From the Guidelines
The peritoneum is accessed for dialysis in patients with end-stage renal disease because it provides a natural and effective means of filtering waste products and excess fluids from the blood, as outlined in the guidelines for peritoneal dialysis adequacy 1. The peritoneal membrane acts as a semipermeable filter, allowing waste products and excess fluids to pass from the bloodstream into the dialysate through diffusion and osmosis. Key advantages of peritoneal dialysis include:
- The ability to perform treatments at home, offering greater independence and flexibility
- Fewer dietary restrictions compared to hemodialysis
- Better preservation of residual kidney function
- Suitability for patients who cannot tolerate the hemodynamic shifts associated with hemodialysis, those with difficult vascular access, and those desiring more control over their treatment regimen However, it's crucial for patients to be capable of performing the procedure and maintaining strict sterile technique to prevent peritonitis, a common complication of peritoneal dialysis, as noted in guidelines for managing peritoneal dialysis complications 1. In cases where peritoneal dialysis is not adequate, such as inadequate solute transport or ultrafiltration, alternative renal replacement therapies like hemodialysis should be considered, as recommended by clinical practice guidelines for peritoneal dialysis adequacy 1.
From the Research
Peritoneal Dialysis Access
The peritoneum is accessed for dialysis in patients with end-stage renal disease (ESRD) due to several reasons:
- Peritoneal dialysis (PD) is a viable alternative to hemodialysis (HD) for patients with ESRD, offering benefits such as lower costs and higher patient satisfaction 2
- PD can be performed at home, providing patients with more flexibility and autonomy in their treatment regimen
- The peritoneum is a natural membrane that can be used for dialysis, allowing for the exchange of waste products and excess fluids from the blood
Advantages of Peritoneal Dialysis
Some advantages of PD include:
- Lower risk of death in the first 3 months of dialysis compared to HD 2
- Higher patient satisfaction due to the flexibility and autonomy of home-based treatment
- Lower costs compared to HD, which can be a significant factor in the selection of dialysis modality 2
Complications and Risks
However, PD is also associated with certain complications and risks, including:
- Peritonitis, a common infection that can occur in PD patients, which can be caused by gram-positive cocci such as Staphylococcus epidermidis and Staphylococcus aureus 3, 4
- Exit-site and tunnel infections, which can be prevented with proper patient training and exit-site care 4
- Catheter removal or replacement, which may be necessary in cases of persistent infection or other complications
Patient Selection and Education
Patient selection and education are crucial in the success of PD:
- Patients should be educated on the benefits and risks of PD, as well as proper techniques for catheter placement and exit-site care 2, 4
- Patient motivation and desire for home-based treatment should be taken into account when selecting a dialysis modality 2
- Nephrologists should focus on educating themselves and their patients about the opportunities for home modality therapies and reducing the reliance on central venous catheters for long-term HD access 2