Peritoneal Dialysis in Delhi, India

There are two types of peritoneal dialysis. They are:

1. Continuous ambulatory peritoneal dialysis (CAPD): CAPD is a machine-free, manual procedure. The patient needs to connect the tube to the catheter and the dialysis bag to empty the dialysis fluid in the belly and later drain it. This process needs to be repeated 3 times a day. Each exchange takes 30 to 40 minutes.
2. Automated peritoneal dialysis (APD): APD, also called continuous cycling peritoneal dialysis, involves attaching a catheter to a machine called a cycler. This process involves sending the dialysis solution to the person's abdomen through the machine. The automated cycler (machine) performs multiple exchanges throughout the night while the person sleeps. The cycler automatically fills the abdomen with a solution allowing it to stay there and drain the solution along with waste into a sterile bag. The person has to remain attached to the machine throughout the night for 10 to 12 hours.

A person with chronic kidney disease reaching end-stage renal disease needs dialysis. It may be due to:

• High blood pressure
• Diabetes
• Glomerulonephritis (kidney inflammation)

Dialysis can be performed in two ways:

• Hemodialysis
• Peritoneal dialysis

In hemodialysis, a person needs to visit a hospital where the blood is removed from the body and sent into a machine for filtration, and the filtered blood is returned to the body.

A major advantage of peritoneal dialysis is it can be done according to patients' convenience. It provides greater flexibility and independence. Peritoneal dialysis is done more frequently than hemodialysis; this causes less accumulation of sodium, potassium and other fluids in the blood.

Peritoneal dialysis is an option for a person:

• Who can't tolerate rapid changes in the fluid shift that occurs with hemodialysis
• Wants lifestyle freedom and minimum disruption in day-to-day activities
• Wishes to retain some residual kidney functioning

Peritoneal dialysis may not work out for everyone. A person shouldn't consider peritoneal dialysis if they have:

• Extensive surgical scars on the abdomen
• Hernia (weak abdominal muscle)
• Diseases such as inflammatory bowel disease or bouts of diverticulitis
• Lack of caregiving support or inability to take care of yourself

The need for peritoneal dialysis is evaluated by conducting blood and urine tests, and sometimes kidney biopsy, along with imaging tests such as CT scans, MRI, and x-ray.

After peritoneal dialysis, the doctor may conduct tests to see if dialysis removes the waste from the blood. The test includes:

• Peritoneal equilibrium test (PET): This test compares samples of the blood and dialysis solution during the exchange. The results show if the waste toxins pass quickly or slowly from the blood into the solution. This helps evaluate the functioning of the peritoneal membrane and how it can be improved.

If the dialysis procedure is not working, the doctor may increase the number of exchanges and the amount of solution or the concentration of dextrose in the solution.

Peritoneal dialysis can cause potential complications such as:

• Weight gain: The solution used during peritoneal dialysis contains sugar. The patient's body might absorb the dialysate that can add 100s of extra calories, causing weight gain. If the patient has diabetes, these extra calories can lead to high blood sugar.

• Infections: For peritoneal dialysis, a catheter is placed inside the patient's abdomen. An infection can develop near the catheter; the risk is higher if the person isn't properly trained for the procedure. An infection of the abdominal lining can also develop due to peritoneal dialysis.

• Inefficiency: Peritoneal dialysis becomes ineffective after continuous use for several years. The patient then needs to shift to hemodialysis.

• Hernia: To filter the blood, dialysis solution is sent into the abdomen. It stays in the body, and after the blood is filtered, the solution is removed along with the waste. This procedure holds the fluid in the abdomen for a long duration that may strain the abdominal muscles.

A person with kidney dysfunction and peritoneal dialysis treatment must avoid prescriptions and over-the-counter medications such as nonsteroidal anti-inflammatory drugs. Such prescriptions can cause further damage to the kidneys.

As dialysis is a lifelong process, a person needs to make lifestyle and diet changes.

Eat healthy food and take prescribed medication to improve the dialysis result. Take nutritional supplements and avoid high-potassium food. Ensure the diet includes a high amount of protein, as peritoneal dialysis removes protein from the waste. Take a renal diet and check the daily intake of sodium, phosphorus, and potassium.