When AVRIL BLEMINGS was diagnosed with kidney disease and learned that she had to go on dialysis three years ago, she knew exactly what kind of treatment she wanted. This 62-year-old former military nurse in Athens, Texas, knew about peritoneal dialysis from her nursing days.

"I wanted peritoneal dialysis right from the beginning," says Avril, a peritoneal patient at Renal Care Group’s Tyler, Texas, facility. "I like to be in control of my own life, and with peritoneal dialysis, I feel like I have more control."

How It Works

Peritoneal dialysis involves the use of the peritoneum, the lining of the abdominal cavity. The peritoneum works like the dialyzer in hemodialysis - except in peritoneal dialysis, the peritoneal membrane filters out the waste products and other chemicals from the patient’s body.

Access to the peritoneal cavity is created by placing a small catheter or tube in the abdominal wall in a minor surgical procedure. This surgery is usually an outpatient procedure under local anesthesia. During treatments, this catheter connects to a special bag of fluid and fills the peritoneal cavity with a special solution called dialysate. The dialysate remains in the peritoneal cavity for several hours. During this time, waste products and fluids move from the bloodstream, through the peritoneal membrane and into the dialysate. After several hours, the fluid containing the waste products is drained from the abdominal cavity.

What’s the Better Choice for Me?

Unlike the four-hour, three times per week hemodialysis schedule, peritoneal dialysis patients do their treatments themselves at home every day. There are two types: continuous ambulatory peritoneal dialysis (CAPD) or continuous cycling peritoneal dialysis (CCPD).

Which type is best for you? At the completion of the first month of peritoneal dialysis, your home dialysis nurse trainer will send a sample of your dialysate to the lab for a peritoneal equilibration test, or a PET. This test reveals how your peritoneum responds to the dialysate and helps your doctor determine which type of peritoneal dialysis will work best for you. For membranes that transport the toxins slowly, the best dialysis type is CAPD. For membranes that transport toxins faster, CCPD is the better choice.

Choosing CCPD

With the cycling method, a portable machine the size of a bread box called a cycler is used to fill and drain the dialysate from the abdominal cavity. This procedure is done at night while the patient sleeps. CCPD is an eight- to 10-hour process that leaves dialysate in the abdomen at the end of the treatment. Sometimes another short exchange is required during the day.

Avril says she’s too active to stay in bed for eight to 10 hours, so the ambulatory, or CAPD, method was a natural choice for her. She makes four exchanges of dialysate daily, each taking about 30 minutes to complete.

"I have no trouble whatsoever. It truly is a habit now - before breakfast, before lunch, before dinner and before bed," Avril says.

CAPD also gives her the flexibility to enjoy life without adhering to a strict schedule. Patients can adjust their schedules according to guidelines they are taught.

"It gives me enough leeway and more freedom with what I want to do with my life," she says. "I love to cook, so if I have friends coming over at 7 p.m., I don’t want to be doing an exchange at 5:30 p.m., when I’m cooking. Instead, I’ll do it an hour earlier. I have a little bit of play with the times, which I really love."

Dialysis on Your Schedule

Avril doesn’t let her dialysis treatments get in the way of her vacations either. "When I go on vacation, I pack up my solutions and go."