Peritoneal Dialysis

Another option that has been around for a long time, but is gaining increasing traction is peritoneal dialysis (PD).  PD is a method of cleaning the body of the toxins and waste products that are normally eliminated by the kidneys.  PD depends on diffusion, or the exchange of material along concentration gradients.  PD depends on the large surface area of the peritoneal cavity.  The peritoneal cavity is the space under your abdominal muscles and chest that hours the intestines and other organs.  In order for a patient to do PD, we have to insert a PD catheter into the peritoneal cavity and begin it out of the side of the abdomen.  This is an outpatient surgical procedure that takes about 45-60 minutes to perform and is not a very painful surgery.  The incisions are allowed to heal for about 2 weeks prior to the PD catheter being used or dialysis.

In essence, a large volume of dialysis fluid is placed into the abdominal (peritoneal) cavity, and allowed to dwell form some time, usually overnight.  During that time frame, due to the difference in the difference in concentration of electrolytes and other substances in the fluid as compared to the body, there is an exchange of products.  The fluid that was placed into the peritoneal saps a lot of the bad products that the kidneys would normally remove. This fluid is then drained out the next morning, resulting in “cleaning of the blood”, much like regular hemodialysis.

The good thing about PD is that is is much more physiologic than hemodialysis, meaning that it is gentler on your body because of the slower nature of the exchange.  The downside is that you have a piece of plastic tubing hanging out of your body, and you have to make adjustments to your lifestyle for it.  The other major risk of a PD catheter is the chance of infection.  An infection of the peritoneal cavity is called peritonitis, and can sometimes be treated with antibiotics in the dialysis fluid.  If the infection is severe, particularly if it s fungal infection, the catheter needs to be surgically removed in order to clear the infection.

PD requires  specialized training by peritoneal dialysis education centers, because it needs to be done correctly in order to reduce the chance of infection and other potential complications.  Patients who are significantly overweight, or who have had multiple pelvic or abdominal surgeries generally do not do as well with PD.


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