Peritoneal dialysis is a viable option for patients whose kidneys are unable to filter wastes and excess fluids from the body. In this article, we will explore the fundamentals of peritoneal dialysis; its purpose, who can benefit from it, its pros and cons, and what to expect while undergoing treatment.
How does Peritoneal Dialysis (PD) Works?
Peritoneal dialysis relies on a membrane within the abdominal region, known as the peritoneal membrane, for its efficacy. It works by allowing a special solution, known as dialysate, to pass into this via a catheter. This fluid draws out toxins and excess fluid from the bloodstream, which is then expelled along with the solution. The frequency of this process in a day can vary according to an individual’s specific needs.
Can I undergo and start Peritoneal Dialysis?
Patients suffering from End-Stage Renal Disease (ESRD) may be suitable candidates for peritoneal dialysis, especially when they have the physical ability and mental capacity to undergo the procedure independently. This form of dialysis can also provide an alternative to hemodialysis, which requires utilising a machine to filter the blood.
Peritoneal dialysis may not be suitable for all patients. Such conditions include previous multiple abdominal surgery, severe abdominal adhesions, inflammatory bowel disease, and patient’s with stoma (an opening used for removing body waste).
What Are the Pros and Cons of Peritoneal Dialysis?
Pros:
Peritoneal dialysis offers patients more control over their treatment and allows them to have greater independence and flexibility. This is because it can be performed in the comfort of their own homes. The absence of the need for a large machine is another benefit, which can make it more suitable for certain individuals.
In comparison to hemodialysis, peritoneal dialysis is often easier on the body as it minimises any fluctuations in blood pressure and other potential risks.
Patients on peritoneal dialysis can travel more easily, as they can arrange for the dialysate bags to be delivered to the country they are travelling to. It can be done in their own hotel room during their travels.
Cons:
As peritoneal dialysis may be performed independently at home, it demands an added degree of patient accountability and dedication. To successfully perform the procedure, patients must be able to do it themselves or get a caregiver’s help several times daily.
Additionally, compared to hemodialysis, peritoneal dialysis poses a greater risk of infection due to its use of a catheter. These infections can lead to the complication of exit site infection or a more serious infection called peritonitis, which can potentially be life-threatening.
What to Expect During Peritoneal Dialysis Treatment
Prior to starting peritoneal dialysis, a catheter must be placed into the abdomen of the patient which is usually done under regional or local anaesthesia. After the catheter has been inserted, it is essential for patients to learn how to do the procedure themselves or have a caregiver available that can help them.
Peritoneal dialysis requires patients to insert the solution into their abdomen on a daily basis and allow it to sit for an allotted time before draining it out. This process needs to be carried out multiple times a day, as instructed by the patient’s doctor. There are two methods of instilling the dialysis fluid. One is doing it manually, which means the water is drained in and out, by the patient himself. The other method is attaching to an automated peritoneal dialysis machine, which will do the draining in and out automatically, at a fixed duration. This is usually done while patient is asleep at night.
Generally, the process does not cause any discomfort. Patient may feel the fluid draining in, or may feel the coolness the fluid when draining in, as the temperature of the fluid is at room temperature. This sensation is temporary and typically diminishes as the fluid rises to body temperature in the peritoneal cavity.
Although the dialysis is done daily, patients will still need to follow certain dietary guidelines while taking prescribed drugs to keep their blood pressure and other medical issues in check.
Catheter Site Care
Keeping your catheter site clean and free from infection is critical in preventing serious medical condition such as peritonitis, which may require medication or hospitalisaton in severe cases. It is therefore essential to take proper care of your catheter exit site to ensure successful dialysis treatment.
Patients should follow these steps:
► Wash your hands with soap before touching the catheter site.
► Clean the skin around the catheter site with an antiseptic solution, such as chlorhexidine. Use a clean cloth or a sterile gauze to apply the solution and let it dry completely.
► Use sterile gloves to handle the catheter and connections.
► Inspect the catheter site for signs of infection, such as redness, swelling, or discharge. Notify your specialist if you notice any signs of infection.
► After each dialysis session, flush the catheter with heparin solution to prevent blood clots from forming.
► Secure the catheter to prevent accidental dislodgement.
Patients on peritoneal dialysis should also take the following precautions:
► Avoid swimming or soaking in a bathtub or hot tub, as these activities can increase the risk of infection.
► Avoid tight clothing or anything that puts pressure on the catheter site.
► Avoid lifting heavy items or doing any strenuous physical activity that may put strain on the catheter site.
Peritoneal dialysis, although beneficial, may not be suitable for everyone. It is important to consult with your kidney specialist to determine if it is the right option for you.