From the Guidelines
Peritoneal dialysis (PD) is a type of kidney replacement therapy that uses the peritoneal membrane in the abdomen as a semipermeable membrane to filter waste products from the blood.
Key Principles of Peritoneal Dialysis
- PD is based on the exchange of solutes between the blood in the peritoneal capillaries and the dialysis fluid introduced into the peritoneal cavity 1
- The process involves diffusion and convection, with the movement of solutes from an area of high concentration to an area of low concentration across the peritoneal membrane 1
- Peritoneal dialysis fluids are removed by creating an osmotic gradient versus the peritoneal capillaries through the instillation of osmotic solutions (hypertonic glucose or icodextrin) in the peritoneal cavity 1
Types of Peritoneal Dialysis
- Continuous ambulatory peritoneal dialysis (CAPD): a PD modality based on daily manual exchanges by the patient at home 1
- Automated peritoneal dialysis (APD): a PD modality where exchanges are performed by a simplified machine, usually at home and at night 1
Clinical Considerations
- PD is associated with greater patient autonomy and treatment satisfaction compared to in-center modalities, but its use is limited by various factors, including local resources, dialysis costs, and healthcare policies 1
- Clinical outcomes across all dialysis modalities are largely similar, but the choice of modality should be based on individual patient preferences, quality of life, and clinical characteristics 1
- Adherence to PD therapy is crucial, and nonadherence can be influenced by factors such as age, employment status, and cultural background 1
From the Research
Definition and Overview of Peritoneal Dialysis
- Peritoneal dialysis (PD) is a dialysis option for end-stage renal disease patients in whom preemptive kidney transplantation is not possible 2.
- PD is an excellent treatment option for patients with end-stage renal disease, yielding improved patient satisfaction and economic benefits 3.
- It is a simple, "low-tech" form of renal replacement therapy that is less expensive than conventional in-center hemodialysis in many parts of the world 4.
Comparison with Hemodialysis
- The selection of PD or hemodialysis (HD) is usually based on patient motivation, desire, geographic distance from an HD unit, physician and/or nurse bias, and patient education 2.
- Most studies show that the relative risk of death in patients on in-center HD versus PD changes over time, with a lower risk on PD, especially in the first 3 months of dialysis 2.
- PD survival is best at the start of dialysis, and patient satisfaction may be higher with PD, with significantly lower costs compared to HD 2, 5.
Patient Eligibility and Considerations
- Many surgeons and physicians believe that patients with prior abdominal surgeries or other abdominal complications are not viable candidates for PD, but this is not always the case 3.
- With appropriate planning, PD can still be an acceptable option for patients with end-stage renal disease and certain abdominal complications, including abdominal surgery, provided that the peritoneum is not compromised 3.
- A "PD First" approach can be beneficial for patients, physicians, healthcare systems, and society, providing comparable clinical outcomes, superior quality of life measures, and significant cost savings 6.