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What is Dialysis?

Dialysis is a treatment modality offered to patients who have kidney failure.
When you have kidney failure, your kidneys do not filter blood properly. As a result, wastes and toxins build-up in the bloodstream. So by removing waste products and excess fluid from your blood by Dialysis, it will replicate the work of your kidneys.

Who needs Dialysis?

Dialysis is advised to people who have kidney failure or end-stage renal disease (ESRD). Kidney disease can be caused by injuries or conditions such as high blood pressure, diabetes, and lupus. Kidney failure can be chronic or acute, resulting from a severe illness or injury. Usually acute kidney failure is reversible if treated appropriately but chronic kidney failure is irreversible. Hence the need for dialysis is temporary in acute kidney failure and the need for dialysis will be permanent in chronic kidney failure.

Types of Dialysis?

There are two types of dialysis:

1. Haemodialysis
2. Peritoneal dialysis
Many prospective patients believe that dialysis will be done in a center at least three times per week for an average of four hours is the only option for end-stage renal disease (ESRD). This is not true and there are other options available, such as peritoneal dialysis (PD), home hemodialysis, and transplants.

What is Peritoneal Dialysis?

Peritoneal Dialysis (PD) is a treatment that uses your peritoneum, a membrane
lining your abdominal cavity, as a filter to remove wastes from your body. This type of dialysis requires the assistance of a care provider.
Your peritoneum performs a similar job to that of the dialyzer in a dialysis
machine during treatment or that of your kidneys every day. Waste products and excess fluid in blood pass through the peritoneal membrane and combine with dialysate (dialysis fluid) in abdominal cavity, which is then drained along with the waste product diffused from blood. The peritoneum separates your blood from the dialysis fluid and allows this diffusion process to take place. An exchange occurs whenever fluid is added to the abdomen and thus extra fluid and wastes are drained along with the fluid.

When your kidneys are not working well, wastes and extra fluid can build up in your blood and make you sick.

This can cause:

• Nausea

• Trouble sleeping

• Poor appetite

• Loss of energy

• Hiccups

• Dry, itchy skin

• Weight loss

• Irregular menstrual periods

• Muscle cramping, especially at night

• welling

• Anemia (low blood count)

• Difficulty in breathing
  

Types of Peritoneal Dialysis

Continuous-Cycler Assisted Peritoneal Dialysis (CCPD):

Continuous cycling peritoneal dialysis (CCPD) is a method of performingperitoneal dialysis exchanges while sleeping by using a machine called a cycler.Each night, three to five exchanges are performed. There peritoneal dialysisfluid is drained into drain bags and that you would empty in the morning. Thisprogram enables you to free up your daytime hours. And every nightly sessionlasts between eight and ten hours. And there are various modified techniquesto this method which will be advised by a nephrologist as per the clinical need.

Continuous Ambulatory Peritoneal Dialysis (CAPD):

Continuous ambulatory peritoneal dialysis (CAPD) is a method of performing peritoneal dialysis exchanges that utilizes gravity to drain and fill your peritoneal membrane with solutions. Usually three to four exchanges per day are advised. The exchanges are done manually by a patient in a clean environment, and it takes about 30 minutes to complete. And the patient is allowed to roam or travel after the peritoneal fluid exchange.

What is dialysate?

Dialysate is a liquid with sugar that pulls out fluid and waste from your blood. It works on the principle of diffusion and osmosis. When you exchange, the dialysate holds the waste and fluid and removes them from your body. How does the catheter get into belly? Before you start PD, doctors will perform a minor surgery to insert the catheter into your belly. The end of the catheter will come through your skin, either on belly or on your chest. And the catheter is inserted either using laparoscop or percutaneous method.

What will my dialysis prescription be based on?

Your doctor will base your prescription on:
Your size
Your remaining kidney function
Your nutritional health
Your general health
Your peritoneal equilibration test (PET)


Catheter Placement and Care:

A tube or catheter is inserted into the abdominal muscles. One end is inserted into the peritoneal cavity. The peritoneal space is the empty space that surrounds the organs of the abdomen. The other end of the tube extends about 6 inches from the abdomen. To protect the catheter site, promote healing, and prevent infection, a large dressing will be placed over it. The dressing will be changed about 5 days after surgery. The catheter is not used for two weeks following placement to allow the area to heal. And If you require dialysis during this time, you will receive hemodialysis.

How does peritoneal dialysis (PD) work?
Peritoneal dialysis is carried out through a dialysis catheter placed in the abdomen, where you exchange old solution for new solution.

An exchange has 3 steps:

STEP 1: Drain
The PD catheter is connected to a drain bag, and the used and saturated solution inside the abdomen is drained. This solution contains waste as well as excess fluid.

STEP 2: Fill
After the old solution has been completely removed from the abdomen, new dialysis solution is poured-in through the catheter to fill the peritoneal cavity, which is located in the abdomen.

STEP 3: Dwell
The dialysis tubing and bags are removed once the new solution has been placed. You can go about your normal activities while wearing only a short tubing set covered by a sterile cap. During this time, the dialysis solution

remains in the peritoneal cavity. This is the time when dialysis takes place and

the solution collects waste and excess fluid from your body.

Benefits of Peritoneal Dialysis

 There are no needles or pricks involved in this type of treatment.

 Diet and fluid intake is less restricted.

 You have more control and greater flexibility about when and where you

dialyze.

 You can do therapy while sleeping (APD).

 You can dialyze in the comfort of your home independently or with the

help of a loved one.

 You can take a more active role in your treatment which has been

proven to yield better outcomes.

 Health benefits include more energy and better blood pressure control.

 Portable therapy allows for ease of travel.

 All home dialysis patients have access to a home dialysis nurse 24 hours

a day if assistance is needed. This includes access to a technical support

team for equipment issues.

Complications of peritoneal dialysis (PD)

The most common complication for peritoneal dialysis is Peritonitis, other

complications are:

 Fluid Imbalance

 Hypertension

 Anaemia

 High blood sugar

 Joint Disease

 Vascular and extra-articular calcification

 Cardiac Disease

 Hernia

 Weight Gain

What is peritonitis?

One thing you have to be very careful about in PD is peritonitis, an infection of

the peritoneum (the lining of the belly). Peritonitis happens when germs get

into the peritoneal cavity through the catheter. It is treatable with antibiotics,

but it's important to get it treated promptly.

The main signs of peritonitis are:

 a cloudy dialysis bag when you are

 draining out the used fluid

 unusual stomach pain, either mild or severe

 fever or chills

If you notice any of these signs, call your doctor or dialysis centre right away.

Getting prompt treatment for peritonitis is very important. If you do not get

prompt treatment, the infection can get worse and you may have to go to the

hospital. In addition, the infection may scar your peritoneal membrane, making

PD less effective. In extreme cases, you may have to change to haemodialysis.

In DR Pranith Ram's Renal Care Center, Our team have expertise in treating

advanced kidney diseases and conditions, and play a vital role with the patient

in ensuring their total well-being and providing the best available options

depending on the situation. Patient’s diagnosis and treatments are of the top

quality, and they always tend to ease up any patient irrespective of the

complexity of their position, to provide the best possible dialysis (Hemodialysis

& peritoneal dialysis) treatment in Hyderabad.