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Peritoneal dialysis

Peritoneal dialysis (PD) is a type of dialysis used to treat patients with end-stage renal failure when their kidneys can no longer adequately perform their function. Unlike hemodialysis, which filters blood through an external machine, PD utilizes the patient’s own peritoneum (the lining of the abdominal cavity) to filter waste products and excess fluid from the blood.

Here’s a step-by-step overview of how peritoneal dialysis works:

  1. Catheter Placement: A surgical procedure places a catheter into the patient’s abdomen. This catheter serves as the access point for the dialysis process. It’s typically inserted about an inch below and to the side of the navel, with 2-4 inches of the catheter extending outside the body.
  2. Dialysate Infusion: The catheter allows a special fluid called peritoneal dialysate to be introduced into the abdominal cavity. This fluid contains chemicals that help draw waste products and excess fluid from the blood through the peritoneum.
  3. Dwell Time: Once the dialysate is infused, it remains in the abdominal cavity for a period known as dwell time. During this time, waste products and excess fluids from the blood pass through the peritoneal membrane and into the dialysate.
  4. Drainage: After the dwell time, the used dialysate, now filled with waste and excess fluid, is drained from the abdomen through the catheter into a sterile collection bag.
  5. Cycle Repeats: This process is usually repeated several times a day, depending on the specific treatment plan. Some patients use a machine (cycler) to automate this process, particularly at night, while others may perform manual exchanges during the day.

Types of Peritoneal Dialysis (PD)

  1. Intermittent Peritoneal Dialysis (IPD):
    • Description: Used temporarily, often in emergencies or for acute conditions.
    • Duration: Typically 24-48 hours.
    • Use: Can be applied in situations like low blood pressure or acute renal failure in children.
  2. Continuous Ambulatory Peritoneal Dialysis (CAPD):
    • Description: Manual filling of the peritoneum with dialysate; no dry periods.
    • Process: Patients perform exchanges throughout the day and night, with the dialysate remaining in the abdomen during the dwell time.
  3. Automated Peritoneal Dialysis (APD):
    • Description: Utilizes a cycler machine to perform exchanges.
    • Process: Usually performed at night while the patient sleeps, allowing for a more automatic approach to dialysis.
  4. Continuous Cyclic Peritoneal Dialysis (CCPD):
    • Description: A type of APD where the machine performs exchanges at night.
    • Process: The patient is connected to the machine during the night and remains free from the machine during the day, offering greater daytime mobility.
  5. Daytime Ambulatory Peritoneal Dialysis (DAPD):
    • Description: Dialysate is used during the day, with the abdomen left dry at night.
    • Process: Patients manage exchanges during their waking hours and have dry periods at night.
  6. Night-time Intermittent Peritoneal Dialysis (NIPD):
    • Description: Dialysate is used during the night.
    • Process: Exchanges are carried out at night, with the peritoneal cavity left dry during the day.

Each type has specific indications and advantages, depending on the patient’s lifestyle, health condition, and treatment goals.

Benefits of Peritoneal Dialysis:

  • Flexibility: It can be done at home, allowing patients more freedom and independence.
  • Gentler on the body: It may be easier on the cardiovascular system compared to hemodialysis.

Fewer dietary restrictions: Patients may have fewer dietary restrictions than with hemodialysis.

Considerations:

  • Infection Risk: There is a risk of peritonitis (infection of the peritoneum), which requires prompt treatment.
  • Space Requirement: It requires space for storing dialysis supplies and may affect the patient’s daily routine.
  • Potential Complications: Includes issues like catheter problems or changes in abdominal wall integrity.

CAPD CENTRE

  1. CAPD Center Setup: BKC, in collaboration with Baxter, has set up a CAPD center. This center is equipped with necessary facilities and staffed with a coordinator who is specifically trained in CAPD.
  2. Patient Care and Education: The center not only initiates patients on CAPD but also provides comprehensive education to patients and their caregivers. This education covers the procedure itself, proper hygiene practices, and other relevant aspects.
  3. Counseling Services: The center offers counseling on various treatment options for patients with end-stage renal disease, ensuring they have a full understanding of their choices.
  4. CCPD Capability: The center is equipped with a cycler machine for Continuous Cycler Peritoneal Dialysis (CCPD). This automated process allows for efficient and effective dialysis treatment for patients who require it.

This setup reflects a holistic approach to dialysis care, combining education, counselling, and advanced technology to support patients through their treatment journey.