What is Peritoneal Dialysis?

Peritoneal dialysis (PD) is a treatment for kidney failure that uses the peritoneal membrane in the abdomen to filter wastes and excess fluid from the blood. In PD, a cleansing fluid called dialysate is introduced into the abdomen through a surgically placed soft tube called a catheter. The peritoneal membrane that lines the inside of the abdomen acts as a natural filter. Wastes and extra fluid from the blood pass through the peritoneal membrane and into the dialysate fluid. The used dialysate fluid is then drained from the abdomen and replaced with fresh fluid. This cycle of filling and draining is called an exchange.

How does Peritoneal Dialysis work?

Peritoneal Dialysis in the peritoneal membrane that lines the inner wall of the abdomen is used to filter waste products and extra fluid from the blood through simple diffusion and osmosis. A cleansing fluid called dialysate is introduced into the peritoneal cavity through a surgically placed permanent catheter. During each exchange, wastes like urea and creatinine along with extra fluids pass from the blood into the dialysate fluid through the peritoneal membrane. The used dialysate is drained from the body and replaced with fresh dialysate. This process of dialysate filling and draining cleans the blood. Several exchanges are performed each day, either manually or automatically using a device called a cycler.

Types of Peritoneal Dialysis

There are two main types of PD - Continuous Ambulatory Peritoneal Dialysis (CAPD) and Automated Peritoneal Dialysis (APD).

In CAPD, exchanges are performed manually by the patient several times a day. The patient connects the tubing from a bag of fresh dialysate to the catheter and performs fills and drains without using a machine. CAPD provides good clearance and is convenient since it doesn't require a machine.

In APD, an automated cycler performs dialysate exchanges at night while the patient sleeps. The cycler is programmed to gradually fill and drain the peritoneal cavity with dialysate during sleep in cycles. During the day, the patient disconnects from the cycler. APD offers dialysis during sleep without disrupting daily activities.

Benefits of Peritoneal Dialysis

Some key advantages of peritoneal dialysis include greater flexibility and independence for patients as treatment can be performed at home or work. This allows patients to largely maintain an active lifestyle and better quality of life without disrupting their daily routine since they do not need to commute to a dialysis center three times a week. Peritoneal dialysis is also more gradual and continuous compared to hemodialysis, providing better fluid and waste control. It puts less strain on the cardiovascular system and has fewer dietary restrictions. Recovery after transplant surgery is usually quicker for PD patients as well.

Challenges of Peritoneal Dialysis

Some challenges associated with peritoneal dialysis include the need for extensive training to learn proper exchanges technique. Peritonitis, or infection of the peritoneal cavity, is a risk that requires close monitoring. The dialysate bag needs to be changed several times a day which can disrupt sleep and activities. The catheter site requires careful cleaning and dressing changes to prevent exit site infections. Long term peritoneal dialysis may result in shrinkage of the peritoneal membrane over time. Emotional adjustments are also needed to adapt to a home-based treatment routine and lifestyle changes.

Patient Selection and Care

Peritoneal dialysis is an option for most patients with end stage kidney disease provided they do not have factors like severe cardiac issues, abdominal adhesions or recurrent hernias that could complicate the procedure. Careful patient selection and training are important for a successful PD program. Diet, medication, fluid and exchange technique must be followed diligently under the supervision of a nephrologist and dialysis team. Regular checkups help monitor complications and optimize treatment. With proper selection, education and support, peritoneal dialysis can offer adequate dialysis to meet the needs of numerous patients with kidney failure.

Government Support and Insurance Coverage

Government programs and health insurance play a crucial role in supporting peritoneal dialysis by providing coverage for the capital expenditure involved in establishing a home-based PD program including cyclers, tubing sets and supplies. Reimbursement policies help make PD a viable and affordable treatment option. Initiatives to streamline credentialing of PD programs and simplify billing have also increased patient access. Tax benefits for medical equipment assist in offsetting costs. Expanding insurance eligibility and improving reimbursement rates can further empower more patients to choose PD and benefit from its advantages compared to in-center hemodialysis.

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