III. Efficacy
- Similar overall mortality rates with Peritoneal Dialysis as with Hemodialysis
- Hemodialysis is preferred for solute/Electrolyte and volume management
- When asked, ESRD patients prefer Peritoneal Dialysis
IV. Indications
- Hemodynamically Unstable Patient
- Difficult Vascular Access for shunt placement
- Mild ESRD
- Children
- Developing World
V. Mechanism
- Based on osmotic pressure gradient between blood and dialysate (chiefly Glucose concentration)
- Dialysate is infused via a peritoneal access port
VI. Types
- Continuous Ambulatory Peritoneal Dialysis (CAPD)
- Infuse 2 liters dialysate and allow to dwell for 4-6 hours, then repeat four times daily
- Volume infused/day: 8 liters
- Volume withdrawn/day: 10 liters
- Intermittent Peritoneal Dialysis (IPD)
- Rapid dialysate cycling (hourly)
- Continuous Cycling Peritoneal Dialysis (CCPD)
- Rapid dialysate exchanges overnight (uses an automated device)
VII. Complications
- Infection
- Catheter infections
- Findings
- Peritoneal access site may present with localized pain, erythema, swelling or discharge
- Most commonly infected with Staphylococcus Aureus or Pseudomonas Aeruginosa
- Ultrasound to evaluate for abscess and to direct Incision and Drainage
- Management
- Incision and Drainage (if needed)
- Antibiotics: Cephalexin, Ciprofloxacin or Dicloxacillin
- Findings
- Catheter leaks
- Leaks present with abdominal wall edema and clear drainage from catheter skin entry margin
- Temporize with Hemodialysis (and stop Peritoneal Dialysis until leak resolves)
- Consult nephrology and general surgery
- Obtain cultures of dialysate fluid and consider empiric Antibiotics
-
Abdominal Hernias
- Due to increased abdominal pressure from dialysate
- Referral to general surgery due to incarceration risk
- Hydrothorax (rare)
- Typically right-sided
- Confirmed with methylene blue in dialysate
- Temporize with Hemodialysis (and stop Peritoneal Dialysis until leak resolves)
- Consult nephrology and thoracic surgery
VIII. References
- Glauser (2013) Crit Dec Emerg Med 27(10): 2-12
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| Definition (MSH) | Dialysis fluid being introduced into and removed from the peritoneal cavity as either a continuous or an intermittent procedure. |
| Definition (NIC) | Administration and monitoring of dialysis solution into and out of the peritoneal cavity |
| Concepts | Therapeutic or Preventive Procedure (T061) |
| MSH | D010530 |
| ICD9 | 54.98 |
| ICD10 | 1060 |
| SnomedCT | 151055004, 71192002 |
| LNC | LP149602-7, LA10059-6 |
| English | Dialyses, Peritoneal, Peritoneal Dialyses, Dialysis, Peritoneal, Peritoneal Dialysis Therapy, peritoneal dialysis, peritoneal dialysis (treatment), dialysis peritoneal, dialysis peritoneal dialysis, peritoneal dialyses, Peritoneal dialysis, PD - Peritoneal dialysis, Peritoneal dialysis (procedure), Peritoneal dialysis, NOS, Peritoneal Dialysis, Dialysis;peritoneal |
| Japanese | 腹膜透析, ﾌｸﾏｸﾄｳｾｷ |
| Swedish | Påsdialys |
| Czech | peritoneální dialýza, Peritoneální dialýza |
| Finnish | Vatsakalvodialyysi |
| Russian | BRIUSHINNYI DIALIZ, DIALIZ PERITONEAL'NYI, БРЮШИННЫЙ ДИАЛИЗ, ДИАЛИЗ ПЕРИТОНЕАЛЬНЫЙ |
| Croatian | PERITONEJSKA DIJALIZA |
| Polish | Dializa otrzewnowa |
| Hungarian | Peritonealis dialysis |
| Norwegian | Posedialyse, Peritonealdialyse |
| Spanish | diálisis peritoneal (procedimiento), diálisis peritoneal, SAI, diálisis peritoneal, Diálisis peritoneal, Diálisis Peritoneal |
| Portuguese | Diálise peritoneal, Diálise Peritoneal |
| Dutch | peritoneale dialyse, Dialyse, peritoneale |
| French | Dialyse péritonéale |
| German | Peritonealdialyse |
| Italian | Dialisi peritoneale |
