What Is Peritoneal Dialysis?

Introduction

Hemodialysis is a well-known dialysis method.  Simply put, it takes the patient's blood out of the body, removes excess water and toxins through the machine, and then transports the blood back into the body.  This is equivalent to the patient's own kidney failure.  The blood is put into a machine outside the body, which replaces the kidney function, and the "purified" blood is returned to the patient.  Similarly, peritoneal dialysis is actually the process of replacing the external machine with your own peritoneum for dialysis.

The peritoneum is one of the human body's own tissues.  It wraps all the organs in our abdominal cavity and protects our internal organs from damage.  It is like a magical "sieve", retaining substances that are beneficial to the human body and expelling excess and harmful water.  and material.  Peritoneal dialysis uses the "sieve" function of the peritoneum.  By constantly replacing the dialysate, it is like clean and fresh water to "wash" out the toxins and waste left in the blood, thereby purifying the blood and replenishing the blood at the same time.  Substances needed by the human body.

How does peritoneal dialysis work?

Before starting peritoneal dialysis, a safe passage needs to be established for fluid exchange.  Therefore, the patient first needs to go to the hospital for an abdominal surgery and insert a peritoneal dialysis tube into the abdominal cavity.  This tube is called a peritoneal dialysis tube.  One end of the tube remains in the abdominal cavity, the middle section is buried under the skin, and the other end remains outside the abdominal wall.  Before discharge, patients will receive specific training, and specialized doctors and nurses will teach you how to perform peritoneal dialysis.

When the patient is at home, he needs to connect special dialysate pipes to each other, pour the dialysate into the abdominal cavity, and keep it for a period of time to allow the fresh dialysate to fully exchange with excess or harmful components in the blood.  At this time, the peritoneum is like a sieve.  It also removes excess water and toxins from the body into the dialysate in the abdominal cavity.

Then the toxin-containing dialysate is released through the peritoneal dialysis tube, and new dialysate is poured into the dialysate and circulated continuously, finally achieving the effect of peritoneal dialysis.  The real principle of peritoneal dialysis is to take advantage of the fact that the peritoneum is a semipermeable membrane with a large area and rich capillaries.  During the process of peritoneal dialysis, the blood and dialysate in the peritoneal capillary cavity are soaked in dialysate.  Extensive material exchange is carried out to remove metabolites and poisons from the body, and to correct imbalances in water, electrolytes, and acid-base balance.  In peritoneal dialysis, the main methods of material exchange for solutes are diffusion and convection, and water removal mainly relies on improving Osmotic pressure performs ultrafiltration.

What are the options for peritoneal dialysis?

CAPD (continuous ambulatory peritoneal dialysis) is currently the most commonly used peritoneal dialysis method in the world and is a 24-hour uninterrupted dialysis method.

Generally, routine CAPD exchanges dialysate 3-5 times a day, using 1.5-2L of dialysate each time. It is exchanged 3-4 times during the day, and the dialysate is left in the abdominal cavity for 4-6 hours each time; it is exchanged once at night and left in the abdominal cavity. Within 10-12 hours.

This solution ensures the continuity of peritoneal dialysis, allowing toxic substances in the blood to be continuously and slowly removed throughout the day, which is more consistent with normal kidney function. However, the shortcomings of this method are also obvious, that is, patients must constantly change dialysate regularly every day, which still has some impact on normal life, and CAPD has the disadvantages of manual operation contamination, and there is a certain limit to the increase in dialysis dose. APD (automated peritoneal dialysis) ) has shown a rapid growth trend in recent years in the West.

ADP dialysis mode requires patients to buy an automatic peritoneal dialysis machine and connect the machine to peritoneal dialysis tubes and peritoneal dialysate. The patient does not need to pour peritoneal dialysate into the abdominal cavity by himself. He only needs to set the parameters of the machine and perform dialysis. The machine will automatically inject dialysate into the abdominal cavity according to the set program to complete dialysis.

Therefore, ADP can perform dialysis at night while sleeping. The patient can connect the peritoneal tube to the machine during night rest or before going to bed, set the program, and the machine will automatically inject and drain fluid while the patient sleeps. ; After the treatment is completed in the morning, the pipeline is separated from the machine, and the patient can resume normal life and work.

What are the advantages of ADP compared with traditional peritoneal dialysis?

Compared with traditional peritoneal dialysis, ADP not only retains the advantages of CAPD, but also has advantages in the following aspects:

①The biggest advantage of automated peritoneal dialysis is that it uses machinery to complete the exchange of dialysate during peritoneal dialysis. The operation is simple and the patient can do it at home. It can be done while the patient is resting at night. It has little impact on work during the day and adjusts the patient's social role. , reducing mental stress, significantly better than traditional peritoneal dialysis.

②Automated peritoneal dialysis reduces a large number of manual operations during the dialysis process and reduces the chance of peritoneal contamination. The incidence of peritonitis is lower than that of traditional peritoneal dialysis.

③ADP can more flexibly adjust the frequency of peritoneal dialysis and the amount of dialysate infused to achieve better elimination of toxins and water. And studies have found that ADP has better ultrafiltration capacity and solute removal rate than CAPD, which means that ADP can better discharge water and toxins.

Therefore, automated peritoneal dialysis is more suitable than traditional peritoneal dialysis for patients who need to work normally during the day or need help from others, such as patients who need to go to school or go to work, children with high peritoneal transport, elderly patients with limited mobility or visual impairment, patients with abdominal Expansion affects people with psychological problems, etc.

Which patients are suitable for peritoneal dialysis?

First of all, there is no doubt that patients with acute kidney injury and chronic renal failure should undergo peritoneal dialysis as appropriate.

Secondly, many people actually want to know how to choose between hemodialysis and peritoneal dialysis?

①Because peritoneal dialysis does not require special equipment, has little impact on hemodynamics, has little impact on residual renal function, and does not require anticoagulation, peritoneal dialysis can be given priority to some patients with chronic renal failure, such as infants, children, and circulation. Functional instability, obvious bleeding or hemorrhage tendency, good residual renal function, poor vascular conditions or repeated arteriovenous impotence failure, hemodialysis patients who repeatedly experience severe symptoms related to dialysis, etc.

②For certain toxic diseases, water and electrolyte imbalance, congestive heart failure, etc., if hemodialysis is not available, peritoneal dialysis may also be considered.

③Patients who prefer home treatment and whose transportation is inconvenient to go to the hospital for hemodialysis.

④Hemodialysis is to directly draw blood out of the body for dialysis, so the blood pressure of patients often fluctuates to a certain extent during the dialysis process. Therefore, peritoneal dialysis is more suitable for patients with hypertension, heart disease, etc. who require strict blood pressure control; in addition, the blood vessels of diabetic patients Hardened, the tube wall is fragile and inelastic, making it more suitable for peritoneal dialysis.

Which patients cannot undergo peritoneal dialysis?

①Various abdominal diseases lead to reduced peritoneal clearance rate, such as chronic persistent or recurrent abdominal infection, or extensive peritoneal metastasis of intra-abdominal tumors, leading to extensive peritoneal fibrosis and adhesions in patients, reducing the dialysis area, affecting the distribution of fluid in the peritoneal cavity flow, weakening or losing the ultrafiltration function of the peritoneum, and reducing the solute transport efficiency.

②Patients with severe skin diseases, extensive abdominal wall infection or large abdominal burns who do not have a suitable location for inserting a peritoneal dialysis catheter.

③Within 3 days of abdominal surgery, if the wound has not healed, fluid will leak from the incision during peritoneal dialysis.

④There are localized inflammatory lesions in the peritoneum, and peritoneal dialysis can spread the inflammation.

⑤In late pregnancy or huge intra-abdominal tumors, the peritoneal dialysis effect is not ideal due to reduced abdominal volume.

⑥Intra-abdominal vascular diseases, such as polyvasculitis, severe arteriosclerosis, scleroderma, etc., will reduce dialysis efficiency.

⑦Severe obesity. Due to severe obesity, the subcutaneous tissue is very thick, making it very difficult to implant a dialysis tube, and the dialysate is prone to leakage.

⑧Those who have insufficient protein and calorie intake for a long time should not undergo long-term chronic peritoneal dialysis, because peritoneal dialysis will cause protein loss of more than 6g per day.

What are the advantages and disadvantages of peritoneal dialysis?

The main advantages of peritoneal dialysis include:

①Peritoneal dialysis is a daily continuous treatment. The metabolic balance of the human body is in a relatively stable state and has a relatively small impact on the cardiovascular system.

②Peritoneal dialysis is better at maintaining residual renal function.

③Peritoneal dialysis does not require special equipment, is simple and easy to operate, and is relatively cheap. It is a good home dialysis method, especially suitable for patients in rural and remote areas.

④There is no need for blood vessel puncture, which avoids puncture pain.

⑤The chance of being infected with hepatitis (hepatitis C, hepatitis B) is low.

⑥Peritoneal dialysis does not require extracorporeal circulation and has less impact on anemia.

Disadvantages include:

①If performed improperly, peritonitis is likely to occur, which is the most common complication of peritoneal dialysis.

②Due to the treatment at home, the living environment is required to be relatively good and clean.

③A certain amount of space is needed at home to store peritoneal dialysis items and perform fluid changes.

What complications can occur with peritoneal dialysis?

①Peritonitis and catheter-related infection: Peritoneal dialysis requires pouring dialysate into the abdominal cavity. If the surrounding environment is not clean and the aseptic operation is improper, it may cause infection in the abdominal cavity or around the catheter. If infection occurs, peritoneal dialysis should be stopped immediately and treated with antibiotics.

②Early complications related to dialysis catheter insertion, such as bleeding, leakage, dialysis catheter obstruction, displacement, pain, etc.

③Non-infectious complications related to dialysis, such as hernia at the catheter outlet, peritoneal dialysis fluid leakage, pleural effusion, low back pain, etc.

How to care for peritoneal dialysis patients?

Peritoneal dialysis is very convenient and can be performed at home, but if care is not taken regularly, the probability of complications will be greatly increased, and the effect of dialysis will be greatly reduced. Therefore, peritoneal dialysis patients should pay attention to the following points in their daily lives:

①Before changing the peritoneal dialysis fluid, make sure the environment is clean, wash hands, wear a mask, and perform strict aseptic procedures. Under normal circumstances, the skin at the catheter exit should be disinfected, cleaned and cared for every 2 days. If there is infection or scab, care should be taken once a day, and the iodophor cap should be used once.

②Accurately record the input and drainage volume of dialysate, and observe the color and clarity of the effluent. If you encounter symptoms such as poor drainage, abdominal distension, and abdominal pain, you should seek medical attention immediately and receive timely treatment.

③Peritoneal dialysis will take away excess water and toxins such as creatinine and urea nitrogen, as well as some proteins, vitamins and other substances beneficial to the human body. When the loss of nutrients is not serious, it can be compensated for through diet, and at the same time, It should be noted that the intake of some foods that may aggravate the condition should be limited. Patients with peritoneal dialysis should usually eat more high-quality animal protein, foods rich in vitamins B and C, and foods rich in fiber. However, you should eat less high-phosphorus foods and reduce salt intake to prevent overload of body fluids.

④Peritoneal dialysis patients should undergo regular post-discharge follow-up visits based on their condition and treatment needs. Patients who have newly started peritoneal dialysis treatment will return to the hospital for the first follow-up visit 2-4 weeks after discharge to complete the peritoneal balance test and evaluate the adequacy of dialysis. After that, it is recommended to check once every 6 months. Those whose condition is unstable or changes will be followed up or hospitalized at any time.

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