Scribd
Upload
17 views30 pages

13. PD

Peritoneal dialysis (PD) involves the infusion of a sterile solution into the peritoneal cavity, using the peritoneal membrane for solute exchange. There are various types of PD, including Continuous Ambulatory PD (CAPD) and Automated PD (APD), with specific indications and contraindications for use. Complications can arise from infections and technique failures, necessitating proper protocols to minimize risks.

Uploaded by

mohamed
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
17 views30 pages

13. PD

Peritoneal dialysis (PD) involves the infusion of a sterile solution into the peritoneal cavity, using the peritoneal membrane for solute exchange. There are various types of PD, including Continuous Ambulatory PD (CAPD) and Automated PD (APD), with specific indications and contraindications for use. Complications can arise from infections and technique failures, necessitating proper protocols to minimize risks.

Uploaded by

mohamed
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
You are on page 1/ 30

Peritoneal dialysis

Sahier Omar El-Khashab


Professor of Internal Medicine and
Nephrology
Kasr Al-Aini Hospital
Cairo University
EGYPT
Peritoneal Dialysis
Definition
• Sterile solution into the
peritoneal cavity

• Peritoneal membrane
as the exchange surface

• Addition of osmotic
agents (most commonly
glucose)
Types
• IPD

• CAPD Manually
(continuous ambulatory
PD),

• APD Machine -assisted


PD (automated PD)
Phases of PD

Exchange
Indications of PD
Indications Preferred
• Vascular access failure • Bleeding diathesis
• Intolerance to hemodialysis • Multiple myeloma

• Congestive heart failure • Labile diabetes mellitus


• Prosthetic valvular disease • Chronic infections
• Poor cardiac function
• Peripheral vascular disease
• Possibility of RTX in the near
future

• Children aged 0-5 years


• Age between 6 and 16 years
• Patient preference
• Needle anxiety
• Distance from a hemodialysis
center • Active lifestyle
Non Renal indications for PD
• Refractory congestive • Dialysis-associated
heart failure ascites
• Hepatic failure • Drug poisonings
• Hypothermia • Pancreatitis
• Hyperthermia • Inherited enzyme
• Hyponatremia deficiencies
Contraindications
ABSOLUTE RELATIVE
• Documented type II ultrafiltration• Severe malnutrition
failure • Multiple abdominal adhesions
• Ostomy
• Severe inflammatory bowel disease
• Proteinuria >10 g/day
• Acute active diverticulitis
• Abdominal abscess
• Active ischemic bowel disease
• Upper limb amputation with
• Severe active psychotic disorder no help at home
• Marked intellectual disability • Poor personal hygiene
• Dementia
• Women starting third trimester of • Homelessness
pregnancy
PD not preferred
• Obesity • Impaired manual
• Multiple hernias dexterity
• Severe backache • Blindness
• Multiple abdominal • Poor home situation
surgeries • Depression
PERITONEAL ACCESS
• Tenckhoff catheter • 2 weeks
• If immediate small
volumes
TYPES OF PD TREATMENT AND SOLUTIONS

• CAPD • Automated PD (APD)


• 2-4 L 3-4 Times/Day • Intermittent Night
Peritoneal Dialysis
• ( residual Renal
function) 6 L bags

• Continuous Cycling
Peritoneal Dialysis:
• ( No residual Renal
function)2 L bags
Composition of the dialysis solution
• Glucose (1.5%, 2.5% • LOW pH
4.25%) • avoid glucose
• Calcium (2.5 and 3.5
caramelization during
mEq/L)
heat sterilization.
• Sodium 132 mEq/L
• pain during infusion
• Chlorin e 95 to 102 mEq/L
• Lactate 35 to 40 mEq/L).
• pH of the dialysis solution
is low (5.5)
• Magnesium levels of 0.5 or
0.25 mM.
Osmotic agents
• ICODEXTRIN, isomolar high
• GLUCOSE molecular weight glucose polymer
• Being known • is absorbed into the plasma through
• Relatively safe the lymphatic vessels
• Inexpensive
• Source of calories • ABSORPTION
• much slower than that of glucose,
• BUT more continuous
• Hyperglycaemia
• dyslipidaemia, • Metabolised to maltose, maltotriose
• obesity and other polysaccharides.
• peritoneum damage in the long- • Maltose interfere with capillary
term, directly or through the blood glucose readings,(falsely
products of elevated )
• glucose degradation.
• In Brasil
ADEQUACY IN PERITONEAL DIALYSIS
The Guidelines of the International Society of
Peritoneal Dialysis (ISPD)

• Adequate clearance of small • Clearance of solutes


solutes
• Quality of life • 1.7 at end of first
• Laboratory tests month and every 4
• Nutritional aspects months
• Appetite
• Volume status with adequate
ultrafiltration to avoid volume
overload,
• Hb values
• Response to ESA
• Ca Po4
• BP
Peritoneal equilibrium test PET
• According to the
• Infusing 2 L of dialysate
• creatinine D/P ratio in the 2nd and 4th h,
(D) at 2.5% glucose in • the glucose D/D0 in the same period /the
the P cavity volume of dialysate drained after 4 hours,
patients can be classified into 4 categories

• Samples of D at 0, 2 ,h High transporters:


• quickly D/P balance for creatinine / urea,
4 hours • quickly absorb glucose with a rapid loss of
osmotic gradients
• benefit from short-term changes.
• A plasma sample (P) is
also obtained mid- Low transporters
period (2 h). • creatinine D/P balance is slower /incomplete
• the osmotic gradient remains longer.
• need changes with a longer permanence
COMPLICATIONS IN PD
INFECTION NON INFECTION
D Leak
Drainage failure
• Peritonitis
Hernia
Hydrothorax
• Catheter infection
Edema ‘Ultrfiltratio
Weight gain
• Wound infection
Hypertriglyceridemia
Hyperglycemia

Encapsulating peritoneal sclerosis


COMPLICATIONS IN PD
EARLY LATE
• Bowel perforation • Cuff infection
• Bleeding • Outflow obstruction
• Wound infection • Peritonitis
• Outflow obstruction
• D leakage
• Peritonitis
Protocols to decrease infection risk in PD
1. Proper catheter placement
2. Exit-site care that includes
staphylococcus aureus
prophylaxis
3. Careful training of patients
with periodic retraining
4. Treatment of
contamination
5. Prevention of procedure-
related and fungal
peritonitis.
Technique failure
Shift to HD
• Target Kt/V not reached • Severe
• Low fluid removal (with hypertriglyceridemia
no residualrenal • Frequent peritonitis
function)
• Development of
• High transporter patients
technical/mechanical
who have inadequate
problems
ultrafiltration and/or
excessive protein loss • Severe malnutrition
(relative contraindication, resistant to aggressive
obviously discovered after treatment (relative)
initiation and first PET)
Summary
• PD / HD • Complications
• IPD/ CAPD • Shift to HD
• High/ Low

• Phases
• Dialysate type

• Tenckoff
• Technique
Studies
Guidelines
• International society for • https://ispd.org/ispd-
PD guidelines/
Books and Journals
• Peritoneal Dialysis Man • Peritoneal Dialysis Inter
ual - national: SAGE Journals
Karger Publishers • Peritoneal Dialysis | Pee
• Peritoneal Dialysis - Thir r Reviewed Journals
d edition | K.D.
Nolph | Springer
• The Textbook of Periton
eal Dialysis | R.
Gokal | Springer
• Handbook of Peritoneal
Dialysis: Second Edition
...
E- links
• Step by step • CAPD /Automated
• https://www.youtube.c • https://www.youtube.c
om/watch?v=IWufgduE om/watch?v=eQCxz38p
xvE kmQ
’
• Education
• https://
• https:// www.youtube.com/
www.youtube.com/ watch?v=kqSFb1rk0Uc
watch?v=9bRnG3NaCug

You might also like