to the fluid and it won't bother you.
Availability CCPD is one of the most common types of home dialysis, and is offered in every state. Find a dialysis clinic near you.
Cost For most Americans who qualify (93%), a large part of the cost of dialysis—including CCPD—is paid for by the Medicare End-stage Renal Disease (ESRD) Program, no matter how old you are.
Cost for you Medicare is secondary to your work insurance for the first 30 months of treatment. After 30 months, it becomes primary. Having more than one form of insurance can reduce your out-of-pocket costs.
Read more about Medicare. As hard as it can be, it is very important to read your policy. Some insurance carriers have begun to charge co-pays per day for PD (and per-treatment for hemodialysis). You may be able to avoid plans like these if you read the fine print.
Cost for your clinic
Medicare pays for dialysis with a set fee per treatment, called the composite rate. This rate has lost value, in real dollars, since 1972. CAPD is one of the few treatments that allow clinics to make money on Medicare-only patients, though it's still much better for them—and you—if you have other insurance, too.
Dialysis is the only Medicare-covered treatment that does not have an automatic cost-of-living adjustment. Efforts are underway to fix this—if you'd like to help, go to our Legislative Action Center.
Time You can do CCPD at home, and take the cycler with you when you travel to do manual exchanges on vacation. Exchanges are painless, take about 8-11 hours, and need to be done each night.
Once you're trained, you'll have monthly clinic visits to check your lab tests and treatment logs. You'll also need to allow time to check your supply levels, order supplies each month, and receive the shipment.
Space needed Supply delivery is usually once a month, so you will need to be able to store a month's worth of boxes of dialysate—about 30 boxes that are about one foot by two feet—plus a couple of smaller boxes with other supplies.
The boxes are heavy because they contain fluid, and they must be kept dry. If you keep them in a basement, they should be stored on a pallet so they are not on the floor. Otherwise, a closet will do. Some people just line up the boxes against a wall where they are easy to reach.
Helper tasks You can do CCPD without a helper. Even blind people can do CCPD. If you have someone who can help you, this person might help you gather supplies, move boxes, or in some cases, do your exchanges.
Some of the benefits of CCPD include:
CCPD is a continuous treatment with few ups and downs and a more liberal diet than regular hemodialysis. You won't feel wiped out or tired after exchanges.
You have your days free from dialysis. CCPD is a work-friendly form of treatment.
CCPD uses no needles, and the exchanges themselves are painless.
Your own peritoneum—not a dialyzer— is used to clean your blood. Your blood does not go outside of your body.
You can do CCPD at home or while traveling. Supplies can be shipped to you anywhere in the U.S.—even to campsites. You won't be around other patients except at clinic visits—and you may be more likely to think of yourself as basically healthy.
Research shows that the more you know about your treatment and the more you do for yourself, the longer you are likely to live.
Some of the negatives to CCPD include:
Having a catheter in your belly can change your appearance and your feelings about your body. (Having a fistula, graft, or catheter for hemodialysis can also change your appearance.)
Dialysate has sugar in it, which can cause weight gain.
The catheter is a portal into your body. Infection (peritonitis) can occur at any exchange, so you need to follow hand-washing and technique instructions exactly.
Because of the risk of infection, some activities like lake or pond swimming, or a tub bath may not be approved by your care team.
With exchanges every night, CCPD can cut into your social schedule and make you feel tied down. Machine alarms or noises may disturb your sleep.
Supply delivery times may not be convenient (you may have to miss work), and the boxes are heavy to lift.
Who is best suited for CCPD? The most important factor in whether you are suited for CCPD is how much you want to do it. If you have had many abdominal surgeries, you may not be able to do CCPD. If you are a large person, it may be hard to get enough dialysis with CCPD alone.
Continuous Cycling Peritoneal Dialysis (CCPD) is usually done at home using a cycling machine. The process is identical to CAPD except the cycle (exchange) periods are usually 1½ hours and are performed several times a night, while the patient sleeps.