peritoneal dialysis; continuous abdominal/ambulatory (cycling) peritoneal dialysis (CAPD, CCPD)
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Indications
- cardiovascular instability
- poor hemodialysis access
- patient preferences[3]
Contraindications
- recent abdominal surgery
- history of multiple abdominal surgeries with adhesions
- colostomy
- nephrostomy
- obesity may be relative contraindication[6]
Advantages
- does not require systemic anticoagulation
- produces less stress on the cardiovascular system
- fewer abrupt changes in blood pressure
- fewer abrupt changes in electrolytes
- allows greater patient independence[6]
- ~$20,000/year less expensive than hemodialysis[5]
- outcomes similar to hemodialysis[6]
* vs hemodialysis
Disadvantages
- less efficient, but outcomes similar[5]
- mortality may be 8% higher for hemodialysis than peritoneal dialysis[7]
* vs hemodialysis
Procedure
- CAPD uses the peritoneum as a dialysis membrane
- solutes are removed by diffusion into dialysate introduced into the peritoneal cavity through a catheter
- the osmotic gradient for dialysis is created by the addition of glucose to the dialysate
- higher glucose concentrations & more frequent exchanges increase the rate of fluid removal
- peritoneal catheters are placed ~ 1 month prior to initiation of dialysis[6]
- 2 liters of dialysate is infused into the peritoneal cavity.
- glucose concentrations are generally 1.5-4.25 g/dL
- following a period of equilibration, the dialysate is drained
- sterile technique is necessary
- continuous ambulatory peritoneal dialysis (CAPD) generally involves 4-5 exchanges/day performed by the patient, but the procedure may be performed hourly if indicated
- an automatic cycler is available to perform exchanges during sleep
Complications
- infections
- peritonitis (see bacterial peritonitis)
- infection of the catheter site
- hyperglycemia
- protein loss
- hypoalbuminemia is common
- increase dietary protein to 1.2-1.4 g/kg/day
- catheter leak
- hyperlipidemia
- obesity
- pancreatitis 1.8%/year, 3-fold risk for hemodialysis[4]
- may be more common in blacks
More general terms
Additional terms
References
- ↑ Manual of Medical Therapeutics, 28th ed, Ewald & McKenzie (eds), Little, Brown & Co, Boston, 1995, pg 275
- ↑ Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed) Lippincott-Raven, Philadelphia, 1998, pg 618
- ↑ 3.0 3.1 Journal Watch 24(6):45, 2004 Rubin HR et al, JAMA 291:697, 2004 PMID: https://www.ncbi.nlm.nih.gov/pubmed/14871912 Heaf J, JAMA 291:740, 2004 PMID: https://www.ncbi.nlm.nih.gov/pubmed/14871920
- ↑ 4.0 4.1 Quraishi ER, Goel S, Gupta M, Catanzaro A, Zasuwa G, Divine G. Acute pancreatitis in patients on chronic peritoneal dialysis: an increased risk? Am J Gastroenterol. 2005 Oct;100(10):2288-93. PMID: https://www.ncbi.nlm.nih.gov/pubmed/16181382
- ↑ 5.0 5.1 5.2 Mehrotra R et al. Similar outcomes with hemodialysis and peritoneal dialysis in patients with end-stage renal disease. Arch Intern Med 2010 Sep 27 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/20876398 <Internet> http://dx.doi.org/10.1001/archinternmed.2010.352)
Kutner NG et al. Patient awareness and initiation of peritoneal dialysis. Arch Intern Med 2010 Sep 27; <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/20876396 <Internet> http://dx.doi.org/10.1001/archinternmed.2010.361)
Johansen KL. Choice of dialysis modality in the United States. Arch Intern Med 2010 Sep 27 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/20876395 <Internet> http://dx.doi.org/10.1001/archinternmed.2010.370 - ↑ 6.0 6.1 6.2 6.3 6.4 Medical Knowledge Self Assessment Program (MKSAP) 16, 17, 18. American College of Physicians, Philadelphia 2012, 2015, 2018.
Medical Knowledge Self Assessment Program (MKSAP) 19 Board Basics. An Enhancement to MKSAP19. American College of Physicians, Philadelphia 2022 - ↑ 7.0 7.1 Weinhandl ED, Foley RN, Gilbertson DT et al Propensity-matched mortality comparison of incident hemodialysis and peritoneal dialysis patients. J Am Soc Nephrol. 2010 Mar;21(3):499-506. PMID: https://www.ncbi.nlm.nih.gov/pubmed/20133483 Free PMC Article
- ↑ Hansson JH, Watnick S. Update on Peritoneal Dialysis: Core Curriculum 2016. Am J Kidney Dis. 2016 Jan;67(1):151-64. PMID: https://www.ncbi.nlm.nih.gov/pubmed/26376606
- ↑ Peritoneal Dialysis Dose and Adequacy http://kidney.niddk.nih.gov/kudiseases/pubs/peritonealdose/index.htm
Treatment Methods for Kidney Failure: Peritoneal Dialysis http://kidney.niddk.nih.gov/kudiseases/pubs/peritoneal/index.htm