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Peritoneal Dialysis

Peritoneal Dialysis

PERITONEAL DIALYSIS

Kidney failure occurs due to several different reasons to countless different people. Each patient must take the active role in understanding and choosing the treatment that best suits them and for the duration of their own care. The patient is the most important part of the health care team. With the support and guidance of their family and friends, group of professionals such as their doctors, nurses, and other medical team member, the patient will never be alone.

Most people have two kidneys, one located at either side of the spine. Their major role is to clean the blood. Each of the kidneys has over a million processing units, called nephrons. As the blood passes through the nephrons, water, salts and other wastes are removed from the body. Aside from these functions, the kidneys also help balance body fluid and chemical levels, keep valuable substances, and release hormones that control blood pressure, produce red blood cells and maintain healthy bones.

When kidneys fail, toxic wastes starts to build up in the blood. Fluid accumulates causing tissue swelling, congestion and high blood pressure. You will feel tired or weak, and lose appetite. Common causes of Chronic Kidney disease include Diabetes Mellitus, High blood pressure, Glomerulonephritis and a hereditary disease called Polycystic kidneys. When kidneys no longer function sufficiently to meet daily needs, the treatment options includes dialysis or transplantation. Neither of these cures nor treats the initial cause of kidney failure.

Kidney dialysis helps to remove these wastes and excess fluid that accumulate in the body when the kidney stops functioning. There are two types of kidney dialysis: hemodialysis (HD) and peritoneal dialysis (PD).

In Peritoneal dialysis, instead of being cleaned by an artificial membrane outside the body, the blood is cleaned inside the body, through the peritoneum, the lining of the abdomen. It allows waste products to pass through it and is very rich in small blood vessels. It acts as a filter. A tube, called the catheter, is surgically placed through the walls of the abdomen. About 3-4 inches of the catheter extends out of the body. The catheter is the permanent access during PD.  With proper training, PD can be performed as a home therapy.

During treatment, a special dialysis solution, called dialysate, flows through the catheter into the peritoneal cavity. While the dialysate is left there for a period of time, waste products and excess fluids pass from the blood through the peritoneal cavity into the dialysis solution. The peritoneal membrane acts as a filtering device similar to the dialyzer in hemodialysis or that of the kidneys. These wastes then leave the body when the used solution is drained from the abdomen.

Each cycle consists of:

a)        Filling-in of the fresh dialysis solution into the peritoneal cavity,

b)        Few hours of dwell time to allow the waste products and excess fluids to move into the dialysis solution contained in the cavity, and

c)        ‘Exchange’ - draining out of the used dialysate containing the waste products and the excess fluids.

 

There are two types of peritoneal dialysis:

a)        Continuous Ambulatory Peritoneal Dialysis (CAPD)

b)        Automated Peritoneal Dialysis (APD)

 

In CAPD, the manual form of PD, most patients need three to four exchanges per day, lasting up to thirty minutes with each exchange. Patients are free to carry out their normal chores (and are therefore ‘ambulatory’) between the exchanges. The patient connects himself/herself to a disposable ‘Twinbag’, a pre-connected system of a fresh dialysis solution bag (for filling-in) and an empty drain bag (for draining out the dialysate from the cavity). It does not require a machine; the process uses gravity to fill and empty the abdomen. After the exchange is over, the used ‘Twinbag is simply discarded and the patient moves around freely without any bags or tubings.

While APD, a variation of PD, is a treatment wherein the tubings and the solution bags are attached to a small portable machine. The patient connects himself/herself to the tubings and the machine automatically performs dialysis treatment making several exchanges throughout the night. Many patients on APD have their day free of dialysis and, therefore, enjoy a better quality of life with a greater degree of control over their schedules.

 

Advantages of PD:

 Freedom/Control over schedule since the procedure may be home-based. Suitable for active patients who want to continue to work and be active, socially and economically

 Less restricted diet, because the treatment ensures continuous removal of toxins and wastes

 Possibly the option of remote patient living far away from hospital set-up who are for regular dialysis

 No needles, not like in HD

 Preserves residual renal function (any urine that the patient may still be producing) better which may lead to improved long term survival.

Requiring lower doses of erythropoietin (for many PD patients) as compared to HD patients

Well suited for cardiac patients due to continuous removal of fluid

 

PD has grown to be successful and reliable option for kidney failure therapy. With this, Davao Doctors Hospital, together with the hospital’s unfaltering commitment of continually advancing its services, has chosen to create a Peritoneal Dialysis (PD) Center that will cater to dialysis patients and even conduct trainings regarding PD for patients who wants to do dialysis at the comfort of their home.  

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