PD & Home HD

What is a major difference between peritoneal dialysis and hemodialysis?

• Peritoneal dialysis (PD): usually self-care or done with a care partner at home

• Hemodialysis (HD): usually done by a nurse or technician

• PD offers more flexibility, while HD is often tied to a clinic schedule

Why do many patients find peritoneal dialysis more flexible than hemodialysis?

• PD is usually done at home

• Patients have more control over timing of treatments

• Diet is often more liberal than with HD

• They do not usually have to travel to a dialysis center 3 times per week

What is one drawback of peritoneal dialysis even though it is flexible?

• It is a daily treatment

• Some patients feel like they never get a “day off” from dialysis

How do patients often describe how they feel on hemodialysis versus peritoneal dialysis?

• Hemodialysis: may have “highs and lows” between treatments

• Peritoneal dialysis: often feel more steady or more “normal” because treatment is daily

Why can patients on peritoneal dialysis have a better blood pressure profile and need fewer medications?

• PD is done daily, so fluid and waste are removed more gradually and consistently

• This can improve blood pressure control and reduce fluctuations

Why might patients on peritoneal dialysis have a poor appetite even though their diet is more flexible?

• Fluid in the abdomen makes them feel physically full

• The dialysis solution contains sugar, and some is absorbed, which can reduce hunger cues

How much fluid is commonly in the abdomen during peritoneal dialysis?

• Usually about 2 to 3 liters, sometimes more

• This can make the patient feel very full

What membrane acts as the filter in peritoneal dialysis?

• The peritoneal membrane

• It is sometimes called the body’s “third kidney”

How does the peritoneal membrane work in dialysis?

• It is selectively permeable

• Waste products and fluid move from the blood across the peritoneal membrane into the dialysis fluid in the abdomen

What can peritoneal dialysis remove from the blood?

• Fluid

• Urea

• Creatinine

• Glucose

• Electrolytes

• Some proteins

• Some medications

What does peritoneal dialysis NOT replace?

• It does not replace the hormonal functions of the kidneys

• It does not make erythropoietin or other kidney hormones

Why are peritoneal dialysis patients at high risk for infection?

• There is a catheter entering the body

• The solution is going into a warm, dark area

• The fluid contains sugar, which supports bacterial growth

• Infection can occur at the exit site, tunnel, or as peritonitis

Why is peritonitis a serious complication of peritoneal dialysis?

• It is a medical emergency

• It is very painful

• It is life-threatening if not treated quickly

Who usually performs peritoneal dialysis in the inpatient setting?

• Usually the bedside nurse

• Not usually the dialysis nurse who does hemodialysis

What is the focus of outpatient peritoneal dialysis nursing care?

• Teaching the patient or family member how to do treatments safely at home

• Supporting follow-up care

• Monitoring labs, medications, exit site, and patient outcomes

What is the focus of inpatient peritoneal dialysis nursing care?

• Supporting the patient with treatment

• Assessing the catheter and exit site

• Monitoring for complications

• Providing general nursing care

What is in peritoneal dialysis solution?

• Sterile water

• Electrolytes

• Dextrose

• Buffer solution

• Sometimes amino acids

• Sometimes medications such as insulin, potassium, or heparin

What determines how much fluid is removed during peritoneal dialysis?

• The dextrose concentration of the solution

• More dextrose = more fluid pulled off

What are common dextrose concentrations used in peritoneal dialysis fluid?

• Around 1.5% to 4.25%

• Higher concentrations remove more fluid

Why should patients not rely on the highest dextrose concentration all the time?

• Too much absorbed dextrose can damage the peritoneal membrane over time

• Higher concentrations should be used more for times of extra fluid overload, not as the constant routine choice

What is CAPD?

• Continuous Ambulatory Peritoneal Dialysis

• “Manual” PD

• The patient does exchanges several times during the day

How does CAPD work?

• Drain out old fluid

• Fill with new fluid

• Disconnect

• Repeat several times a day

What are disadvantages of CAPD?

• Requires several exchanges during the day

• Takes time

• Requires a clean, safe place

• Limits mobility during exchange times

• Requires storage space for supplies

What is CCPD or cycler peritoneal dialysis?

• Continuous Cycling Peritoneal Dialysis

• Uses a machine to perform exchanges, usually overnight

What are advantages of the cycler form of peritoneal dialysis?

• More freedom during the day

• Machine performs exchanges automatically at night

• Can fit better with some patients’ lifestyles

What are disadvantages of cycler peritoneal dialysis?

• Patient is connected to equipment during treatment

• Still needs a clean and safe setup area

• Still requires storage space

• Setup time is needed

What does “wet” or “dry” mean in peritoneal dialysis?

• Wet: patient has dialysis fluid left in the abdomen between treatments

• Dry: patient has no fluid left in the abdomen between treatments

What is the purpose of the transfer set in peritoneal dialysis?

• It connects to the patient’s catheter

• If contaminated, the transfer set can be changed without replacing the whole catheter

Why is hand hygiene so important in peritoneal dialysis?

• It helps prevent contamination of the catheter or tubing

• It is one of the biggest protections against peritonitis

Who needs to wear a mask during peritoneal dialysis setup and connection?

• The patient

• Anyone handling supplies or tubing

• Anyone in the room during connection or disconnection

Why are masks required during connection and disconnection?

To reduce contamination from droplets and help prevent infection

Why might gloves not always be required during some parts of peritoneal dialysis care?

• Some policies emphasize excellent hand hygiene instead

• Tiny glove particles could contaminate equipment or access

• Facility policy should always be followed

What are common electrolyte issues in peritoneal dialysis?

• Electrolyte imbalances can still occur

• Potassium may need to be replaced

• Some patients may need electrolytes added to dialysate or given separately

What kind of fluid imbalance is common in peritoneal dialysis?

• Dehydration can occur if too much fluid is removed, often from using higher-dextrose solutions too often

How can dehydration from peritoneal dialysis be managed?

• Oral or IV fluid replacement if needed

• Skip an exchange or adjust therapy per provider order

• Use lower dextrose concentration if prescribed

Why might a peritoneal dialysis catheter have trouble filling or draining?

• Catheter malposition

• Catheter curling

• Fibrin clog

• Omentum wrapping around the catheter

• Mechanical obstruction

What is protein wasting in peritoneal dialysis?

• Protein diffuses out of the blood into the dialysate and is lost when fluid is drained

• This can lead to malnutrition

Why are peritoneal dialysis patients at risk for calorie malnutrition?

• Poor appetite from abdominal fullness

• Protein losses in dialysate

• Reduced oral intake

Why are peritoneal dialysis patients at risk for hyperglycemia?

• They absorb dextrose from the dialysate

• This raises blood glucose levels

Why can peritoneal dialysis lead to lipid problems?

• Chronic absorption of dextrose can contribute to hyperglycemia and eventually altered lipid levels

What should the nurse assess in a hospitalized patient on peritoneal dialysis?

• Ability to safely perform their own treatment

• Exit site condition

• Catheter function

• Signs of infection

• Complications such as poor drainage, fluid imbalance, or glucose issues

What is home hemodialysis?

Hemodialysis performed by the patient or care partner outside of the dialysis center after special training

Who can be trained to do home hemodialysis?

• The patient

• A care partner/family member

• Training must be done by an RN

What does home hemodialysis require?

• Training

• Clean area

• Water

• Electricity

• Storage space

• Ongoing clinic follow-up

How often do home hemodialysis patients usually come back to clinic?

Usually at least monthly for labs, medication review, and assessment

What are advantages of home hemodialysis?

• More flexible schedule

• Self-managed care

• Can often be done more frequently

• Better individualized treatment

• Evidence suggests improved outcomes and fewer cardiovascular events

What are disadvantages of home hemodialysis?

• Big time commitment

• Requires training

• Requires a care partner or quick help nearby

• Requires space and equipment at home

• Risk of caregiver role strain or burnout

Why might some patients not want home hemodialysis even if it offers flexibility?

• They may not want their home to feel like a hospital

• They may not want equipment and supplies in their living space

What is one major safety concern with home hemodialysis?

Patient and caregiver must be ready to respond to complications or emergencies at home

Why do outcomes sometimes look better with home hemodialysis than traditional in-center hemodialysis?

• Treatments can be more frequent and individualized

• More gradual fluid and waste removal may reduce cardiovascular stress

A nurse is teaching a client about peritoneal dialysis. Which statement by the client shows correct understanding?

A. “Peritoneal dialysis is usually done by a technician in a clinic.”
B. “Peritoneal dialysis is often a self-care treatment done at home.”
C. “Peritoneal dialysis cures kidney failure.”
D. “Peritoneal dialysis replaces the hormonal functions of the kidneys.”

B. “Peritoneal dialysis is often a self-care treatment done at home.”

Rationale:

• Peritoneal dialysis is most often a self-care modality done by the patient or care partner at home

• It does not cure kidney failure

• It does not replace hormonal kidney functions

• Hemodialysis is more commonly done by nurses/technicians

A nurse is caring for a client on peritoneal dialysis. Which complication is the priority concern?

A. Mild hunger
B. Peritonitis
C. Increased mobility
D. Slightly liberalized diet

B. Peritonitis

Rationale:

• Peritonitis is a life-threatening medical emergency

• Infection is one of the most serious complications of peritoneal dialysis

• The nurse should always think infection first with PD concerns

A nurse is reviewing the prescription for peritoneal dialysis fluid. Which change would remove the most fluid?

A. 1.5% dextrose solution
B. 2.5% dextrose solution
C. 4.25% dextrose solution
D. Solution with no dextrose

C. 4.25% dextrose solution

Rationale:

• Higher dextrose concentration creates a stronger osmotic pull

• This pulls more fluid from the bloodstream into the peritoneal cavity

• The highest dextrose solution removes the most fluid

A nurse is teaching a hospitalized patient about infection prevention during peritoneal dialysis. Which interventions should the nurse include? Select all that apply.

A. Wash hands before handling equipment
B. Wear a mask during connection and disconnection
C. Allow family to talk over the open tubing
D. Keep the setup area clean
E. Use good exit-site care

A, B, D, E

Rationale:

• Excellent hand hygiene is essential

• Masks are required during connection/disconnection

• The setup area must be clean and safe

• Exit-site care helps prevent infection

• Talking over open tubing increases contamination risk

A patient on peritoneal dialysis reports feeling full and having poor appetite. What is the best explanation?

A. The patient is developing iron deficiency
B. The abdomen contains dialysis fluid, which can create a feeling of fullness
C. The kidneys are producing too much erythropoietin
D. The patient is likely bleeding internally

B. The abdomen contains dialysis fluid, which can create a feeling of fullness

Rationale:

• PD patients often have liters of fluid in the abdomen

• This makes them feel physically full

• They also absorb sugar from the dialysate, which may reduce hunger cues

Which findings are possible complications of peritoneal dialysis? Select all that apply.

A. Hyperglycemia
B. Protein wasting
C. Difficulty draining
D. Peritonitis
E. Increased RBC production

A, B, C, D

Rationale:

• Patients can absorb dextrose and develop hyperglycemia

• Protein can be lost in the dialysate

• Catheters can have fill/drain problems

• Peritonitis is a major complication

• PD does not increase RBC production because it does not replace erythropoietin function

A client performs CAPD at home. Which statement about CAPD is accurate?

A. It is usually done only once each week
B. It uses a machine at night for all exchanges
C. It requires several manual exchanges during the day
D. It does not require a clean environment

C. It requires several manual exchanges during the day

Rationale:

• CAPD is the manual form of peritoneal dialysis

• The patient performs multiple daytime exchanges

• It still requires a clean, safe environment

A nurse is comparing CAPD with CCPD. Which statement is correct?

A. CCPD usually uses a cycler machine, often overnight
B. CAPD always requires a machine
C. CAPD is only performed in the hospital
D. CCPD removes the need for infection precautions

A. CCPD usually uses a cycler machine, often overnight

Rationale:

• CCPD uses a machine to do exchanges, commonly overnight

• CAPD is manual

• Both require infection prevention measures

• Neither is limited only to hospital care

A patient on peritoneal dialysis has been using high-dextrose solutions often. Which complication is most likely?

A. Severe hypertension from fluid overload only
B. Dehydration and possible membrane damage over time
C. Increased red blood cell production
D. Elimination of all infection risk

B. Dehydration and possible membrane damage over time

Rationale:

• High-dextrose solutions remove more fluid, which can dehydrate the patient

• Repeated exposure to high dextrose can damage the peritoneal membrane

• These stronger solutions should not be the constant first choice unless needed

A nurse is teaching a patient about home hemodialysis. Which statements are true? Select all that apply.

A. Home hemodialysis requires training
B. The patient needs water and electricity access
C. The patient usually never returns to clinic
D. A clean treatment area is needed
E. A care partner is often needed

A, B, D, E

Rationale:

• Home HD requires formal training

• Water, electricity, and space are needed

• A clean treatment environment is necessary

• A care partner or quickly available helper is often needed

• Patients still return for periodic clinic follow-up, usually monthly

A nurse is explaining an advantage of home hemodialysis. Which statement is best?

A. “It removes the need for any caregiver involvement.”
B. “It usually offers more flexibility and may improve outcomes.”
C. “It eliminates the need for follow-up care.”
D. “It cures chronic kidney disease.”

B. “It usually offers more flexibility and may improve outcomes.”

Rationale:

• Home HD allows more individualized scheduling and often more frequent treatment

• Evidence suggests improved outcomes, including fewer cardiovascular events

• It does not cure CKD and does not remove the need for follow-up care