Renal replacement therapy
Peritoneal dialysis
Tbilisi referral hospital, Tbilisi, Georgia
Nephrologist
Nino Maglakelidze
Peritoneal dialysis
•Peritoneal dialysis (PD) is a treatment for patients with chronic
kidney disease, stage V – ESRD
•A dialysis technique that uses the patient’s own body tissue –
peritoneal membrane inside the abdominal cavity as a filter.
Goals of peritoneal dialysis:
Remove toxic substances and metabolic wastes
Reverse the symptoms of uremia
Reestablish normal fluid and electrolyte balance
Maintain a positive nitrogen balance
Prolong life
Have a maximal level of quality of life
Contra indications
Absolute contraindications
•Peritoneal fibrosis and adhesions following intra abdominal operations
•Inflammatory gut disease
Relative contra indications
•Hernias
•Significant loin pain
•Diverticulitis
•Colostomy
•Obesity
•Significant decrease lung function
Principles underling peritoneal dialysis
Three processes take place simultaneously
Diffusion
Osmosis
Ultrafiltration
Types of peritoneal dialysis
•Continuous ambulatory peritoneal dialysis (CAPD)
•Automated peritoneal dialysis (APD)
Continuous ambulatory peritoneal dialysis (CAPD)
Carried out during day time, manually by patients or
caregivers
Dialysis fluid is infused to the peritoneal cavity
Dwell time between 4-8 hours
Automated peritoneal dialysis:
Is performed through a cycler machines
During the night when the patient sleep
Types of automated peritoneal dialysis
•Continuous cycling peritoneal dialysis (CCPD)
•Tidal peritoneal dialysis (TPD)
•Nocturnal (night) intermittent peritoneal dialysis (NIPD)
Automated peritoneal dialysis (APD)
Continuous cycling peritoneal dialysis (CCPD)
•CCPD has a long daytime dwell
•Several cycles over night
•Minority of patients do not have a day time dwell
•Some patients have ,,midday exchange” to achieve adequate
ultrafitration
Nocturnal (night) intermittent peritoneal dialysis (NIPD)
•Noctural intermittent peritoneal dialysis have treatments periods
,,wet abdomen” altering with times during which peritoneal cavity has
been drained of dialysate ,,dry abdomen”.
Tidal peritoneal dialysis (TPD)
•TPD is modification of cycler therapy in which exchange consists of
partial drain. (Usually 80 - 90% of instilled volume plus ultra filtration
from the body)
•The peritoneal cavity always contains 250 – 400ml dialysate
•The patients may or may not have a day time dwell
PD catheters
An internal section with numerous openings and an
open tip to let dialysate flow freely
A subcutaneous section
An external section for connection to dialysate
section;
Types of peritoneal catheters
Straight Tenckhoff
Curled Tenckhoff
Swan-neck
T-fluted
Types of peritoneal membrane
Four types peritoneal membrane
High transporter
Low transporter
High average transporter
Low average transporte
PET – peritoneal equilibration test evaluates:
Type of peritoneal membrane
Ultrafitration capacity of peritoneal dialysis
Types of peritoneal solutions
Dextrose solutions:
1,5% dextrose solution 2000-2500 ml;
2,5% dextrose solution 2000-2500 ml;
4,25% dextrose solution 2000-2500 ml;
7.5% 2000ml Icodextrine solution;
Complications of peritoneal dialysis
Dialysate leakage
Ceased peritoneal dialysis
Drainage problems
Kinking in tubes
Constipation
Fibrin formation – Heparin or streptokinase
administration
Malpositioned catheter
Shoulder pain
Following infusion of fresh dialysate
Resolve within 20min after instillation, analgesics can
be given
Complications of peritoneal dialysis
Hemoperitoneum
Occurs in female;
Management :
Heparin administration;
Transfer to HD
Peritonitis
Abdominal pain
Cloudy effluent
Tenderness,
Identification of micro organism, culture or gram
staining
Treatment -antibiotics ;
Remove PD catheter if unresolved in 4 days;
Complications of peritoneal dialysis
Exit site infection
The presence of purulent drainage with or without
erythema of the skin
Tunnel infection
Swelling, pain and redness over the subcutaneous
tunnel may be observed
Management:
Drainage culture and
Antibiotic therapy
Thank you for
your attention
