What Is Dialysis?
Dialysis is a procedure that is used in the treatment of renal failure. In this procedure, the waste products and the excess fluids are removed from the body with the aid of an external machine.
What Are the Types of Dialysis?
There are three types of dialysis, it includes:
-
In-center hemodialysis.
-
At-home hemodialysis.
-
Peritoneal dialysis.
What Is Hemodialysis?
Hemodialysis is a process to remove waste products and extra fluid from the body in which the entire blood in the body is circulated outside the body in a machine called a dialyzer. This machine filters the blood by removing waste products, salts, and excess fluid. Then the blood is resent into the body. It can be carried out either in the center or at home.
What Is a Peritoneal Membrane?
The peritoneal membrane forms the inner lining of the abdomen and pelvis and also contains the stomach and large intestine. It is a smooth, transparent membrane that protects and separates the organs of the abdomen and the pelvis.
What Is Peritoneal Dialysis?
Peritoneal dialysis is different from hemodialysis as it uses the peritoneal membrane (lining of the abdomen) to filter the blood and remove the excess fluid from the body.
What Are the Types of Peritoneal Dialysis?
There are two types of peritoneal dialysis, which include,
-
Continuous ambulatory peritoneal dialysis.
-
Automated peritoneal dialysis.
What Is the Difference Between Continuous Ambulatory and Automated Peritoneal Dialysis?
The continuous ambulatory type involves the manual delivery and drainage of the dialysis fluid and the waste products. In automated type, dialysis exchanges are automatically performed by the machine.
What Is the Mechanism Behind Peritoneal Dialysis?
In peritoneal dialysis, a catheter is surgically placed in the abdomen a few weeks before the treatment. A dialysis solution called dialysate consisting of water, salt, and other additives (such as bicarbonate, glucose, etc.) is taken in a bag and is slowly passed into the permanently placed catheter. This injected dialysate absorbs waste products and the extra fluid from the body and gets collected in the abdomen, which is then removed either manually or automatically with the aid of a machine and drained out of the body into the empty bag. This process needs to be repeated four to six times a day by refilling the abdomen with a fresh solution to enhance the absorption of waste products.
What Is the Procedure in Continuous Ambulatory Peritoneal Dialysis?
In the continuous ambulatory type, the exchanges are done manually, and during this procedure, the patient can do normal activities like walking, talking, etc. In this type, the solution is allowed to stay in the belly for about four to six hours, and the solutions need to be changed at least four times a day with an interval of 30 to 40 minutes. The solution can be left in the abdomen for the whole night and can be drained in the morning.
What Is the Procedure in Automated Peritoneal Dialysis?
Automated peritoneal dialysis is also known as continuous cycler-assisted peritoneal dialysis, as it uses a machine called a cycler to perform the exchanges (filling and emptying the dialysate). In this type, the dialysis procedure is carried out at night, where the cycler carries out the process three or four times during night hours when the patient is sleeping. The fresh dialysate solution can be allowed to stay inside the body throughout the day.
How to Perform the Exchanges?
The instruments needed in this process include:
-
Catheter
-
Transfer set.
-
Dialysis solution.
-
Drain bag.
-
Surgical gloves and masks.
-
Cycler (in the case of automated peritoneal dialysis).
Process:
-
First, the catheter should be placed in the belly three weeks prior to the procedure by a minor surgery carried out by the nephrologist. This allows proper healing of the catheter placement site and allows for the ease of the procedure. Once the healing is ensured, the health care providers would train the patient as well as the family member to carry out the procedure on their own. It is important to carry out the procedure in a sterile environment as there is an increased risk of infection. The patient or the attendee performing the procedure should wash their hand priorly, should wear sterile surgical gloves and masks, and clean all the instruments with the spirit.
-
The transfer set is nothing but a tube that connects the permanent catheter and the bag containing the dialysis solution. The end of the permanent catheter is secured with a cap to prevent infection.
-
In the case of continuous ambulatory peritoneal dialysis, with a sterile hand, the cap should be opened, the transfer set should be connected, and the free end of the transfer set should be secured with a cap. At the beginning of the procedure, the disposable cap is removed from the free end of the transfer set and is connected to the Y-shaped tube. This Y-shaped tube connects one end with the bag containing dialysis solution and the other end with the empty bag, which drains the waste products and the extra fluid. The bag of dialysis solution should be warmed before administering it to the body, which can be done either by putting it in a tub of warm water or by using an electric blanket. The new bag of solution should be hung on a pole and connected to the transfer set, and the other end of the Y-shaped tube should be connected to the draining bag. Once the procedure is done with sterile hands, the used dialysis solution should be drained.
-
In the case of automated peritoneal dialysis, the machine called a cycler is programmed to perform the exchanges by setting three to four dialysis in the evening. Three to five bags of dialysis solution bags are connected to the tubing that is connected to the cycler. It will automatically perform the dialysis by releasing the clamp to allow the dialysis solution into the body and drain the waste and the excess into the drain line. It will automatically warm the next solution to enter the body. Likewise, the machine by itself performs the exchanges once it is set.
How Is Peritoneal Dialysis Better than Hemodialysis?
-
Cost-Effective - Peritoneal dialysis is cost-effective as compared to hemodialysis.
-
Fewer Symptoms - Peritoneal dialysis comparatively produces fewer symptoms of kidney failure as the accumulated fluids and waste products are removed then and there as compared to hemodialysis, which is done twice or thrice a week.
-
Fewer Diet Restrictions - As peritoneal dialysis is done four to six times a day, the amount of water intake and the diet can be flexible as compared to hemodialysis.
-
Greater Lifestyle Flexibility - As peritoneal dialysis can be performed at home and one can perform it on his own, it allows for normal lifestyle habits like one can work, travel, etc., as compared to hemodialysis, which needs a specific time to carry out the procedure.
What Are the Complications Associated with Peritoneal Dialysis?
The complications include:
-
Infection - The most common complication of peritoneal dialysis. As it is performed in the home setup, there is an increased chance of infection. It may be due to the unsanitized hands, or improper handling of the dialysis tools that infection occurs, resulting in life-threatening complications.
-
Peritonitis - Peritoneal dialysis-related peritonitis is one of the major complications encountered in these patients. Peritonitis is the inflammation of the peritoneal membrane due to the spread of infection during the insertion of the catheter, transfer of the bowel bacteria, or as a result of any systemic infections. Studies report that around 80 % of peritoneal dialysis-related peritonitis occurs due to infection.
-
Hernia - Hernia may occur as a result of high pressure created by the dialysis fluid in the abdomen.
-
Volume Shift - It is important to monitor how much fluid is lost from the body and how much is retained in the body during peritoneal dialysis. Excessive loss of fluid would affect the blood volume resulting in hypotension (decreased blood pressure) and hypovolemic shock (life-threatening cardiovascular collapse due to decreased fluid volume). Increased retention of fluid in the body would result in hypertension (increased blood pressure) and edema (collection of fluid in the interstitial fluid).
-
Fibrosis of the Peritoneum - It is reported that around 2.5 % of cases under long-term peritoneal dialysis may develop peritoneal fibrosis. The peritoneal membrane may undergo fibrosis, causing obstruction of the bowel and resulting in fatal complications.
What Are the Precautions to Be Taken to Lead a Good Life With Peritoneal Dialysis?
-
Diet - The patients under peritoneal dialysis should restrict the intake of sodium, phosphorus, etc., and increase the intake of proteins and an optimal amount of potassium. The amount of water intake should be followed as suggested by the nephrologist and the dietician.
-
Proper Handling of the Dialysis Instruments - The instruments used in dialysis should be stored in a cool, dry place. Avoid using unsterile instruments or reusing the instruments, and each bag of dialysis solution should be inspected for the presence of contamination.
-
Self Care - The skin where the surgically placed catheter enters the body should be maintained clean to prevent the risk of infection. Always wash hands thoroughly and use surgical gloves and masks to prevent cross-infection and peritoneal infections.
-
Medications - The medicines prescribed by the doctor should be taken on a regular basis.
-
Coping Up - The patients should understand the effects of renal failure and may have to give up on some activities for better survival.
Conclusion:
Renal failure is one of the leading causes of death in many countries. The development of treatment procedures like peritoneal dialysis has improved survival rates to a great extent. Though peritoneal dialysis improves survival, it is not the permanent cure for renal failure. Patients should be educated about the infection control methods and the risk of infection in this method.
