End-stage renal disease (ESRD) occurs when your kidney gradually loses its function and can no longer remove waste or excess fluid from your body. It is an advanced stage of renal failure and usually happens when the function of kidneys declined to below 15 percent of its normal function. Patients diagnosed with ESRD often suffer from general weakness, nausea, vomiting, limbs edema, arrhythmia, and dyspnea. When chronic kidney disease develops into ESRD, renal replacement therapy, which includes hemodialysis, peritoneal dialysis, and renal transplantation, is necessary.
A treatment option for patients with ESRD is peritoneal dialysis (PD). It uses the peritoneum in the abdomen as the dialysis membrane. Toxins and fluids are removed through the peritoneum into the dialysate, which is usually composed of minerals and dextrose water. There are mainly two types of peritoneal dialysis: continuous ambulatory peritoneal dialysis (CAPD) and automated peritoneal dialysis (APD). Individual PD regimen will be prescribed by a nephrologist. PD differs from HD (requires frequent hospital visits) in that it is usually manipulated at home by the patient or caregiver with proper training.
Kidneys function to remove waste products, such as creatinine, urea, and excess water, from the blood. When there is a gradual loss of kidney function due to disease, dialysis is needed to prevent the accumulation of waste products in the body.
A surgery for catheter implantation will be performed two weeks before PD. The catheter is inserted through the skin with one end in the peritoneum. After proper cleaning of catheter, PD solution is infused through the catheter and retained in the abdomen. Uremic toxins and fluids are removed via the peritoneum. The solution is drained out 4-6 hours later and another clean PD solution is infused. The peritoneal solution (dialysate) usually contains minerals and dextrose water at different percentages. The amount of PD solution, usually 1.5-3 liters per bag, the percentage of dextrose water ranging from 1.5% to 4.5%, the number of daily exchanges, and the dwell time will be prescribed by a nephrologist as individualized PD regimen after complete evaluation. APD works in the same way as CAPD, but can be carried out during the night by the machine.
Potential risks and complications include:
- Infection around the catheter site or abdominal lining (peritonitis)
- Hernia due to abdominal muscle straining
- Hyperglycemia, especially in patients with diabetic mellitus
- Inadequate dialysis
- Fibrosis of peritoneum after long-term use of peritoneal dialysis
- Hydrothorax due to leakage of diaphragm
- Abdominal and genital leaks
- Encapsulating peritoneal sclerosis, a rare but serious complication causing bowel obstruction, malnutrition, and intra-abdominal infection that may be fatal in some cases
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