Continuous Ambulatory Peritoneal Dialysis (CAPD)
Continuous ambulatory peritoneal dialysis (CAPD) is a kidney replacement therapy that uses the peritoneum as a natural filter membrane, allowing patients with renal failure to perform dialysis at home.
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Continuous ambulatory peritoneal dialysis (CAPD) is a kidney replacement therapy that uses the peritoneum as a natural filter membrane, allowing patients with renal failure to perform dialysis at home.
What is Continuous Ambulatory Peritoneal Dialysis?
Continuous ambulatory peritoneal dialysis (CAPD) is a form of dialysis used in chronic kidney failure. Unlike hemodialysis, where blood is filtered outside the body, CAPD uses the peritoneum (the lining of the abdominal cavity) as a natural filter membrane. This method allows patients to carry out treatment independently at home, without the need to visit a dialysis center on a daily basis.
Through a permanently implanted peritoneal catheter, a special dialysis fluid (dialysate) is introduced into the abdominal cavity. Through osmotic and diffusive exchange across the peritoneum, waste products, excess electrolytes, and water pass from the blood into the dialysate. The used dialysate is then drained and replaced with fresh solution.
Indications
CAPD is primarily used in patients with end-stage renal disease (chronic kidney disease stage 5), when remaining kidney function is no longer sufficient to adequately remove waste from the body. Common underlying conditions include:
- Diabetic nephropathy
- Chronic glomerulonephritis
- Hypertensive nephropathy
- Polycystic kidney disease
- Other chronic kidney diseases
CAPD can be used as a primary dialysis method or as a bridge to kidney transplantation.
Mechanism of Action
The principle of CAPD is based on two physical processes:
- Diffusion: Uremic waste products such as urea, creatinine, and potassium move along the concentration gradient from the blood through the peritoneum into the dialysate.
- Osmosis (ultrafiltration): The osmotically active agent in the dialysate (usually glucose or icodextrin) draws excess water from the blood into the abdominal cavity.
The peritoneum is richly vascularized and has a surface area of approximately 1 to 2 square meters, making it an effective natural filter membrane.
Procedure
In CAPD, the dialysate is typically exchanged three to five times per day, with a dwell usually remaining in the abdominal cavity overnight. Each bag exchange takes approximately 20 to 40 minutes and involves the following steps:
- Draining the spent dialysate into an empty bag
- Connecting a new bag containing fresh dialysis solution
- Allowing the fresh solution to flow into the abdominal cavity
- Capping the catheter until the next exchange
Strict hygiene and sterile technique are essential to minimize the risk of infection during each exchange.
Advantages and Disadvantages
Advantages
- Home-based treatment without regular clinic visits
- Continuous, gentle detoxification around the clock
- Better preservation of residual kidney function compared to hemodialysis
- Reduced cardiovascular stress due to absence of rapid fluid shifts
- Greater independence and flexibility in daily life
Disadvantages and Risks
- Peritonitis: Inflammation of the peritoneum, the most common and serious complication
- Catheter exit-site infections
- Loss of ultrafiltration capacity over time
- Glucose load from the dialysate (particularly relevant for diabetic patients)
- Contraindicated in patients with prior abdominal surgeries or significant adhesions
Complications
The most common and serious complication of CAPD is peritonitis (inflammation of the peritoneum), most often caused by gram-positive bacteria such as Staphylococcus aureus or Staphylococcus epidermidis. Symptoms include abdominal pain, cloudy dialysate, fever, and nausea. Treatment involves intraperitoneal or systemic antibiotic therapy. Recurrent peritonitis episodes may lead to technique failure and necessitate a switch to hemodialysis.
Comparison with Other Dialysis Methods
Compared to hemodialysis, CAPD offers continuous detoxification and is particularly suitable for patients who wish to remain mobile or who live in areas with limited access to dialysis centers. Automated peritoneal dialysis (APD) is an advanced form in which the bag exchanges are performed automatically overnight by a cycler device, further improving daytime quality of life.
References
- Kidney Disease: Improving Global Outcomes (KDIGO) - Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. KDIGO, 2024.
- Daugirdas JT, Blake PG, Ing TS (eds.) - Handbook of Dialysis. 5th edition, Wolters Kluwer, 2015.
- World Health Organization (WHO) - Global Kidney Health Atlas. WHO, 2023.
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