Peritoneal Dialysis

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Contents 1 Introduction 2 Indications 3 Contraindications 4 Procedure 5 Complications 6 More General Terms 7 Additional Terms 8 References

Introduction

• Comparison with hemodialysis
• advantages:

• does not require systemic anticoagulation
• produces less stress on the cardiovascular system
• fewer abrupt changes in blood pressure
• fewer abrupt changes in electrolytes
• allows greater patient independence
• ~$20,000/year less expensive than hemodialysis [5]

• disadvantages:

• less efficient, but outcomes similar [5]

Indications

• cardiovascular instability
• poor hemodialysis access
• patient preferences [3]

Contraindications

• recent abdominal surgery
• history of multiple abdominal surgeries with adhesions
• colostomy
• nephrostomy

Procedure

• CAPD uses the peritoneum as a dialysis membrane
• solutes are removed by diffusion into dialysate introduced into the peritoneal cavity through a catheter
• the osmotic gradient for dialysis is created by the addition of glucose to the dialysate
• higher glucose concentrations & more frequent exchanges increase the rate of fluid removal
  
• 2 liters of dialysate is infused into the peritoneal cavity.
• glucose concentrations are generally 1.5-4.25 g/ dL
• following a period of equilibration, the dialysate is drained
• sterile technique is necessary
  
• continuous ambulatory peritoneal dialysis ( CAPD) generally involves 4-5 exchanges/day performed by the patient, but the procedure may be performed hourly if indicated
• an automatic cycler is available to perform exchanges during sleep

Complications

• infections

• peritonitis (see bacterial peritonitis)
• infection of the catheter site

• hyperglycemia

• regular insulin may be added to the dialysate
• 2 units to 2 liters 1.5% dextrose
• 6 units to 2 liters of 4.25% dextrose

• protein loss

• hypoalbuminemia is common
• increase dietary protein to 1.2-1.4 g/kg/day

• catheter leak
• hyperlipidemia
• obesity
• pancreatitis 1.8%/year, 3-fold risk for hemodialysis [4]

• may be more common in blacks

More General Terms

• dialysis
• clinical procedure

Additional Terms

• bacterial peritonitis (BP)
• hemodialysis

References

1. Manual of Medical Therapeutics, 28th ed, Ewald & McKenzie (eds), Little, Brown & Co, Boston, 1995, pg 275
2. Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed) Lippincott-Raven, Philadelphia, 1998, pg 618
3. Journal Watch 24(6):45, 2004 Rubin HR et al, JAMA 291:697, 2004 PMID: [1] Heaf J, JAMA 291:740, 2004 PMID: [2]
4. Quraishi ER, Goel S, Gupta M, Catanzaro A, Zasuwa G, Divine G. Acute pancreatitis in patients on chronic peritoneal dialysis: an increased risk? Am J Gastroenterol. 2005 Oct;100(10):2288-93. PMID: [3]
5. Mehrotra R et al. Similar outcomes with hemodialysis and peritoneal dialysis in patients with end-stage renal disease. Arch Intern Med 2010 Sep 27 <PubMed> PMID: [4] <Internet> [5]
   - Kutner NG et al. Patient awareness and initiation of peritoneal dialysis. Arch Intern Med 2010 Sep 27; <PubMed> PMID: [6] <Internet> [7]
   - Johansen KL. Choice of dialysis modality in the United States. Arch Intern Med 2010 Sep 27 <PubMed> PMID: [8] <Internet> [9]
6. Peritoneal Dialysis Dose and Adequacy [10]
   - Treatment Methods for Kidney Failure: Peritoneal Dialysis [11]
7. National Guideline Clearinghouse NKF-KDOQI clinical practice guidelines for peritoneal dialysis adequacy: update 2006. (National Kidney Foundation) ngc-guideline: [12]
   - Vitamin D in dialysis patients. Caring for Australasians with Renal Impairment ngc-guideline: [13]
   - Peritoneal dialysis. Peritoneal dialysis in the treatment of stage 5 chronic kidney disease. National Institute for Health and Clinical Excellence (NICE) ngc-guideline: [14]

peritoneal dialysis; continuous abdominal/ambulatory (cycling) peritoneal dialysis (CAPD, CCPD)