Urologic Diseases
Peritoneal Dialysis (PD)
 

​Introduction:

Peritoneal dialysis (PD) is a way to remove waste products from the blood when the kidneys can't adequately do the job any longer. During peritoneal dialysis, a cleansing fluid flows through a tube (catheter) into part of your abdomen. The lining of your abdomen (peritoneum) acts as a filter and removes waste products from your blood. After a set period of time, the fluid with the filtered waste products flows out of your abdomen and is discarded. These treatments can be done at home, at work or while traveling.

Names of the process:
Peritoneal dialysis (PD)

PD methods:
Continuous ambulatory peritoneal dialysis (CAPD):
The patient needs to exchange the dialysate three or four times per day. Each exchange takes 30-40 minutes, and with a dwell time (inside the abdomen) of 3-4 hours each.
Automated peritoneal dialysis (APD):
This method uses a machine that performs exchanges at night during sleep.

PD duration:
The duration varies depending on the PD method.

PD is recommended for patients who:
  • Are willing to avoid frequent incision, and dealing with the blood;
  • Want to minimize the disruption of your daily activities;
  • Want to work or travel more easily;
  • Have some residual kidney function.

PD is not recommended for patients under the following circumstances:
  • Extensive surgical scars in your abdomen;
  • Previous surgeries in the abdomen;
  • Weakened abdominal muscle (hernia);
  • Inflammatory bowel disease or frequent bouts of diverticulitis;
  • Malnutrition, and lack of proteins;
  • Obesity.

Components of the PD device:
  • Catheter: The catheter is a tube inserted into the abdomen before the start of PD procedures (of both methods), and remains connected the body constantly.
  • Dialysis solution (dialysate): A solution composed of water, and other elements prescribed by the doctor, varying in accordance with the patient’s condition, such as dextrose etc. The dialysate is filled in 1.5-3-liter containers, and should be warmed before use.
  • PD device: It is a device for automated peritoneal dialysis (APD) only. It pumps and drains the dialysate during sleep.

Preparing for PD: 
The surgeon will insert a catheter that carries the dialysate in and out of your abdomen.
After the tube is inserted, the patient needs to wait for 10-20 days before having the first dialysis procedure, until the catheter time heals.

How PD works?
Dialysate inflow:
The patient pumps the dialysis solution (dialysate) into the abdomen through a tube (catheter), and then disconnects the catheter from the dialysate, so that he or she can perform the daily activities. The dialysate absorbs the wastes and extra fluids through the peritoneum over several hours.
Dialysate drainage:
Once the dialysis duration is over, the patient should connect the catheter to drain the dialysate, along with the wastes.

Side effects:
Infections:
An infection of the abdominal lining (peritonitis) is a common complication of peritoneal dialysis. Infection takes place when the catheter, or the catheter area, is contaminated. The infection symptoms include: abdominal pain, fever, vomiting, nausea, redness and pain in the catheter area, coloring of the dialysis solution after drainage from the body, and discharge from the catheter.
Weight gain:
This is because the dialysate contains sugar (dextrose).
Hernia: 
Holding fluid in the abdomen for long periods may strain the abdominal muscles.
Inadequate dialysis: 
Peritoneal dialysis can become ineffective after several years. The patient might need to switch to hemodialysis.

Effective of PD can be measured through:
  • Weight measurement;
  • Blood pressure measurement;
  • Lab tests:
o To determine how much the PD is effective, a clearance test is conducted during the first week, by analyzing a sample from the waste dialysate (within 24 hours), and another sample from the blood within the same period, to measure the wastes in them. A sample may be taken from the urine (if there is a sufficient quantity), to measure its concentration.
o Other tests, including: kidney function test, kidney filtration rate, albumin test, hemoglobin test, transferrin test, parathyroid gland hormone test, and measuring the potassium and calcium rate in the blood. 

If PD proves to be inadequate:
The healthcare provider may:
  • Increase the number of PD procedures per day;
  • Increase the quantity of the dialysis solution (dialysate);
  • Increase the concentration of the dialysate.

Tips to be followed when conducting PD at home:
  • Make sure the place is clean;
  • Prepare the tools before starting the dialysis procedure;
  • Wash your hands carefully (with water and soap) before starting the PD procedure;
  • Dry your hands, and avoid contact with anything not related to the dialysis.
  • Avoid sneezing or scratching at the PD instruments, and get rid of them if this occurs;
  • Follow the instructions as they are, and try any change until after consulting the healthcare provider.

General tips:
o Consult a nutritionist regarding the weight gained owing to the dextrose sugar, of if you are a diabetic;
o Care for the catheter, by:
Making sure, every day, that the catheter is functioning properly;
Avoid tight clothes or belts around the access (of the catheter);
Keep it away from sharp objects;
Clean the catheter every day by using water and soap;
Don’t remove, pull or push the catheter.

FAQ
Is it harmful to skip or forget a PD procedure?
Yes, skipping or forgetting PD procedures leads to accumulating toxic wastes in the body, which affects the peritoneum.
- Is PD painful?
No, PD is not painful.

Myths & Realities:
- Power outages during APD disrupts the dialysis procedure.
Reality: Not true.​



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