Peritoneal Dialysis
What is Peritoneal Dialysis (PD)?
Peritoneal Dialysis (PD) is a type of dialysis used for patients with kidney failure, offering an alternative to hemodialysis. It’s commonly performed at home and involves the peritoneum, a thin membrane lining the abdominal cavity, which acts as a natural filter for blood purification.
Types of Peritoneal Dialysis:
Intermittent Peritoneal Dialysis (IPD)
Overview: IPD is used for short-term dialysis in emergencies, children, or initial ESKD treatment. It involves inserting a catheter into the abdomen and infusing dialysate fluid into the peritoneal space. This fluid absorbs waste and excess fluids, which are then drained and replaced multiple times a day.
Duration: IPD lasts 24-36 hours, with around 30-40 litres of dialysate used. It’s repeated every 1-3 days depending on patient needs.
Continuous Ambulatory Peritoneal Dialysis (CAPD)
Overview: CAPD is a home-based dialysis method where the patient performs dialysis without a machine. It involves a permanent catheter and a three-step process: filling, dwelling, and draining.
Process:
Fill: Dialysate fluid is infused into the abdomen through a catheter.
Dwell: The fluid remains in the abdominal cavity for 4-6 hours during the day and 6-8 hours at night, allowing waste removal.
Drain: The used fluid is drained and replaced with a fresh solution. This process is repeated 3-5 times daily, with one overnight exchange.
Automated Peritoneal Dialysis (APD) or Continuous Cycling Peritoneal Dialysis (CCPD)
Overview: APD, or CCPD, uses a machine to automate fluid exchanges at night while the patient sleeps. This method typically involves 4-5 exchanges and takes 8-10 hours.
Advantages: Allows daytime freedom and reduces the risk of infections compared to manual CAPD.
PD Fluid
- Composition: PD fluid, or dialysate, is a sterile solution containing glucose and minerals. Glucose helps remove excess fluid from the body. Different concentrations (1.5%, 2.5%, and 4.5%) are used based on the patient’s fluid removal needs. Some newer solutions use icodextrin for slower fluid removal, suitable for diabetic or overweight patients.
CAPD: Complications, Advantages, and Disadvantages
Common Problems:
- Infections: Peritonitis is a common complication characterised by abdominal pain, fever, and cloudy fluid. Prevention involves strict hygiene, and treatment includes antibiotics and possibly catheter removal. Other issues include abdominal distention, hernia, fluid overload, constipation, and scrotal oedema.
Advantages:
- Convenience: PD can be performed at home, allowing flexibility with daily activities.
- Fewer Restrictions: Dietary and fluid restrictions are less stringent than with hemodialysis.
- Comfort: Continuous dialysis avoids the discomfort of intermittent hemodialysis sessions.
Disadvantages:
- Infections: Risk of peritonitis and catheter site infections.
- Maintenance: Requires meticulous daily care and regular procedures.
- Side Effects: Potential weight gain, elevated blood sugar, and inconvenience of handling solution bags.
Dietary Recommendations for CAPD Patients
- Protein Intake: Increased to counteract protein loss.
- Calories: Sufficient intake to prevent malnutrition but avoid excessive weight gain from glucose in PD fluid.
- Salt and Fluid: Restricted but generally less than for hemodialysis patients.
- Potassium and Phosphorus: Controlled dietary intake.
- Fibre: Increased to prevent constipation.
Increased to prevent constipation.
- Symptoms: Abdominal pain, fever, chills, cloudy or bloody fluid.
- Site Issues: Pain or infection around the catheter exit site.
- Problems: Difficulty with fluid infusion or drainage, constipation, unexpected weight changes, or symptoms of fluid imbalance.
Peritoneal dialysis offers flexibility and can be performed independently, but it requires careful management to avoid complications and ensure effective treatment.
