Continuous ambulatory peritoneal dialysis (CAPD)

CAPD benefits in brief

  • Portable—do it anywhere
  • Flexible—suit your own schedule
  • Time—fewer trips to the clinic
  • Easy—learn it in a week or two
  • No needles—avoid needle sticks
  • Less restrictive—easier diet

How CAPD works

Continuous ambulatory peritoneal dialysis (CAPD) replaces some of your kidney function by using the lining of your abdomen, called your peritoneum, to filter wastes and fluid out of your blood.

PD catheter

To do PD, you'll need to have a soft plastic tube (called a catheter) surgically placed in your abdomen. You'll be trained to use the catheter to fill your peritoneum with 2 liters or so of a special fluid called dialysate. Wastes and extra fluid in the blood flow through the tiny blood vessels in your peritoneum into the dialysate.

PD exchanges

After a few hours of "dwell" time—while you go about your usual activities—wastes and fluid will flow into the dialysate. Then, you drain out the used dialysate and put in clean fluid. This process is called an exchange.

See how PD works. Reused with permission from Kidney School™.

Preparing for CAPD

Catheter placement can be done as an outpatient procedure. Some people have little or no pain; others have some pain for a few days afterward.

Ask your surgeon to put a "transfer set" onto your catheter in the operating room. This tubing extension has a valve to open and close the catheter, and will make it easier for you to get started. And, ask the surgeon to make sure the catheter won't come out of your body, or "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

When your catheter is ready to use (in 1-3 weeks), you'll have a week or more of training. Your PD training nurse will teach you how to:

  • Set up an exchange room
  • Wash your hands
  • Care for your catheter and exit site
  • Do an exchange
  • Choose which dialysate to use
  • Store and order your supplies
  • Keep treatment logs
  • Take your blood pressure
  • Follow your diet and fluid limits
  • Recognize and report any problems

A PD nurse will be on call if you need help.

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

CAPD 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 CAPD—is paid for by the Medicare End-stage Renal Disease (ESRD) Program, no matter how old you are.

Cost for you

If you are working, Medicare is "secondary" to your work insurance for the first 30 months of treatment. This means that your work insurance pays first, and Medicare may pay some or all of the remaining costs. After 30 months, Medicare becomes primary. Having two forms of insurance can reduce your out-of-pocket costs, because care that is not paid for by one insurance company may be picked up by the other. If you are not working, Medicare becomes "primary" (pays first) in the month you begin PD training.

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.

  • Life Options offers a free 108-page booklet called Employment: A Kidney Patient's Guide to Working and Paying for Treatment. Download it here.

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 CAPD at home, at work, or when you travel. Exchanges are painless, take about 30 minutes, and need to be done 3-5 times a day. You can set your own schedule, as long as you allow enough time between exchanges for wastes and extra fluids to flow into the dialysate.

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 CAPD without a helper. Even blind people can do CAPD. If you have someone who can help you, this person might help you gather supplies, move boxes, or in some cases, help with your exchanges.

CAPD pluses

Some of the benefits of CAPD include:

  • CAPD is a continuous treatment with few ups and downs, so you feel the same all the time. You won't feel wiped out or tired after exchanges.
  • There are fewer diet and fluid limits with CAPD than with in-center hemodialysis. You decide your schedule and can fit in your exchanges around your day. CAPD is a work-friendly form of treatment.
  • CAPD 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 PD at home, at work, in a car, 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.

CAPD minuses

Some of the negatives to CAPD include:

  • Having fluid—and 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 tub baths may not be approved by your care team.
  • With exchanges several times a day, there are no breaks from CAPD.
  • 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 CAPD?

The most important factor in whether you are suited for CAPD is how much you want to do it. If you have had many abdominal surgeries, you may not be able to do CAPD. If you are a large person, it may be hard to get enough dialysis with CAPD.

↑ Top of page