What Is Peritoneal Dialysis?

Peritoneal dialysis is a type of treatment that utilizes an individual's peritoneum or abdominal lining and a special fluid to filter the blood when the kidneys are unable to do so. Dialysis must be used, or kidney transplantation is required, when the kidneys cannot filter blood any longer. The kidneys remove excess waste substances and water from the blood so they can leave the body through the urine. When the kidneys are unable to function without some form of medical treatment, it is called kidney disease. Kidney disease can lead to kidney failure, which is characterized by kidneys with less than fifteen percent functionality. It is common for affected individuals to undergo dialysis until they can receive a new kidney. Hemodialysis utilizes a machine to externally filter blood, while peritoneal dialysis uses a mechanism to filter it internally.

How The Procedure Works

How the procedure works depends on which type of peritoneal dialysis a patient uses. Continuous ambulatory peritoneal dialysis is done manually by the individual, while automated peritoneal dialysis is done with the help of a machine called a cycler. With both methods, a special solution made of salt and other substances is transferred from a bag through a catheter into the abdomen. Once all of the fluid is in the abdomen and the bag is empty, it is disconnected so the patient can go about their normal daily activities. The fluid stays inside of the patient's abdomen for several hours to allow for the osmosis of extra fluids and waste substances from the body and bloodstream into the fluid. After several hours, the patient empties the solution augmented with wastes from the abdomen and discards it. They then empty a new bag of fresh solution into the abdomen, and then this exchange is repeated between four and six times each day. With automated peritoneal dialysis, a machine automatically performs the solution exchange process between four and six times while the patient is sleeping at night.

What It Helps Treat

Peritoneal dialysis helps treat damage to an individual's kidneys. The kidneys keep a careful balance of minerals and salts in an individual's blood for the body to successfully maintain a healthy state of homeostasis. The minerals and salts that depend on the kidneys for regulation include phosphorus, potassium, calcium, and sodium. An individual's kidneys are also responsible for the production of certain hormones that help keep blood pressure at a healthy level, production of red blood cells, and maintenance of the strength of an individual's bones. When the kidneys can no longer perform one or more of these important functions, the individual is considered to have kidney disease, or in severe cases, kidney failure. Kidney failure results in numerous life-threatening complications, including heart disease, anemia, high blood pressure, loss of bone, excessive itchiness, and malnutrition. Treatment of kidney disease and kidney failure with the use of peritoneal dialysis can help extend a patient's life and relieve many of their symptoms.

Benefits Over Hemodialysis

Peritoneal dialysis is different from traditional dialysis methods and has many benefits over hemodialysis. One of the main reasons why many patients choose to have peritoneal dialysis is because it is more convenient than hemodialysis. Peritoneal dialysis can be done at home or on the go, where hemodialysis requires a visit to a medical facility three times a week with a session duration of four hours. Some patients live too far to travel to undergo dialysis three times a week. In addition, hemodialysis requires an individual to watch how much fluids, potassium, sodium, and phosphorus they consume to prevent complications. Patients who choose to have peritoneal dialysis only have to watch their calorie and sodium consumption. Furthermore, multiple studies have proven patients who use peritoneal dialysis are more likely to retain their kidney function for longer than individuals who have hemodialysis. Some of these benefits are attributed to the fact peritoneal dialysis is performed on a more continuous and frequent basis similar to how healthy kidney would operate, where hemodialysis filters less frequently on a bulk basis.

Complications Of Peritoneal Dialysis

There are some possible complications of peritoneal dialysis that may occur in patients who choose this treatment method. Just like every other type of medical treatment, adverse effects can occur in a small number of peritoneal dialysis patients. An affected individual may develop peritonitis or an infection of the peritoneum. There is also the potential for an infection to occur where the catheter is implanted into the abdomen. The risk of infection is greater when the treatments are not performed as directed. Patients who have peritoneal dialysis may experience weight gain, as a type of sugar called dextrose in the dialysis solution causes an increase in the individual's caloric intake each day. The increase in caloric intake may also result in elevated blood sugar levels, especially for diabetes patients. An individual who has peritoneal dialysis may develop a hernia due to muscle strain from holding a large amount of fluid in the abdomen for extended periods. Some individuals who have peritoneal dialysis can experience a decrease in its effectiveness after several years, requiring a transition to hemodialysis.

Who It's Not Appropriate For

Peritoneal dialysis is not appropriate for every patient who needs treatment with dialysis. An individual who has widespread scarring in the abdominal area may not be able to have a catheter implanted. Because peritoneal dialysis depends on the semi-permeable peritoneal barrier, someone who has a hernia may not have a strong enough barrier to keep the solution from coming in contact with internal abdominal organs. Peritoneal dialysis requires a degree of responsibility and capability of the patient or a dedicated caregiver to ensure treatments are performed correctly and consistently. Many hours of training is required for both the patient and their caregiver to learn how to perform the treatments properly. Affected individuals who also have frequent diverticulitis or an inflammatory bowel disease may not be eligible to use peritoneal dialysis. Those who do not desire to perform the work associated with this type of treatment and would rather have it done by medical staff in a facility may choose to have hemodialysis instead.