- World Kidney Day: Peritoneal dialysis can be carried out with ease
- It doesn't require hospital visits
- It is carried out by filling the patients belly with a cleaning fluid
On the occasion of World Kidney Day 2021 being observed on March 11, let's talk about different kinds of dialysis. Chronic kidney disease is one of the major non-communicable diseases affecting 229 people per million population, according to statistics. Most of the patients with this condition have to undergo dialysis. There are two modalities in dialysis - Hemodialysis and Peritoneal Dialysis. The former needs fully trained technicians and dialysis machine etc. and mostly conducted in hospitals while the latter can be done by oneself whether at home or work or while travelling. The process of peritoneal dialysis is carried out by filling the patient's belly with a cleaning fluid known as dialysate. It has sugar in it which pulls fluid and waste from the blood into it. The dialysate holds on to the waste and fluid and removes them from the patient's body during the exchange. The dialysate uses the belly lining (peritoneum) which covers most of the organs as a filter for the process of dialysis.
World Kidney Day 2021: Peritoneal Dialysis- How it is done
The process requires the patient to let the dialysate sit in the belly for sometime as it cleans the blood. This is known as dwell time. After the required dwell time is over, the dialysate is removed from the belly and replaced with fresh dialysate. The process of removal and refilling of dialysate is known as exchange in the medical parlance. An exchange usually takes 30 to 40 minutes and can be performed by the patient on his/her own or with the help of a machine.
To initiate peritoneal dialysis, the patient needs to undergo a minor surgery which enables the doctors to insert a soft, flexible tube known as a catheter into the stomach or chest. The end of the catheter comes out through the skin and it is used to do the exchanges. The insertion surgery is conducted under either a general anaesthesia or a local anaesthetic application. While general anaesthesia puts the patient to sleep, the local one ensures they don't feel any pain in the area where the surgery is being conducted.
The healing process for the surgery site takes about 2-3 weeks and only after the healing should the patient use the catheter. However, in some cases, the doctor might advise using catheter right after the surgery is done.
Types of Peritoneal Dialysis
There are two common types of PD: Continuous Cycler-assisted Peritoneal Dialysis (CCPD) and Continuous Ambulatory Peritoneal Dialysis (CAPD). Depending upon the lifestyle and condition of the patient, the doctor advises the right option for the patient. Sometimes, the patients can use both types of PD as per suitability.
The difference between CCPD and CAPD
- CCPD: CCPD involves a machine known as Cycler to perform the exchanges. The catheter is connected to tubes going into the cycler, and it fills the patient's belly with dialysate. The machine then waits for the required dwell time. It also drains the used dialysate from the stomach into a bag. The process is repeated for 3-5 exchanges throughout the night. The process is carried out when the patient is asleep at night and it has to be done every night.
- CAPD: CAPD relies on gravity to allow the patients to carry out the exchanges themselves by hand. Gravity is used to fill the stomach with dialysate as well as to remove it. The patient sits in a chair and a tube is attached to a dialysate bag hanging overhead. The gravitational pull makes the dialysate flow down through the tube and into the patient's belly. The used dialysate is drained out using a tube which allows gravity to pull the used dialysate out of the stomach and into a bag lying below the patient. The patient's stomach needs to be refilled with clean dialysate and the process has to be repeated. CAPD is ideally a daytime process since the patient has to do each exchange himself or herself and it has to be done every day.
Is there a risk involved with Peritoneal D?
Patients who do PD are sometimes infected by a belly infection known as peritonitis. The problem occurs when the patient doesn't regularly clean the area where the catheter enters the belly. This allows bacteria to get in the belly and also into the catheter during the process of connecting or removing the dialysate bags. The risk can be eliminated by washing hands thoroughly before touching the catheter and daily cleaning of the area where the catheter enters the body. Exchange should be done in a clean and dry place and the catheter should always be kept dry. If the patient notices any signs of infection then the doctor or treating nurse should be immediately consulted.
PD offers a greater ease of living. The patients opting for PD at night can allocate time for other activities during the day time. Since the catheter has to be kept dry, apart from swimming or using hot tubs, the patients are likely to be allowed most of the activities such as work and travel.
Peritoneal dialysis can be carried out with greater ease and doesn't require hospital visits. As far as the patients adhere to the instructions and maintain utmost hygiene, it can be helpful in improving the ease of living for the patients.
(Dr Vishal Sehgal, Medical Director, Portea Medical)
Disclaimer: The opinions expressed within this article are the personal opinions of the author. NDTV is not responsible for the accuracy, completeness, suitability, or validity of any information on this article. All information is provided on an as-is basis. The information, facts or opinions appearing in the article do not reflect the views of NDTV and NDTV does not assume any responsibility or liability for the same.