CAPD Question

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CAPD Question

Postby Pinkdiamonds14 » Fri Feb 26, 2016 2:16 pm

I would be really grateful if someone could explain the 'dwell' period for me. I appreciate there is a tremendous amount of info on the Internet but all your advice and experience always gives a clearer picture.

My father is starting his PD training next week for CAPD, I would like to join him but my parents are insistent they will be fine without me. However I would like some understanding in readiness. As I understand it CAPD will involve four exchanges a day, each taking place within 4-6 hours of each other; am I therefore correct in thinking that you have to do these exchanges this frequently otherwise the toxins that have been taken will be reabsorbed back into your system? If that is the case how then is it possible to go through a whole night with the same fluid from the last exchange of the day?

Also I was wondering with APD (overnight) why you have to carry a fill during the day if you've had several exchanges throughout the night? Can you not stay empty?

Im sure I am missing the point but am slightly confused :? so would really appreciate an explanation - my head is spinning with it all at the moment! Many thanks.
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Re: CAPD Question

Postby Soobee » Fri Feb 26, 2016 3:22 pm

Hi,

The dwell time is the time the fluid stays in between exchanges, during this time the fluid draws out toxins and 'stuff' (also some water) which you then drain off and re fill with new fluid. If the fluid is in for too long it becomes 'full' and stops drawing out bad stuff through the peritoneal membrane, the body can then start to reabsorb the fluid (and toxins).
The rate the process happens at is different for everyone so they will probably start him on a standard prescription and after a few months do a PET test and a KT/V these measure how efficient the dialysis is and they then change the prescription (stronger solution/time etc) to be the most efficient.

I think some people have a different bag (like extraneal) for overnight if they are hight transporters (which means their membrane is efficient and the fluid would be reabsorbed overnight)

With APD (which I do) you usually have a small fill or a stronger fluid during the day, because I am a high transporter and I got bloated during the day I don't have a final fill and am dry all day (I wasn't allowed to switch to this until I had had the efficiency tests after 3 months.

Hope these ramblings are of some help, it is much clearer once you have done a few runs, I promise! :D
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Re: CAPD Question

Postby bigbuzzard » Sat Feb 27, 2016 3:37 pm

I suppose it is technically possible for toxins to be reabsorbed from the fluid, though in all the time I was on APD and CAPD (I switched between the two as convenient, though mostly APD), I never came across this as something to be particularly worried about. Whether or not you are 'full' or 'empty' during the day is based on various things I think. I was always full with 2 litres in there during the day. I think this was to add to the dialysis achieved overnight, though not everyone may need that.

There's also the physical business of having that fluid on board. I'm fairly large (90+kg) so those extra 2 made no difference to me physically. I know much smaller people can have a different experience.

There's also the things mentioned by Soobee.
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Re: CAPD Question

Postby rheaybou » Sun Feb 28, 2016 6:18 pm

The dwell time for CAPD follows what they think your prescription should be. Over time they will adjust it to give the best results.

I had short dwells on APD due to being what is called a fast transporter. I would transfer fluid and toxins quickly.....but also reabsorb so wouldn't get high fluid removals.

Unfortunately you can never know until you start, I had to switch to HD n the end as PD was killing me
Now 35 with Alports and I had my first kidney-versary 18th feb 2013....I hope to have many more.

My living donor and his family are doing all well.

==
Alports.
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Re: CAPD Question

Postby Pinkdiamonds14 » Fri Mar 04, 2016 9:19 am

Thank you all for taking the time to read and reply. I am beginning to understand that dialysis is very individual and that one size doesn't fit all!
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Re: CAPD Question

Postby bigbuzzard » Fri Mar 04, 2016 9:51 am

That's very true.

It's also the case that there are lots of useful nuggets of knowledge for each kind of dialysis that aren't unique to a particular person. Searching this site (see box, top right) might lead you to some of them.

Once accepting its inevitability I quite enjoyed the 'game' of PD, eg: finding things to do with all the boxes, find the most 'extreme' places to do exchanges, learning how to sort out the inevitable 'short' nights when out till 2am, and up at 7, finding places to warm up a bag before an exchange – or working out how cold it could be and still be tolerable! And the 1am calls to Baxter's tech support line in Texas, or sorting out a replacement machine (flat internal battery) at midnight, when due to leave with it for the airport at 6am (it arrived at 2, and went straight into action!). Plus the occasional mishaps – like a drain bag leaking through the ceiling to the flat below! or me leaking all over a bed when a guest, because a nurse hadn't quite tightened up the catheter properly (always worth getting them to check!). Fun times :-). Good luck.
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Re: CAPD Question

Postby rheaybou » Tue Mar 08, 2016 9:29 pm

Extreme CAPD exchanges became a challenge for me.

In meetings, in the car(as a passenger), parks, theme parks..... But my two favourites were at Goathland, the location for heartbeat and Harry Potter filming in the past, watching the steam trains go through.
Now 35 with Alports and I had my first kidney-versary 18th feb 2013....I hope to have many more.

My living donor and his family are doing all well.

==
Alports.
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