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Q. When is peritoneal dialysis given and how is it given?

A. Peritoneal dialysis is used as a renal replacement therapy acutely in acute renal failure, poisonings (though hemodialysis is more efficient). Intermittently or long term PD is used for chronic renal failure /ESRD. The indications of PD are almost same as HD. PD procedure involves introduction of PD catheter in the peritoneal cavity using a trocar or placement of tenchkoff catheter surgically in the peritoneum (permanent access) when chronic PD is indicated. The catheter is attached to tubings and special bags containing dialysate fluid which infuse special PD fluid into peritoneal cavity (inflow) for ½ hr for acute cases and for a longer time in CAPD. The transfer of solutes takes place and after opening the clamps, the dialysate fluid is discarded in a bag (out flow). Such 20-24 cycles of PD can be given over 24-48 hours for acute PD.

What is continuous ambulatory peritoneal dialysis (CAPD) ? How is it given? When is it indicated? What are its advantages?

A. For chronic PD, the procedure is almost the same but intermittent introduction of catheter being difficult, permanent access using tenchkoff catheter is made. The dialysate fluid is infused and allowed to remain in peritoneal cavity for 4-6 hours after which it is drained in the empty bags. Three to four exchanges per day of PD are done by the relatives of the child or the patient himself/herself after a training period of 2-3 weeks. Thus, the patient is ambulatory and can attend school and carry out normal activities. The continuous ambulatory peritoneal dialysis is physiological and can be managed at home. The growth, control of anemia, hypertension etc is better with CAPD than chronic HD and convenient for the family.

Q. How do you monitor patients who are undergoing dialysis ?

A. The patients on chronic dialysis require continuous treatment to remove accumulated nitrogenous toxic metabolites every 48-72 hours because of failure of the kidneys to perform these functions. Every 30-40 days, renal parameters in blood need to be monitored. B.P, Hb% are done every month. Fluid intake and diet needs to be checked by the dietician strictly. Height should be monitored 3 monthly. During the dialysis procedure - Pulse, temperature, BP, problems such as hypotension, volume overload, infection, fluid and electrolyte imbalance, seizures and CNS problems are monitored by expert nursing staff specially trained for dialysis and supervised by nephrologists.

Q. What are the complications of peritoneal dialysis?

A. Major complications of PD are peritonitis and infection of exit site and tunnel infection. Blockage of catheter, leakage and bleeding are some of the complications requiring immediate attention.

Q. How does one decide whether patients require peritoneal or hemodialysis?

A. Decision regarding whether PD or HD should be done depends on age of the child, whether the indication is for acute or chronic dialysis, socioeconomic state and expertise available in the hospital.

In small infants and children, the vascular access is difficult, hence PD is preferred. Because the procedure is simple, quick, the equipment and fluid are easily available; peritoneal dialysis is preferred for acute renal failure.

For chronic dialysis in India, hemodialysis is preferred because the cost of bags containing PD fluid is very high. Although worldwide, CAPD is gaining popularity for ESRD in children because of home based dialysis, freedom to pursue studies, play, activity, less number of needle pricks, no visits to hospitals etc.

Q. For how many years or for how long can a patient be on a dialysis?

A.Dialysis is a renal replacement therapy for chronic renal failure/ESRD and can be successfully continued as long as the vascular access is maintained for HD or peritoneal catheter is patient for CAPD.

Q. What is the prognosis of a patient on dialysis?

A.Prognosis of a patient on dialysis is good. In acute renal failure, dialysis is life saving and complete recovery is possible. For chronic renal failure/ESRD dialysis can maintain fairly good quality of life, but restriction of activity and continuous or intermittent medical check ups, hospitalization interrupt the daily life.

Q. When is a renal transplant required for a patient undergoing
dialysis?

A.Renal transplant is preferred treatment for patients with ESRD and a healthy kidney from a compatible donor is the final solution to the problem of ESRD who is on dialysis. In children, renal transplantation without dialysis or after a short period of dialysis to stabilize the child while preparing for transplant is the best treatment (pre -empirical renal transplant) to achieve normal growth.

Last created on 24-01-2001
Last submitted on 01-07-2006