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Peritoneal Dialysis
Aka: Peritoneal Dialysis, Continuous Ambulatory Peritoneal Dialysis, Intermittent Peritoneal Dialysis, Continuous Cycling Peritoneal Dialysis
- See Also
- Hemodialysis
- Dialysis Emergencies
- Hypotension in the Dialysis Patient
- End Stage Renal Disease
- Epidemiology
- Accounts for 18% of Dialysis for ESRD in the United States
- 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
- Rubin (2004) JAMA 291:697-703 [PubMed]
- Indications
- Hemodynamically unstable patient
- Difficult Vascular Access for shunt placement
- Mild ESRD
- Children
- Developing World
- Mechanism
- Based on osmotic pressure gradient between blood and dialysate (chiefly Glucose concentration)
- Dialysate is infused via a peritoneal access port
- 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- Volume withdrawn/day: 10 liters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)
- Complications
- Infection
- See Dialysis-Related Spontaneous Bacterial Peritonitis
- 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
- 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
- References
- Glauser (2013) Crit Dec Emerg Med 27(10): 2-12