Polycystic Kidney disease ( types, symptoms and treatment)

 Know peritoneal dialysis (PD)

How peritoneal dialysis (PD) works

When a tube called a catheter is inserted into the peritoneal cavity and the dialysate is injected and retained for a certain period of time, waste products and excess water in the blood move through the peritoneal membrane into the peritoneal cavity. The blood is purified by discharging the dialysate out of the body when it has sufficiently moved.

After removing urinary toxins, adjusting minerals, and removing excess water, it is returned to the body.

what to do every day

Since the purification ability is weak, it is necessary to do it every day. However, taking time every day to remove waste products and excess water is also an advantage of peritoneal dialysis. Unlike hemodialysis, there is no "burden between dialysis and dialysis", and hemodynamic instability is thought to be less.

CAPD vs APD vs CCPD?

There are two types of peritoneal dialysis: “CAPD”, which replaces the dialysate 4 to 5 times a day, and “APD”, which replaces the dialysate at night using a dialysis machine while you are asleep. There is also a "CCPD" method that combines both. Depending on the condition of the peritoneum, it is suitable or unsuitable, but you can choose according to your lifestyle.

Effects of peritoneal dialysate on the peritoneum

Peritoneal dialysate is composed of high concentrations of glucose and minerals. Glucose has no effect on the human body in the short term. However, when the peritoneum is repeatedly exposed to glucose, changes similar to those of diabetic angiopathy occur in the peritoneum, leading to deterioration of the peritoneum. If the function of the peritoneum changes, the ability to remove water may decrease or ascites may appear. Furthermore, when morphological changes occur, the peritoneum may adhere to the intestinal tract, causing intestinal obstruction.

For this reason, it is said that the duration of peritoneal dialysis should be within 7 years.

Preservation of fluid balance and peritoneal function

Peritoneal dialysis is not as effective at removing excess water as hemodialysis, and is prone to swelling. In order to correct this, a more concentrated dialysate must be used to draw water into the dialysate side. However, as a result of this, the peritoneum may deteriorate more quickly. People who tend to swell put a strain on the heart, so like hemodialysis, it is necessary to strictly control salt intake and water intake, or, knowing that the peritoneum will deteriorate, use a thick dialysate to increase the ability to remove water. I have.

For the sake of the heart and the peritoneum, it will be necessary to strictly restrict salt intake.

Preservation of residual renal function

"Preservation of residual renal function" is a phrase that originates from the idea that "we should use the kidneys that are working, albeit only slightly, with care." We shouldn't be too particular about that, but on the premise that the body fluids are in balance, stable peritoneal dialysis and a stable life are necessary in order to have the kidneys, which have decreased their function, work a little harder. Peritoneal dialysis is thought to be superior to hemodialysis in preserving residual renal function, as water removal is gentle.

Benefits of peritoneal dialysis (PD)

• Remaining kidney function is likely to be preserved.
• You can live a life that is not bound by hospital visits and dialysis time.
• Less fatigue from dialysis.
• No drop in blood pressure during dialysis.
• No pain of needle puncturing the shunt.
• Compared to hemodialysis, dietary restrictions (especially potassium) are less severe.

Complications specific to peritoneal dialysis (PD)

• PD peritonitis

is often caused by pathogenic bacteria entering the peritoneal cavity due to unclean operation during peritoneal dialysis bag exchange. My stomach hurts. Drainage becomes cloudy. symptoms such as fever. If repeated, the peritoneal function will deteriorate, the catheter will have to be pulled out, and peritoneal dialysis will have to be interrupted.

• PD Catheter Exit / Subcutaneous Tunnel Infection

Pus may come out from the exit of the PD catheter, bad granulation may appear, and pain may appear along the catheter under the skin. It is caused by pathogenic bacteria entering the exit part of the PD catheter or the subcutaneous tunnel part. It is important to keep the area near the exit of the PD catheter clean.

• Dysfunction of the PD catheter

It may take time to inject or drain the PD dialysate, or the drainage may not be sufficient. It is caused by misalignment of the tip of the catheter, clogging of fibrin clots, entanglement of the omentum around the catheter, or kinking of the catheter.

• Encapsulated peritoneal sclerosis

Peritoneal adhesions prevent the intestinal tract from moving, resulting in gastrointestinal symptoms such as nausea, vomiting, abdominal pain, and constipation. There may be ascites or bloody discharge from the drainage. Long-term use of high-concentration glucose dialysate and refractory peritonitis are considered causes.

• Hernia

Because 1.5 to 2 L of dialysate is injected into the peritoneal cavity and retained, intra-abdominal pressure is applied, which sometimes causes a hernia. It is a relatively common complication.