Peritoneal dialysis is a form of renal replacement therapy that utilizes the patient's own peritoneal membrane as a semi-permeable membrane, primarily used for patients with end-stage renal disease. This therapy involves circulating dialysate into the abdominal cavity, using diffusion and osmosis to remove waste products, excess water, and regulate electrolyte balance, mimicking the filtration function of healthy kidneys.
Compared to hemodialysis, peritoneal dialysis offers the convenience of being performed at home, allowing patients to carry out treatment as part of their daily routine. It is suitable for those with limited mobility or who require flexible scheduling. This therapy can operate continuously for 24 hours, reducing fluctuations in waste accumulation and potentially improving blood pressure control and nutritional status for some patients.
Peritoneal dialysis mainly divides into Continuous Ambulatory Peritoneal Dialysis (CAPD) and Automated Peritoneal Dialysis (APD). CAPD requires patients to manually change dialysate 4-5 times daily, while APD uses a machine to automatically perform exchanges overnight. The glucose in the dialysate creates an osmotic gradient, attracting water and waste products such as urea nitrogen from the body into the fluid for removal.
The capillary network of the peritoneum plays a crucial role, with its selective permeability filtering medium-sized waste molecules while retaining important substances like plasma proteins. During the treatment cycle, the dwell time of dialysate in the abdomen and concentration adjustments can be personalized according to the patient's metabolic needs.
Mainly suitable for patients with chronic renal failure in stages IV to V, when the glomerular filtration rate (GFR) drops below 15 ml/min and is accompanied by severe metabolic acidosis. It can also be considered for short-term use in patients with acute kidney injury when other treatments are not feasible.
Candidates include those with contraindications to anticoagulants used in hemodialysis, difficult vascular access, or recurrent aneurysm formation. Additionally, some diabetic nephropathy patients with better blood sugar control may prefer this therapy to reduce cardiovascular burden.
The process involves surgical catheter placement, followed by daily infusion of pre-packaged dialysate through the peritoneal dialysis catheter into the abdomen. Each infusion typically ranges from 1.5 to 3 liters, with dwell times adjusted based on treatment goals, alternating between short exchanges (4-6 hours) and longer dwell periods (8-10 hours).
The weekly treatment frequency is generally 3-4 times daily, with increased large-volume exchanges on weekends to remove more water. Dialysate glucose concentrations range from 1.5% to 4.25%, adjusted according to the patient's dehydration and metabolic status, with strict adherence to medical instructions to avoid fluid overload.
Compared to hemodialysis, peritoneal dialysis has less impact on blood flow dynamics and is suitable for patients at high risk of heart failure. Long-term follow-up shows it can better maintain serum albumin levels and nutritional status.
The most common complication is peritonitis, with an incidence of approximately 0.5-1.5 episodes per year, which may lead to peritoneal failure. Other risks include catheter displacement, bowel obstruction, and dialysate retention within the abdomen. Long-term use may cause protein-energy wasting syndrome, requiring nutritional support.
Serious complications include:
Contraindications include peritoneal defects (such as uncorrected hernias), severe peritoneal infections, recent abdominal surgery not yet healed, and peritoneal sclerosis. Prior assessment of abdominal cavity structure is necessary to determine suitability for catheter placement.
During procedure, attention must be paid to:
When combined with oral medications, dosage adjustments are necessary as dialysate may affect drug absorption (e.g., iron supplements, vitamin D). Diuretics require calculation of total dehydration to prevent fluid imbalance. If alternating with hemodialysis, evaluate whether peritoneal function permits periodic discontinuation. Patients on immunosuppressants should enhance infection prevention measures, as medications may increase the risk of peritonitis.
Multicenter studies show that regular peritoneal dialysis can achieve a survival rate of over 90% at one year and delay the progression of cardiovascular metabolic abnormalities. Compared to hemodialysis, it offers better phosphate control, but the incidence of hyperglycemia may increase due to glucose in the dialysate.
Long-term follow-up indicates that well-adherent patients can maintain peritoneal function for an average of 5-7 years. Educational programs provided by case managers can reduce complication rates and improve treatment success.
The main alternatives include hemodialysis (requiring three sessions per week at a medical facility) or kidney transplantation (requiring tissue matching). Hemodialysis is superior in removing medium-sized waste molecules but may increase cardiovascular burden.
For acute kidney failure, continuous renal replacement therapy (CRRT) can be considered, while patients with chronic disease who lose peritoneal function will need to switch to hemodialysis. The choice depends on the patient's overall health and lifestyle.
What preparations are needed before starting peritoneal dialysis?
Before initiating peritoneal dialysis, patients need surgical placement of the catheter, along with infection screening and hygiene education. The medical team will teach patients or caregivers how to clean the dialysis exit site, change dressings, and perform lavage procedures, while ensuring the home environment meets hygiene standards.
How can peritoneal dialysis-related peritonitis be prevented?
Peritonitis is a common complication; prevention hinges on strict aseptic technique. Handwashing with antibacterial soap before each lavage, disinfecting the catheter exit site with dedicated disinfectants, and avoiding contact with water at the puncture site (e.g., properly covering during bathing) are essential. Regular follow-up with the medical team provides detailed infection control guidance.
Are there special dietary restrictions for peritoneal dialysis patients?
Restrictions include limiting high-potassium foods (such as bananas, avocados, mushrooms), high-phosphorus foods (such as organs, processed cheese), and high-sodium seasonings. It is recommended to increase high-quality protein sources (such as fish and skinless poultry), and adjust fluid intake according to daily limits. A nutritionist will develop personalized dietary plans based on blood test results.
Can patients perform mild exercise during peritoneal dialysis?
Patients can engage in light exercises such as walking or yoga, but should avoid activities that directly impact the abdomen or compress the catheter (e.g., contact sports). After exercise, the dialysate should be replaced immediately, and the catheter position checked to prevent infection risks from positional changes. Specific activity guidelines should be discussed with the medical team.
What is the five-year survival rate for long-term peritoneal dialysis patients?
According to clinical statistics, the five-year survival rate for patients regularly on peritoneal dialysis is approximately 60-70%, depending on baseline health and treatment adherence. Regular monitoring of renal function, electrolytes, and blood glucose levels can effectively delay complications. Comprehensive health assessments are recommended every 3-6 months.
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