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Dialysis simply means the purification of blood. Dialysis is needed for patients suffering from kidney failure (acute kidney injury stage 3- reversible kidney damage, and/or End stage renal disease- irreversible kidney damage). Dialysis is classified into two types or modalities are Haemodialysis (HD) and peritoneal dialysis (PD), also known as CAPD (continuous ambulatory peritoneal dialysis).
Haemodialysis is typically done at a hospital using a dialysis machine that has a dialysis filter. Blood is taken out, filtered, and purified before flowing back to the patient. In CAPD/PD, we utilize the lining of the abdomen called the parietal peritoneum and an empty space in the abdomen called the peritoneal cavity or peritoneal space. The cells in this membrane have the property of filtration, like the kidneys (of course, not as robustly as the kidney does). In peritoneal dialysis treatment, we utilise this property to remove waste products from the body.
How is the Peritoneal Dialysis Done?
A catheter (silicon tube) is inserted into the abdomen, and a special fluid (called peritoneal dialysis fluid) is piped through the tube into the free space in the abdomen. This fluid collects waste and excess salt and water from the blood. During peritoneal dialysis, the patient is hooked up to a tube in the belly. The fluid stays there for a certain amount of time. When the fluid is in your belly, it's called a "dwell". During a dwell, the abdomen might feel full or bloated, but it shouldn't hurt.
After the dwell, the used fluid is drained out and discarded. Again, the fluid is refilled with a fresh bag of fluid. Each time you drain the used fluid and refill it with clean fluid, it's called an "exchange." It's important to follow the doctor's instructions about each exchange and dwell.
Why is Peritoneal Dialysis Referred?
PD is a gentle form of dialysis with no fluctuations in blood pressure or pulse rate. Some other advantages of peritoneal dialysis are the convenience of being at home and the ability to travel without worrying about the availability of haemodialysis centres. From the case studies of nephrologists in Hebbal, it is indicated that the efficacy wise both haemodialysis and peritoneal dialysis are equal. However, quality-of-life indicators suggest that those undergoing CAPD have a better quality of life.
Choosing the dialysis modality is a shared decision with the patient and family, and the points to consider about the dialysis modality are:
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Personal preference.
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The presence or absence of heart failure.
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Availability of haemodialysis centres in the vicinity.
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Patients job.
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Family support.
CAPD is the preferred modality of dialysis in children, very elderly people, heart failure patients, and those who have exhausted all access to haemodialysis (multiple access failure).
To conclude Peritoneal dialysis or CAPD is a safe, effective, alternative form of dialysis for patients suffering from kidney failure.
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