Peritoneal dialysis ( PD ) is a type of dialysis that uses peritoneum in a person's abdomen as the membrane through which fluid and solute are exchanged for blood. It is used to remove excess fluid, fix electrolyte problems, and get rid of toxins in those with kidney failure. Peritoneal dialysis has better results than hemodialysis during the first few years. Other benefits include greater flexibility and better tolerability in those with significant heart disease.
Complications may include infection in the stomach, hernia, high blood sugar, abdominal bleeding, and catheter blockage. Use is not possible with those with significant previous abdominal surgery or inflammatory bowel disease. It takes some level of technical skill to get it right.
In peritoneal dialysis, specific solutions are introduced through a permanent pipe in the lower abdomen and then removed. This can occur periodically throughout the day, known as continuous ambulatory dialysis, or at night with the aid of a machine, known as automatic peritoneal dialysis. The solution is usually made of sodium chloride, hydrogen carbonate, and osmotic agents such as glucose.
Peritoneal dialysis was first performed in the 1920s; However, long-term use did not go into medical practice until the 1960s. The solution used for peritoneal dialysis is on the World Health Organization's Essential Drug List, the most effective and safe medication needed in the health system. The cost of dialysis solutions in developing countries is about 6.77 to 7.30 USD per two liter bags or about 12,000 USD per year. In the United States, peritoneal dialysis costs approximately 53,400 USD per person per year. In 2009 peritoneal dialysis was available in 12 of 53 African countries.
Video Peritoneal dialysis
Health effects
PD is less efficient at removing waste from the body than hemodialysis, and the presence of tubes presents the risk of peritonitis because of the potential to introduce bacteria to the stomach. There is insufficient evidence to be clear about the best treatment for PD related peritonitis, although direct infusion of antibiotics into the peritoneum appears to offer little benefit over intravenous administration routes; there is no clear advantage for other frequently used treatments such as routine litonic peritoneal or urokinase use. The use of nasal mupirocin prevention is an unclear effect with respect to peritonitis. The infection can be as frequent as every 15 months (0.8 episodes per year of patients). Compared with hemodialysis, PD allows for greater patient mobility, resulting in fewer symptoms changes due to its ongoing nature, and phosphate compounds better removed, but large amounts of albumin are removed which require constant monitoring of nutritional status. PD costs are generally lower than HD in most parts of the world, these cost advantages are most evident in the developed world. There is not enough research to adequately compare the risks and benefits between CAPD and PPE; Cochrane Review of three small clinical trials found no difference in clinically important results (ie, morbidity or mortality) for patients with end-stage renal disease, as well as no benefit in preserving kidney functionality. The results suggest that PPE may have psychosocial benefits for younger patients and those who are employed or pursuing education.
Other complications include hypotension (due to excess fluid exchange and sodium removal), low back pain and hernia or leaking fluid due to high pressure in the stomach. PD can also be used for patients with heart instability because it does not result in rapid and significant changes to body fluids, and for patients with insulin dependent diabetes mellitus because of the inability to control blood sugar levels through a catheter. Hypertriglyceridemia and obesity are also of concern because of the large volume of glucose in the fluid, which can add 500-1200 calories to the diet per day. Of the three types of connections and fluid exchange systems (standard, twin-bag and y-set; the latter two involve two bags and only one connection to the catheter, the y-set uses a single y connection shaped between bags involving emptying, flushing out then filling peritoneum via the same connection) twin-bag and y-set systems are found to be superior to conventional systems to prevent peritonitis.
Maps Peritoneal dialysis
Method
The best practice for peritoneal dialysis states that before peritoneal dialysis should be carried out, people's understanding of the process and support system should be assessed, with education on how to care for catheters and to address gaps in possible understanding. The person should receive continuous monitoring to ensure adequate dialysis, and regularly assessed for complications. Finally, they should be educated about the importance of infection control and medical regimens appropriate to their cooperation.
- The dialysis process
The abdomen is cleaned in preparation for surgery and the catheter is inserted through surgery with one end in the abdomen and the other protruding from the skin. Before each infusion the catheter should be cleaned, and it flows in and out of the stomach tested. 2-3 liters of dialysis fluid is inserted into the stomach for the next ten to fifteen minutes. The total volume is referred to as silent while the liquid itself is referred to as dialysate. Residence can be as much as 3 liters, and medicines can also be added to the fluid immediately before the infusion. His abode remains in the stomach and waste products spread throughout the peritoneum of the underlying blood vessels. After a period of time varies depending on the treatment (usually 4-6 hours), the liquid is removed and replaced with fresh liquid. This can happen automatically during an automatic sleep (automatic peritoneal dialysis, APD), or throughout the day by storing two liters of fluid in the abdomen at all times, exchanging fluids four to six times per day (continuous outpatient peritoneal dialysis, CAPD). ).
The liquid used usually contains sodium chloride, lactate or bicarbonate and a high percentage of glucose to ensure hyperosmolarity. The amount of dialysis that occurs depends on the volume of residence, the regularity of exchange and the concentration of the fluid. The PPE cycle between 3 and 10 stays per night, while CAPD involves four people staying per day of 2-3 liters per stay, with each remaining in the abdomen for 4-8 hours. Visera accounts for about four-fifths of the total surface area of ​​the membrane, but parietal peritoneum is the most important of the two parts for PD. Two complementary models explain dialysis across the membrane - a three-pore model (in which molecules are interchanged across membranes that filter out molecules, either proteins, electrolytes or water, based on pore size) and distributed models (which emphasize that role). capillaries and the ability of solutions to increase the number of active capillaries involved in PD). High concentrations of glucose encourage fluid filtering through osmotic (osmotic UF) from the peritoneal capillaries to the peritoneal cavity. Glucose spreads faster than dialysate to the blood (capillaries). After 4-6 hours of stay, the osmotic glucose gradient usually becomes too low to allow further UF osmotics. Therefore, dialysate will now be reabsorbed from the peritoneal cavity to the capillaries via the plasma colloidal osmotic pressure, which exceeds the colloid osmotic pressure in the peritoneum of about 18-20 mmHg (see Starling Mechanism). Lymphatic uptake will also to some extent contribute to the reabsorption of fluid from the peritoneal cavity to the plasma. Patients with high water permeability (UF coefficient) of the peritoneal membrane may have an increase in the rate of fluid reabsorption of the peritoneum at the end of the dwelling. The ability to exchange small solutes and liquids between the peritoneum and plasma can be classified as high (fast), low (slow) or intermediate. High carriers tend to spread the substance well (easily exchange of small molecules between blood and dialysis fluids, with slightly improved results with short stay duration along with PPE), while the lower transporter has a higher UF (because reabsorption is slower of glucose from the peritoneal cavity, which produces better results with long-term, high volume dwelling, although in practice both types of transporters can generally be managed through the proper use of APD or CAPD.
Although there are different forms and sizes of different catheters that can be used, different insertion sites, the number of cuffs in the catheter and immobilization, there is no evidence to suggest an advantage in terms of morbidity, mortality or the number of infections, although the quality of information is insufficient to allow for strong conclusions.
Complications
The dialysate volume was removed as well as the patient's weight was monitored. If more than 500 ml of fluid is maintained or one liter of fluid is lost in three consecutive treatments, the patient's doctor is generally notified. Excessive fluid loss can lead to hypovolemic shock or hypotension, while excess fluid retention may lead to hypertension and edema. Also monitored is the color of the discharged liquid: usually pink for the first four cycles and clear yellow or pale afterward. The presence of pink or bloody fluid shows bleeding in the abdomen while the stool shows the intestine and cloudy fluid indicates infection. The patient may also experience pain or discomfort if the dialysate is too acidic, too cold or too quickly introduced, while diffuse pain with cloudy whitish may indicate infection. Severe pain in the rectum or perineum can be caused by improperly placed catheters. Shelter can also increase the pressure on the diaphragm that causes respiratory distress, and constipation may interfere with the fluid's ability to flow through the catheter.
A potentially fatal complication that is thought to occur in about 2.5% of patients is encapsulating peritoneal sclerosis, where the intestine becomes inhibited because of the thick layer of fibrin growth in the peritoneum.
The fluid used for dialysis uses glucose as the primary osmotic agent, but this can cause peritonitis, decreased renal function and peritoneal membrane and other negative health outcomes. The acidity, high concentration and presence of lactate and glucose degradation products in the solution (especially the latter) may contribute to these health problems. A neutral solution, using bicarbonate as a substitute for lactate and having some glucose degradation products can offer more health benefits even though this has not been studied.
Usage
In a worldwide survey of 2004 patients on end-stage renal disease, about 11% received PD, compared with a much more common hemodialysis. In Hong Kong and Mexico, PD is more common than the world average, with Mexico doing most of its dialysis (75%) through PD, while Japan and Germany have lower rates than the world average.
Enhanced dialysis
Peritoneal dialysis can be improvised in conditions such as combat operations or disaster relief using surgical catheters and dialysates made from routinely available medical solutions to provide a temporary replacement of the kidney for people with no other choice.
See also
- Icodextrin
- Mesothelium
References
External links
- Treatment Methods for Kidney Failure - National Institute of Diabetes and Digestive and Kidney Diseases
Source of the article : Wikipedia
0 Comments