Peritoneal dialysis
Martina Feichter studied biology with an elective subject pharmacy in Innsbruck and also immersed herself in the world of medicinal plants. From there it was not far to other medical topics that still captivate her to this day. She trained as a journalist at the Axel Springer Academy in Hamburg and has been working for since 2007 - first as an editor and since 2012 as a freelance writer.
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In peritoneal dialysis, the patient's well-perfused, semi-permeable peritoneum is used as the body's own filter membrane for the blood. On the other hand, during hemodialysis ("artificial kidney"), the blood is cleaned outside the body with a special filter. In Germany, however, peritoneal dialysis is only used very rarely - in less than five percent of patients requiring dialysis. Read more about peritoneal dialysis.
What is peritoneal dialysis?
The peritoneum lines the entire abdominal cavity and covers many organs. With peritoneal dialysis, a sterile dialysis solution (rinsing solution, dialysate) is allowed to flow through a catheter into the abdominal cavity several times a day, which absorbs the toxic metabolic products. The abdominal cavity has a different concentration of substances than the blood: According to the principle of osmosis, toxic metabolic products migrate from the blood via the peritoneum into the dialysis solution. After a few hours, the dialysis solution is saturated with toxins and is exchanged.
Another task of dialysis is to remove excess water from the body - experts speak of ultrafiltration. This is why most dialysis solutions contain glucose (sugar). During peritoneal dialysis, water also migrates into the dialysis solution through a simple osmotic process and can thus be removed from the body.
When is peritoneal dialysis performed?
Peritoneal dialysis is a permanent therapy for chronic kidney failure (kidney weakness or renal insufficiency) in an advanced stage. It is used when the blood purification and water excretion by the kidneys no longer work properly and the kidney values rise sharply. Peritoneal dialysis is particularly suitable for children or adults who travel a lot for work.
What do you do with peritoneal dialysis?
There are different variants of peritoneal dialysis:
With continuous ambulatory peritoneal dialysis (CAPD), the abdominal cavity is constantly filled with two to two and a half liters of dialysis fluid. The patient or a helper manually changes all of the rinsing liquid four to five times a day ("bag change").
In device-based peritoneal dialysis (APD), a device (PD cycler) connected to the catheter changes the dialysate. Exactly how and when the change takes place varies: with nightly intermittent peritoneal dialysis (NIPD), for example, the patient connects the device to his catheter for around eight hours in the evening for up to seven days a week - the dialysate is exchanged in the night. If the patient also changes the bag manually once or twice a day, this is called continuous cyclic peritoneal dialysis (CCPD).
Peritoneal dialysis as home dialysis
For peritoneal dialysis, patients sometimes have to go to a dialysis center. In most cases, however, this form of blood washing is carried out as home dialysis: The patient himself carries out the peritoneal dialysis at home (peritoneal home dialysis). The prerequisite is that he undergoes intensive training over several weeks and is under continuous medical care. This dialysis form is carried out either as a continuous outpatient peritoneal dialysis (i.e. with purely manual bag change) or as an apparatus-based peritoneal dialysis (with the support of a device).
With home dialysis, the patient can flexibly structure his schedule according to his needs. However, home dialysis is associated with a great deal of personal responsibility. In addition, with peritoneal dialysis, there is a risk of infections at the exit point or in the abdominal cavity due to the catheter lying permanently in the abdominal cavity.
What are the risks of peritoneal dialysis?
Anyone who opts for peritoneal dialysis (as home dialysis) should be aware that they have a high degree of personal responsibility. That is why every patient receives intensive training prior to peritoneal dialysis.
However, the peritoneum is not suitable as a filter membrane for every patient. In addition, peritoneal dialysis is slightly less effective than hemodialysis. In the case of very severe kidney weakness, peritoneal dialysis is often not sufficient. Even if peritoneal dialysis is an option for a person - some reject it because they find the blood cleansing via their own peritoneum uncomfortable or cumbersome. For example, the bags with the dialysis fluid must be warmed up before use.
Last but not least, the catheter in the abdominal wall is a potential entry point for germs that could cause peritonitis. This must be dealt with immediately. To prevent peritonitis, peritoneal dialysis patients should strictly adhere to the following advice:
- The main principle when changing bags is absolute cleanliness. This means that all parts and utensils must be kept sterile to avoid infections.
- The exit point of the catheter from the skin must be checked again and again for signs of inflammation such as reddening, swelling or leakage of secretion.
If the skin is not irritated, it is sufficient to change the bandage every one or two days. The area is first disinfected, then dried with sterile swabs and bandaged again. Daily showering is also not a problem. After that, however, the exit point of the catheter has to be connected again. If the skin around the catheter exit is reddened, patients should see a doctor.
Every patient must keep a dialysis protocol that contains regularly measured values for blood pressure, body weight and fluid excretion. Every eight to twelve weeks the patient goes to the dialysis center for a check-up. During peritoneal dialysis, the body loses vitamins and protein. In return, he absorbs calories, since the dialysate usually contains sugar. It is therefore important to pay attention to a balanced diet.
What do I have to consider during peritoneal dialysis?
Peritoneal dialysis largely corresponds to the natural functioning of the kidney, as it detoxifies and drains the body continuously and evenly. The patient must therefore generally expect fewer side effects than with hemodialysis. During peritoneal dialysis, the patient is mobile and independent. He can go about his usual job and his job. In addition, he is less restricted in terms of food and fluid intake than patients on hemodialysis. So he can lead a largely normal and symptom-free life as long as he carefully observes certain rules of behavior (such as strict hygiene when changing bags) during peritoneal dialysis.
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