What is Peritoneal Dialysis, and which are the available treatments?

Peritoneal Dialysis (best-known as PD,) involves the removal of extra waste products from your blood. In this mode of dialysis, unlike other treatments, such as hemodialysis, the process is performed inside the body. This is a point that grabs the attention of many patients suffering from kidney disease, as it offers more practical conveniences. In contrast to hemodialysis, peritoneal dialysis is performed every day (just the way the kidneys work), and it is the patient who carries it out.

From the medical point of view, it is an advantage that this procedure is performed every day of the week because the blood stays cleaner and it is actually easier to prevent eventual crises. People do not have to wait to go to the hospital or to connect to the machine at home. All that is needed is a catheter which is inserted into the patient’s belly (and by a rather rapid procedure.)

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In reality, there are two types of peritoneal dialysis. The best-known is continuous ambulatory peritoneal dialysis (CAPD.) In this case, the catheter is connected to a tube, and through it, a cleaning liquid is introduced to start the waste elimination process, such as salts and excess of water in the blood. The cleansing fluid enters and is installed throughout the patient’s abdomen in less than a quarter of an hour, and then the patient’s abdomen lining begins to filter the disposable substances. At the same time, it retains nutrients and other necessary elements for the proper functioning of the organism. The introduction of the liquid should be performed under conditions of total asepsis, as an infection in these circumstances would be very serious and difficult to treat. In case of poor hygiene, peritonitis may occur. Peritonitis occurs when germs enter the peritoneal cavity through the catheter. It may be treated with antibiotics, but the performance of a treatment is extremely urgent. However, if the patient follows the medical recommendations, he or she will have no problem at all.

Recommended: The impact of peritoneal dialysis-related peritonitis on mortality in peritoneal dialysis patients

The cleansing liquid (dialyzer) is left in the patient’s womb for an average of four hours so that the filtration can be effected smoothly. Obviously, each body is different, and, depending on the physiological characteristics, as well as the level of presence of noxious substances to be filtered, it remains more or less time. This treatment offers a lot of freedom since while the dialysis is taking place the patient can do everything that a normal person would do, without having to sit or lie next to a machine for hours. This is carried out in the most natural way possible: Thanks to gravity. It is not necessary to artificially suck the solution, and the patient simply replaces the liquid by the same procedure as it is mentioned above. When the dialysate has done its work, the solution containing all the residues (normally filtered by a kidney) is drained and expelled. The process is then repeated because the functions of the body do not stop, and it is repeated permanently. Hence, its name.

The other procedure is automatic. In this treatment, the patient connects the catheter to a machine, and this catches up with everything. The patient does not need to perform the exchange of new dialysate per used: It is an automatic process that even offers more freedom to patients. The machine works by cycles, like a washing machine. The patient schedules the machine at night, before going to bed, and the rest of the process is performed while the patient is resting. The interesting thing is that this machine is a totally independent equipment that works without connecting it to the drainage or the electricity. The cycling machine is not large, and, therefore, it is easy to transport, in case the patient should travel and carry it in the luggage. That is certainly another advantage.

The Merck Home Manual of Medical Information - Dialysis

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It is important to keep in mind that this treatment takes more time (overnight, to be precise.) The patient lies down to sleep, and seven or eight hours later, the machine will have cleaned the whole body. Manual functions in this process are minimal, and, in some cases, simply non-existent.

No matter what your choice is for the peritoneal dialysis procedure when it comes to the number of times the dialysis process is performed per day, it is the very same thing. In both cases, it is permanent. The only difference is that in the first one is done manually, while in the second one it is carried out by a machine. In both procedures, insertion of a catheter into the patient’s belly is necessary, and, again, it is not a complicated operation.

These are very good options for patients with kidney failure and are a sign that it is possible to follow a normal life. I hope this information has been helpful to you, and I hope you share it with your friends, especially those who you know need these treatments.

Read also: The Most Common Questions Patients Have About Dialysis, by Joe Cosgrove

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The Most Common Questions Patients Have About Dialysis

The kidneys are vital organs in the human body. Their functions are those of secreting hormones, cleaning your blood, absorbing minerals and producing urine among others. They are absolutely necessary to maintain the body’s toxin levels at normal levels, they help regulate blood pressure and even stimulate the production of red blood cells.

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As you can probably guess, the kidneys have a lot of responsibility and are organs that work under constant stress. It is expected that when organs such as these stop working like they are supposed to, the consequences are dire, as the body loses its ability to regulate the toxins that are normally cleansed by the kidneys and you begin to feel sick.

Kidney disease is the term utilized to refer to the condition by which the functions of kidneys are reduced in their efficiency or in some cases completely impaired. In cases like this, there are but a few options available for a patient to stay alive. One would be a kidney transplant, and the other would be to receive dialysis treatment. Dialysis is a treatment by which advanced machinery is used to help cover the slack left by kidneys unable to perform their functions and thus remove excess toxins from the patient’s body.

Today in Joe Cosgrove’s blog, we want to talk about some of the most common questions and concerns raised by new patients to dialysis treatment, and by the family members who want to support them during their process.

What are the different types of dialysis?

There are three primary types of dialysis. Hemodialysis and hemofiltration work similarly because they are both concerned with the cleansing of the blood directly. Blood is removed and cleaned in a machine before being pumped back into the body. The difference between both of these methods is that one uses a dialyzer solution while the other uses pressure to separate substances through a permeable membrane.

The third type of dialysis is called peritoneal dialysis and is less efficient than the former methods. In peritoneal dialysis, the blood is not directly but indirectly cleansed by pumping dialyzer into the patient’s abdomen and then removing it after the waste material has transferred to the fluid. The process is repeated several times per session.

How does dialysis work?

Dialysis is a treatment that simulates the process done by the kidneys when they are healthy by removing excess toxins from the blood and keeps the body in balance. A machine is used to extract the blood of the patient (in the case of hemodialysis) and clean it before injecting it back in. Minor surgery is necessary to create a vascular access. Vascular access is a place where the needles and tubes can be easily connected every time the patient needs to undergo the procedure. An access can be created by joining an artery and a vein together into a blood vessel called a fistula or by placing a narrow plastic tube in a large vein near the chest or neck.

In peritoneal dialysis, the blood is actually cleaned inside the body. The doctor places a catheter in the patient’s abdomen so the peritoneal cavity can be filled with fluid and thus excess toxins from the blood can be extracted from blood vessels in the abdomen that come in contact with the dialyzer that is later removed.

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Is it possible to travel?

Traveling is absolutely possible, but it requires a bit more planning that you may be used to. Dialysis can be done by the patient him or herself while traveling with no real risk. There are also many centers around the country and even worldwide that can accommodate your needs while traveling and give you all the care you need. It is imperative to plan properly and to have everything planned well in advance so you can receive the treatment you need.

Does my diet have to change?

The food you eat will depend on many factors like your current health, the stage of your particular kidney disease and the recommendations of your doctor depending on their evaluation of your specific situation. Salt, in general, is to be avoided in large quantities; the same goes for foods that contain too much phosphorus. Anything that can affect your blood pressure has to be eaten in moderation, and it is recommended to eat fewer proteins than usual, especially if you eat lots of meats and animal products.

How often do I have to undergo the treatment?

The frequency of dialysis sessions you require depends mainly on the current state of your kidneys. Some patients with a more advanced condition may require more sessions than someone whose kidneys are still performing partially. Normally, hemodialysis takes places about 3 times a week while visiting the clinic and peritoneal dialysis is usually done at home, several times during the day. As we have mentioned before, one method is more effective than the other, and that is why it requires fewer sessions.

 

A Brief History of Dialysis

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Dialysis is a procedure commonly used to help filter the waste present in the blood when the kidneys simply can’t do it. As a medical procedure, it has been around for more than 70 years, helping patients have normal lives or at least livable ones.

Like most medical procedures, dialysis also has a story to be told, one that dates back to the 1940’s when the first dialysis machine was invented by a Dutch physician called Willem Kolff. Since the day this first machine was invented, to nowadays, dialysis has evolved incredibly, reaching the point where many patients are able to live with it for many years and still have regular lives.

In this article, Joe Cosgrove will share a bit of history related to dialysis and the great impact is has had in medical history and the lives of millions of people in time.

The 1940s: The beginning

At the beginning of the 1940’s a physician named Dr. Willem Kolff invented a device that worked as an artificial kidney. Thanks to his invention, Kolff is considered to be the pioneer of dialysis. As a physician, Kolff spent about 10 years of his career developing an artificial kidney in the Netherlands while working at the University of Groningen Hospital. He was first inspired to create this type of artifact when visiting the University Hospital and watching how a young man would irremediably die because his kidneys couldn’t filter waste anymore.

Once motivated to create something that could help those experiencing kidney failure, Kolff decided to go to research about ways to remove waste from the blood once the kidneys stopped working. Then he found an article written by the pharmacologist John Abel in 1913 about hemodialysis in animals. Thanks to this article, Kolff dedicated himself to the cause of developing an artificial kidney for humans.

Kolff had a hard time developing this device since he was sent to a remote hospital to serve at during war. Despite the poor conditions he kept on moving forward and improvised many times with many different materials (including sausage skins) to create something that could remove waste away from the blood.

By the year 1943 and after overcoming a great share of difficulties, Kolff’s invention was finished and was tested without any success on numerous patients, until in 1945, it helped an old woman overcome a uremic coma.

The machine Kolff invented is considered to be the first dialyzer of our times and its structure remained almost untouched for ten years as the best alternative for physicians to treat patients who were suffering from kidney failure. Probably Kolff didn’t know it back then, but his machine turned out to be one of the most important medical inventions in history and helped to save the lives of thousands.

The 1950s: Evolution of the dialyzer

At the beginning of the 1950’s, Kolff’s dialyzer had already been improved and used to treat injured soldiers fighting during the war. It had also been used to treat end-stage renal disease and acute renal failure patients. However, during the middle of the 20th century, not many doctors were optimistic about the usage of Kolff’s dialyzer because they believed a human made machine couldn’t resemble the kidneys’ function and they also found it difficult for the human veins to stand such treatment in the long term.

It was in Boston where a professor named Dr. Belding Scribner came up the idea of plugging the patient to the dialyzer by using flexible tubes made of a new plastic called Teflon. This way the tubes could be introduced inside the arteries and veins, keeping the circulatory access opened thanks to the usage of a tiny device with the shape of a “U”. This u-shaped device was called The Scribner Shunt.

By using this device patient no longer needed to get a new incision when going under the dialysis treatment. Even though this method isn’t used today, it helped other doctors develop new techniques to access the circulatory system that were useful to treat those who had acute kidney failure.

The 1960s: A decade of changes

Scribner was the first person on earth to open a dialysis facility in 1962. Problems started to appear when the number of patients who wanted and needed to be treated exceeded the capacity of the clinic – with only six available machines. Scribner needed to find a way to decide which patients were getting the dialysis done since many of them actually were close to death.

By this moment, Scribner decided to create an anonymous committee of people who could make that decision for him. This committee was composed of local people and doctors who worked in the kidney fields. Although this Solomonic choice created controversy, in time this committee was seen as the first bioethics committee of all time and changed the relationship common people had with the offer of health services.

The Past 60 Years

During the past 60 years, the history of dialysis has gone under several changes, new machines have been developed, new materials have been invented and many people in the world depend on this treatment to survive. We still know medical pioneers like Kolff or Scribner that are concerned about the way medicine evolves and is being practiced.

It is always expected in the future to come for specialists to be able to create new solutions that may help patients live longer, happier and have regular lives despite the fact they need to undergo dialysis treatment several times per week. History is still being written and hopefully, the years to come will be full of great surprises in this important medical field.