Should older patients be offered peritoneal dialysis?
“Physicians really should consider a home-base peritoneal dialysis for older patients because they appear to cope with it very well and it intrudes less into their life,” Dr. Brown said. “They can learn how to do the technique and it gives them independence, and of course it costs less [than in-center HD].”
How often should peritoneal dialysis be performed?
In continuous ambulatory peritoneal dialysis (CAPD), an exchange is usually done 3 to 4 times each day, every 4 to 6 hours. Each exchange takes about 30 minutes. Usually, the dialysate fluid is also put into the belly at night and drained out in the morning. Here is an example of a typical CAPD schedule:
Can peritoneal dialysis be done at home?
We had heard that home peritoneal was easier on the heart than traditional ... three times per week at a dialysis center. Peritoneal dialysis is done by the person, and can be done either at nighttime or continuously during the day, which means much ...
What is the lifespan on peritoneal dialysis?
• The average life expectancy of someone receiving kidney dialysis is 4.25 years. • The 10 year kidney dialysis life expectancy is 23%. (Mailloux LU,et el. Clin Nephrol. 1994 Aug;42(2):127-35.) Kidney Dialysis Life Expectancy. It might be hard to read such statistics, but I believe knowing such statistics can give you a chance to change your life.
Is obesity a contraindication for peritoneal dialysis?
Some view obesity as an absolute or relative contraindication to peritoneal dialysis (PD), with the main concerns being metabolic complications, infectious complications, PD fluid leaks, lower dialysis adequacy, and lower patient survival.
Which of the following is the most common complication of peritoneal dialysis?
The most frequent and important complication of peritoneal dialysis (PD) catheters is infection, which may result in catheter loss and discontinuation of PD [1,2]. However, some evidence suggests that the transfer to hemodialysis for these reasons may be decreasing.
What are the indications and complications of peritoneal dialysis?
Complications of peritoneal dialysis can include: Infections. An infection of the abdominal lining (peritonitis) is a common complication of peritoneal dialysis. An infection can also develop at the site where the catheter is inserted to carry the cleansing fluid (dialysate) into and out of your abdomen.
Is peritonitis a contraindication for peritoneal dialysis?
Absolute contraindications for PD are the following: recent abdominal or cardiothoracic surgery, diaphragmatic peritoneal-pleural connections, faecal or fungal peritonitis.
What are the contraindications for a renal transplant?
Absolute contraindications for kidney transplantation are the inability to tolerate surgery due to severe cardiac or pulmonary disease, active malignancy, active infection, active drug abuse, and uncontrolled psychiatric disease.
What are the side effects of peritoneal dialysis?
The most common side effects of peritoneal dialysis include peritonitis, hernia, blood sugar changes, potassium imbalances, and weight gain. Report any symptoms you experience during treatment to your care team. They can help you manage them with dietary and lifestyle changes.
What are the contraindications of hemodialysis?
Absolute contraindication to hemodialysis is the inability to secure vascular access, and relative contraindications include:Difficult vascular access.Needle phobia.Cardiac failure.Coagulopathy.
When is peritoneal dialysis indicated?
Why do I need peritoneal dialysis? You need treatment because your kidneys no longer clean enough wastes from your blood and remove extra fluid from your body. Even though people with kidney failure may still have some kidney function, it's not enough and without treatment you will die.
What is the criteria for peritoneal dialysis?
There are only two absolute contra-indications for peritoneal dialysis: the absence of a functional peritoneal membrane and lack of a suitable home environment.
What are indications for dialysis?
Indications for Starting Renal Replacement Therapy There is relatively little difference in opinion about intractable hyperkalaemia, acidosis, uraemic symptoms (nausea, pruritus, malaise) and therapy-resistant fluid overload being firm indications to commence dialysis.
When do you use hemodialysis vs peritoneal dialysis?
Peritoneal dialysis offers continuous filtration and does not require as much disruption to your daily activities. However, hemodialysis is ideal for patients with less kidney function. Peritoneal dialysis is not a good option for obese patients or people who have abdominal scarring.
Can you do peritoneal dialysis with a colostomy?
BELIEF: Patients with an ostomy can't do PD. FACT: Although there are concerns about leaks and catheter or exit site infection from urine or feces contamination, one study found reasonable outcomes for PD in patients with ostomies.
What is peritoneal dialysis?
Renal replacement with continuous ambulatory peritoneal dialysis allows patients the freedom to perform dialysis independently and improving their daily life. Peritoneal catheters are placed using variety of modalities by surgeons, nephrologists and interventional radiologists. The technique used for catheter placement plays an important role in the success of peritoneal dialysis, as mechanical complications related to the insertion technique are among the leading causes of peritoneal dialysis failure and need for hemodialysis. With the introduction of less invasive techniques, the use of open insertion technique has fallen to 27% in the United States; however, it continues to remain the main technique used at certain hospitals worldwide and for certain patient populations. One benefit of open peritoneal dialysis catheter insertion is the ability to perform the operation under local anesthesia. This technique, however, is not ideal for patients with severe intraabdominal adhesions, obesity, and abdominal wall defects. Catheter-related outcomes of open peritoneal dialysis catheter placement technique are superior to blind percutaneous insertion method, but inferior to basic and advanced laparoscopic insertion techniques. In this chapter, we describe the history, peri-operative considerations, operative technique and outcomes of open peritoneal dialysis catheter insertion method.
What is the global utilization of peritoneal dialysis?
Global utilization of peritoneal dialysis ranges from 6% to 91% in various parts of the world. This paper reviews the indications and contraindications for chronic peritoneal dialysis (PD), providing evidence when available, and recommendations based on the considerable experience of the authors when evidence is lacking. Strong indications for PD include obligate situations such as vascular access failure and intolerance to hemodialysis (HD); medical preferences such as congestive heart failure, prosthetic valvular disease, and children aged 0-5 years; and social situations such as patient preference and living far from an in-center dialysis unit. The situations where PD is preferred include bleeding diathesis, multiple myeloma, labile diabetes, chronic infections, possibility of transplantation in the near future, age between 6 and 16 years, needle anxiety, and active lifestyle. Situations where PD is not preferred but possible with some special considerations include obesity, multiple hernias, serve backache, multiple abdominal surgeries, impaired manual dexterity, blindness, less-than-ideal home situation, and depression. Relative contraindications for PD include patients with severe malnutrition, multiple abdominal adhesions, ostomies, proteinuria >10 g/day, advanced COPD, ascites, presence of a Le Veen or ventriculo-peritoneal shunt, upper limb amputation with no help at home, poor hygiene, dementia, and those who are homeless. PD is contraindicated in patients with documented Type II ultrafiltration failure, severe inflammatory bowel disease, active acute diverticulitis, abdominal abscess, active ischemic bowel disease, severe active psychotic disorder, marked intellectual disability, and in women starting dialysis in the third trimester of pregnancy. In most of the remaining situations, either HD or PD is equally preferred. To take full advantage of the advances that have occurred over the past decade, successful PD requires committed and knowledgeable physicians and nurses, and a center with at least 20-25 patients on this modality.
What is the best treatment for renal failure?
Patients with chronic renal failure may necessitate renal replacement therapy. Probably, the most advantageous therapy in terms of survival is kidney transplantation, but no more than 30 to 40% of patients are suitable for it. Therefore, more than two thirds of patients require chronic haemodialysis or peritoneal dialysis. Both methods seem to offer adequate replacement of renal function, at least for a certain period. Peritoneal dialysis is a form of self-treatment that allows a more independent life style. Currently, it is used by approximately 14% of the dialysis population worldwide. Via diffusion, ultrafiltration and convective forces, the regularly changed intraabdominal dialysate eliminates solutes, salts and fluid from the systemic circulation, thereby enabling adequate detoxification. Various technical systems, manual and automated, are available to perform dialysate exchanges. Volume and composition of the dialysate are tailored according to the individual patient's needs. Potential infectious complications are peritonitis, tunnel- and exit-site-infection. Accurate care is needed to keep the rate of infection acceptably low (e.g. peritonitis rate: 1 per 2 to 5 patient years). Although the complications are different from those of haemodialysis, the morbidity of technique related complications measured by in-hospital days per year is virtually identical. Non-infectious complications include an increased incidence of herniation, overhydration, haemoperitoneum and back pain. In conclusion, peritoneal dialysis may be recommended to patients with chronic renal failure, especially when this treatment modality is seen as part of an integrated care approach.
What is PD in kidney transplant?
4,5 Peritoneal dialysis (PD) is currently considered the preferred treatment for patients with congestive heart failure, vascular access failure and as a short time bridging therapy to kidney transplantation. 6 The long-term durability of peritoneal dialysis is determined by a solid and functional peritoneal access. Complication-free access depends largely upon a meticulous catheter placement technique and rigorous attention to detail at the time of implantation. ...
How many ports are needed for a PDC?
Abstract Background Different laparoscopic approaches for insertion of a peritoneal dialysis catheter (PDC) have been adopted. Most of these techniques require 2–3 ports. One port laparoscopic technique for PDC placement was introduced by some authors to minimize potential complications. The main drawback of these techniques was the inadequate position of catheter tip and hence affecting its efficacy. The purpose of this study is to evaluate a simple modified laparoscopic technique during insertion of PDC. Results The mean age of these patients was 6 ± 4.1 years. There were 11 females. The mean body weight was 13 ± 3.3 kg. The mean operative time was 35.5 min. No operative complications occurred. Two cases had catheter obstruction. Wound infection developed in three cases. Mean follow-up period was 11 ± 5.3 months Conclusions Laparoscopic insertion of PDC in children suffering end-stage renal disease using a pre-tied catheter tip with V-loc/STRATAFIX ® size 3/0 suture and two-port-only technique was associated with shorter operative time and longer life of catheter without migration or catheter malfunction.
Is HD or PD better for ESRD?
Although HD is the most common dialysis modality in the United States, in some studies PD has shown a survival advantage over HD, at least in the first 2 years of dialysis treatment, especially in non-diabetic patients and in young patients with diabetes. Other advantages accrue to early PD use in many patients. An integrated care approach with "healthy start" and PD as the initial renal replacement therapy, followed by timely transfer to HD once complications arise, may improve the long-term survival of ESRD patients.
Is peritoneal dialysis better than hemodialysis?
It has been reported that pretransplantation peritoneal dialysis was correlated with a better recovery of graft function than hemodialysis in adult kidney recipients. However, the effect of pretransplantation dialysis mode (PDM) seemed to be unclear on the early outcome of KT in pediatric recipients.
What happens if you have peritoneal dialysis?
It's also likely that people using peritoneal dialysis will eventually have a decline in kidney function that requires hemodialysis or a kidney transplant.
Why is peritoneal dialysis important?
Greater lifestyle flexibility and independence. These can be especially important if you work, travel or live far from a hemodialysis center. A less restricted diet. Peritoneal dialysis is done more continuously than hemodialysis, resulting in less accumulation of potassium, sodium and fluid.
How to improve dialysis results?
Increase the amount of dialysate you use for each exchange. Use a dialysate with a higher concentration of dextrose. You can improve your dialysis results and your overall health by eating the right foods, including foods low in sodium and phosphorus. A dietitian can help you develop an individualized meal plan.
How long does dialysis stay in your body?
During peritoneal dialysis: The dialysate flows into your abdomen and stays there for a prescribed period of time (dwell time) — usually four to six hours. Dextrose in the dialysate helps filter waste, chemicals and extra fluid in your blood from tiny blood vessels in the lining of your abdominal cavity.
How long should I wait to put a catheter in my belly?
The tube is usually inserted near your bellybutton. After the tube is inserted, your doctor will probably recommend waiting up to a month before starting peritoneal dialysis treatments to give the catheter site time to heal.
What is the fluid that is drawn out of the body during peritoneal dialysis?
Overview. During peritoneal dialysis, a cleansing fluid (dialysate) is circulated through a tube (catheter) inside part of your abdominal cavity (peritoneal cavity). The dialysate absorbs waste products from blood vessels in your abdominal lining (peritoneum) and then is drawn back out of your body and discarded.
What is the purpose of dialysis?
Peritoneal dialysis (per-ih-toe-NEE-ul die-AL-uh-sis) is a way to remove waste products from your blood when your kidneys can't adequately do the job any longer.
How long should you wait to use peritoneal dialysis?
Timing of placement of peritoneal dialysis access. Optimally, one should wait at least 2 weeks from the time of placement of the catheter before it is used for full-volume peritoneal dialysis (‘break-in’ period). This allows for adequate healing of the tunnel tract and minimizes the risk of leaks.
How long does peritoneal dialysis take?
The initiation of peritoneal dialysis should be delayed by 4-6 weeks in patients who have had surgical repair of abdominal aortic aneurysm. After the initial post-operative period, peritoneal dialysis may be safer than starting hemodialysis with a central venous catheter. Since the aorta is retro-peritoneal, the prosthetic graft is unlikely to be infected if the patient was to develop peritoneal dialysis-related peritonitis. On the other hand, the graft is significantly more likely to be infected in the setting of bacteremia – not an uncommon complication in patients with central venous catheters.
How long can a peritoneal catheter be buried?
The external limbs of peritoneal dialysis catheters have been successfully buried for up to 3 years ; however, it is preferable to bury the external limb of the catheter only if the anticipated interval between the time of placement of the catheter and the need for dialysis is between 6 weeks and 6 months.
How often do you ship dialysis supplies?
The patient must have sufficient space at home to store supplies for performing peritoneal dialysis. Monthly supplies take up roughly as much space as a refrigerator. In the United States, manufacturers generally ship supplies to a patient’s home once a month; in patients with space constraints at home, the frequency of delivery of supplies can be increased to once every 15 days.
What are the different types of PD patients?
There are three types of PD patients: those that start their dialysis therapy with PD; those who turn to PD after complications from HD; and those who turn to PD after a failed transplant. It is important to remember that modality education should be offered to each group and patients should be reminded that there are options when it comes to ...
Can peritoneal dialysis be used for polycystic kidney disease?
While hernias may be more common, they are readily treatable and peritoneal dialysis can be performed peri-operatively. Hence, a diagnosis of polycystic kidney disease generally should have no bearing on selection of dialysis modality.
Does dialysis affect weight gain?
The effect of peritoneal dialysis on glycemic control, potential for weight gain, and patient longevity are important to consider. Glucose absorption from the peritoneal dialysate and increased nutrient intake after the amelioration of uremic anorexia with the start of dialysis treatment has the potential to influence glycemic control. In most patients, this can be readily managed with appropriate adjustment of medical therapy.
What is the responsibility of peritoneal dialysis?
Peritoneal dialysis requires responsibility on the part of the patient. Peritoneal dialysis patients must adhere to their treatment schedules, be compliant with monthly clinic visit appointments, and order their own monthly supplies.
What is kidney dialysis?
The word 'dialysis' usually refers to hemodialysis (kidney dialysis) that uses an external machine to clean the blood. However, this requires that a patient acquires a vascular access, such as a fistula or a graft. This access is stuck with a large bore needle every time a patient receives dialysis, usually three times per week.
Can peritoneal dialysis cause scarring?
Contraindications for peritoneal dialysis may include patients who have significant abdominal scarring from previous abdominal surgeries. Diabetic patients with poor glucose control may not be good candidates either, as some of the glucose from the dialysate diffuses into the blood and may contribute to higher blood glucose levels.
Why It's Done
- You need dialysis if your kidneys no longer function well enough. Kidney damage generally progresses over a number of years as a result of long-term conditions, such as: 1. Diabetes 2. High blood pressure 3. Kidney inflammation (glomerulonephritis) 4. Multiple cysts in the kidneys (polycystic kidney disease) In hemodialysis, blood is removed from the body, filtered through a …
- Complications of peritoneal dialysis can include: 1. Infections.An infection of the abdominal lining (peritonitis) is a common complication of peritoneal dialysis. An infection can also develop at the site where the catheter is inserted to carry the cleansing fluid (dialysate) into and out of your abdomen. The risk of infection is greater if the pe...
How You Prepare
- You'll need an operation to insert the catheter that carries the dialysate in and out of your abdomen. The insertion might be done under local or general anesthesia. The tube is usually inserted near your bellybutton. After the tube is inserted, your doctor will probably recommend waiting up to a month before starting peritoneal dialysis treatments to give the catheter site tim…
What You Can Expect
- During peritoneal dialysis: 1. The dialysate flows into your abdomen and stays there for a prescribed period of time (dwell time) — usually four to six hours 2. Dextrose in the dialysate helps filter waste, chemicals and extra fluid in your blood from tiny blood vessels in the lining of your abdominal cavity 3. When the dwell time is over, the solution — along with waste products draw…
- Many factors affect how well peritoneal dialysis works in removing wastes and extra fluid from your blood. These factors include: 1. Your size 2. How quickly your peritoneum filters waste 3. How much dialysis solution you use 4. The number of daily exchanges 5. Length of dwell times 6. The concentration of sugar in the dialysis solution To check if your dialysis is removing enough …