HOW IS THE PERITONEAL APPROACH TO DIALYSIS PERFORMED?

The main disadvantages of peritoneal dialysis compared to hemodialysis are:

• the risk of infectious complications (peritonitis);
• structural and functional degradation, over time, of the peritoneal membrane;
• Metabolic complications: protein malnutrition, hyperglycemia, and dyslipidemia.

The change of dialysis modality from peritoneal dialysis to hemodialysis should be consider in the following situations:

• insufficient clearance or ultrafiltration;
• frequent episodes of peritonitis;
• mechanical complications of peritoneal access that cannot be solve;
• significant protein loss and severe malnutrition;
• Severe hypertriglyceridemia.

What are peritoneal dialysis regimens?

Peritoneal dialysis regimens are divide into continuous peritoneal dialysis and intermittent peritoneal dialysis. Continuous peritoneal dialysis involves the permanent presence of the dialysis solution in the peritoneal cavity (24 hours a day, 7 days a week). Doctor Muhammad Khan provides the best nephrology physicians in the USA.  In contrast, intermittent peritoneal dialysis is administer only a few days a week or a few hours a day, usually at night.

Continuous ambulatory peritoneal dialysis is a form of portable dialysis that requires no equipment other than dialysis fluid bags and a line connecting them to the peritoneal dialysis catheter. The changes are made manually by the patient or another person in his entourage. Its simplicity, low cost, and independence from automatic equipment have made continuous ambulatory peritoneal dialysis the most popular form of peritoneal dialysis. It allows the maintenance of physiological stability, control of volume and blood pressure in most patients.

An automate peritoneal dialysis is a form of peritoneal dialysis in which exchanges are performed using a machine. Talks are shorter and more frequent than in continuous ambulatory peritoneal dialysis. Thus, automated peritoneal dialysis increases the volumes of dialysis infused up to 20-30 liters in 24 hours, thus being useful in anuric patients (especially those with high body mass) and in patients who cannot perform clearance or ultrafiltration. Appropriate in continuous ambulatory peritoneal dialysis. Automated peritoneal dialysis at night also has the advantage of not disturbing patients’ activity and of allowing the infusion of larger volumes (which are better tolerate while lying down).

How is the peritoneal approach to dialysis performed?

In peritoneal dialysis, the peritoneal approach is made through the peritoneal catheter. They are made of silicone rubber and have two segment: intraperitoneal and extra peritoneal.

The inner end of the intraperitoneal segment, placed in the bottom of Douglas’s sac, has numerous holes that allow fluid to pass through. It can be straight or spiral, sometimes equipped with specific devices (sticks or discs). Spiral-tipped catheters would theoretically have the advantage of less pain on dialysis infusion (by reducing the “jet effect”), a lower risk of migration, obstruction of the omentum, and visceral trauma.

The extraperitoneal segment, in turn, has a subcutaneous part and an outer part. The subcutaneous part is straight or curved and has one or two Dacron (polyester) sleeves. Manufactured curved catheters are more stable. Dacron sleeves induce local fibrosis, acting as a fixative and antimicrobial barrier. The most widely used worldwide is the Tenckhoff catheter, which has a straight or spiral tip and a straight subcutaneous segment with two sleeves.

A surgeon by laparotomy or laparoscopy implants catheters. The skin of the catheter should be kept clean by daily or bi-daily washing with antibacterial soap or an antiseptic solution.

Complications of peritoneal dialysis

 Hyperhydration and insufficiency of peritoneal ultrafiltration

In the case of a peritoneal dialysis patient who is in a state of hyperhydration (with edema), the following causes should be consider: (hernias and eventrations), comorbidities (heart failure, nephrotic syndrome), and insufficiency of peritoneal ultrafiltration.

Insufficiency of peritoneal ultrafiltration occurs in 30% of patients on peritoneal dialysis over 2 years of age. It is associate with hypervolemia, high blood pressure, left ventricular hypertrophy, and increased mortality risk, especially cardiovascular. It is one of the leading causes of peritoneal dialysis failure, along with recurrent peritonitis. The structural and functional deterioration of the peritoneal membrane over time. Which underlies the insufficiency of peritoneal ultrafiltration. Is mainly due to the biocompatibility of the peritoneal dialysis solution especially its glucose content. And acidic pH and lactate used as a buffer. Treatment of peritoneal ultrafiltration insufficiency is not well establish. Still, the use of icodextrin peritoneal dialysis solutions and other more biocompatible solutions (with neutral. No glucose degradation products) could be helpful for both prophylactic and curative purposes…

Peritonitis associated with peritoneal dialysis

Infectious peritonitis (bacterial, fungal, mycobacterial) is a significant complication of peritoneal dialysis. Which remains the leading cause of its failure despite progress in recent years in preventing it. The etiological agents of peritonitis are usually (80-90%) bacteria, more often Gram-positive than Gram-negative.

In peritonitis associated with peritoneal dialysis as opposed to surgical peritonitis, the infection is a single germ. And the bacterial inoculum is usually tiny.

The pathways of microorganisms in the peritoneal cavity are variable and often difficult to identify: