National Kidney Foundation of Malaysia
Peritoneal Dialysis: Information for Patients
This information is for people who have kidney failure and are considering peritoneal dialysis as a treatment option. Healthy kidneys clean your blood by removing toxins and excess fluid. As your kidney fails, harmful toxins build up in your body and your body may accumulate excessive fluid. Peritoneal dialysis is one of the available treatment options to remove waste products and excess fluid from your body when the kidneys are no longer functioning. Another treatment option is hemodialysis where the toxins and excess fluid are removed from the blood via a hemodialysis machine. The best treatment option is a kidney transplant where a new kidney is put inside your body. You will have to discuss with your attending Nephrologist on which treatment option is best for you.
What is Peritoneal Dialysis?
Peritoneal dialysis is the removal of toxins and extra fluid from your body using the peritoneal membrane as a filter. The peritoneal membrane is the natural lining of your abdomen that surrounds most of your organs. The peritoneal membrane has a good blood supply and can act as a filter to enable dialysis to take place. A soft tube, called a catheter, is surgically placed in your abdomen. This catheter makes it possible for you to connect to a special tubing allowing 2 litres of cleansing fluid (called dialysate) to flow into your abdomen. The dialysate usually stays in your abdomen for a few hours (dwell time) and during this dwell time wastes and extra fluid pass through the peritoneal membrane into the cleansing fluid. During the dwell time, the catheter is capped and you can continue your usual activities. After your dwell time, you drain the cleansing fluid from your abdomen into an empty bag and discard it. You then repeat the in-and-out process usually 4 times a day using fresh dialysate. The process of exchanging bags (called an exchange) usually takes 20 to 30 minutes.
The training staff at your peritoneal dialysis centre will teach you everything you need to know about how to do the exchanges, order supplies, clean your catheter and guard against infection. Once you and the training staff are comfortable with your ability to do the peritoneal dialysis on your own, you can start doing your own treatment at home.
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Types of Peritoneal Dialysis therapy
There are 2 types of peritoneal dialysis treatment – continuous ambulatory peritoneal dialysis (CAPD) and automated peritoneal dialysis (APD).
CAPD is carried out by hand every day. There are usually 4 exchanges of dialysate during the day – first thing in the morning, around lunch time, before dinner time and before going to bed at night. You can carry out normal daily activities in between the bag exchanges. Since you do not have dialysis sessions at a dialysis unit, you can do your own treatment at home, at work or on holiday. Automated peritoneal dialysis (APD) requires a machine to fill and drain your abdomen; performing three to five exchanges during the night while you sleep. The process usually lasts 8–10 hours. You will need to prepare the machine before you go to bed. This takes about 20 to 30 minutes. When you go to bed, you attach your catheter to the lines on the machine. While you are sleeping the machine will perform the 3 to 5 bag exchanges overnight. Every morning, the machine will fill your abdomen with dialysate for the last time and this dialysate will sit in your abdomen for the whole day till your next treatment at night. On waking up in the morning you can detach your catheter from the machine and discard the used lines and bags of fluid.
GET TO KNOW YOUR PD CARE TEAM
Your nephrologist is your kidney doctor. He or she will discuss with your treatment options, your dialysis prescription and medicines. You will meet with your nephrologist often to check on your kidney health and make any necessary changes to your care plan.
The nephrology nurse is a registered nurse who is trained to take care of kidney patients. The nurse will teach you how to do PD at home and will plan, coordinate and oversee your care. You may contact a nephrology nurse on any questions you have or help you need.
Your renal dietitian can help you meet your specific and unique nutrition needs. Your renal dietitian will help you understand what types of food and drinks are healthy for you and how to control the amount of fluids that you take. He or she will also help you plan how much of each nutrient you should eat per day.
Nephrology social worker
Your social worker will support you in many ways as you go through dialysis. Social workers provide emotional support to you and your family, help you to communicate your needs to the other members of your care team and help you to find the resources to improve your quality of life. If you have financial difficulties, for example, your social worker can help you apply for financial assistance programmes.
The National Kidney Foundation of Malaysia (NKF) is a non-profit charity organization that was established in 1969. The vision of NKF is to be a one-stop National Resource Centre for the prevention and treatment of kidney diseases. Over the past 47 years, the NKF has organized various programmes on the prevention, early detection and treatment of kidney disease. The NKF mission is also to promote organ donations, kidney transplants and medical research into kidney diseases. The National Kidney Foundation of Malaysia has assisted thousands of financially poor kidney failure patients with access to quality haemodialysis treatment in its nationwide network of haemodialysis centres for the past 22 years.
In 2016 the National Kidney Foundation of Malaysia launches the NKF Peritoneal Dialysis Financial Assistance Programme to provide financial assistance to poor Malaysians with kidney failure to have access to peritoneal dialysis treatment. The amount of financial assistance given to patients under this programme will depend on the patient’s financial status as assessed by the NKF Welfare Department.
Who is eligible to apply for the NKF PD Financial Assistance Programme?
Poor kidney failure patients in government hospitals, university hospitals and private medical centres who meet the following requirements are encouraged to apply to the NKF for financial assistance for their peritoneal dialysis treatment :
Which peritoneal dialysis centres are affiliated with the NKF PD Financial Assistance Programme?
You can check with your Consultant Nephrologist on whether the peritoneal dialysis centre in which you intend to receive peritoneal dialysis treatment is an affiliated PD centre for the NKF PD Financial Assistance Programme. Each affiliated PD centre has to meet certain professional standards including manpower requirements, equipment and facilities requirements and operational requirements. These requirements are put in place to ensure that quality peritoneal dialysis treatment will be provided to patients receiving financial assistance from the NKF PD Financial Assistance Programme. Peritoneal dialysis centres can contact NKF regarding further information on affiliation status.
How to apply for the NKF PD Financial Assistance Programme?
The patient will fill in the appropriate application form and submit this form together with the necessary financial documents, medical report from the referring Consultant Nephrologist and quotation from the relevant peritoneal dialysis company on the appropriate peritoneal dialysis dialysate and consumables to the NKF Welfare Department. A Socio-Economic report from the Medical Social Work department of the referring medical institution (if available) can also be submitted with the completed application form.
The NKF Welfare Department will acknowledge receipt of the application form and schedule an appointment for a personal interview. The NKF Welfare Officer may make a home visit to complete her assessment. After the interview process, the NKF Welfare Department will inform each applicant of the outcome of his/her application within 14 working days.
Upon approval of the application, the NKF will inform the relevant peritoneal dialysis company to deliver the peritoneal dialysis dialysate and consumables to the patient’s home. The PD supply company shall issue an invoice to NKF after each monthly delivery.
For further information, kindly contact:
National Kidney Foundation of Malaysia
70 Jalan 14/29, 46100 Petaling Jaya, Selangor