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.)

Peritoneal Dialysis_Renal compensation_health

Image courtesy of PresidenciaRD at Flickr.com

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

Image courtesy of Amber Case at Flickr.com

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

Advertisements

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.

renal-dialysis-technician

Image courtesy of wistechcolleges at Flickr.com

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.

hands-walking-stick-elderly-old-person

Image courtesy of Pixabay at Pexels.com

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.

 

Understanding the 5 stages of Chronic Kidney Disease

We do not have to stress out or even define what CKD is because we have discussed it in this blog in several articles and we already know what it is all about.

Instead today we are going to take a deep look at the 5 stages of Chronic Kidney Disease that were developed or designed by the National Kidney Foundation (NKF) in order to understand better Kidney diseases and to give doctors  some sort of guideline that will help them identify the evolution of the kidney disease and know how to give the patient the best care possible for each stage.

FIVE_5 stages of Chronic Kidney Disease

Image courtesy of electricnude at Flickr.com

Let’s take a look at those 5 stages.

Stage 1 and 2:

Somebody that is in stage 1 or 2 of CKD has a small kidney damage and his or her glomerular filtration rate (GFR) is normal or a bit higher than 90 ml/min. in this stage, symptoms are not common and the kidneys are still working normally. If the person is to find out he or she is on stage 1 CKD it is because the person was being tested for other things and the results came out with certain amount of creatinine levels or they discovered blood or protein in the urine or there was an imaging test and the results said there was a kidney damage.

For people that are in this stage the treatment only focuses on a healthy diet including whole grains, fresh fruits and vegetables, no fats or low fat diets, control the intake of sugar and sodium, have a good weight and exercise very regularly, take vitamins recommended by doctors and definitively stop smoking and having bad habits for the body.

When it comes to stage 2, the description is just the same with the disease having no symptoms and the kidney working at a very good level. The only difference here is that the kidney already has a mild damage and it is getting a bit late to discover it or to treat it and the glomerular filtration rate is around 60-89 ml/min.

Stage 3:

Here the person has already a moderate kidney damage. This stage has two parts which are called A and B. in stage 3A the glomerular filtration rate is 45-59 mL/min, and in stage 3B the glomerular filtration rate is 30-44 mL/min.  Here the disease is already noticeable and patients start to feel the symptoms. A condition called uremia appears and secondary complications such as high blood pressure, anemia and bone disease start to appear as well.

The symptoms for this stage are the feeling of being tired all the time, high retention of fluids, extremities start to swell and the patient starts feeling that his or her breath is just not enough, urine changes color to a more reddish, brownish color or it even contains blood which will make it red, lower back pain, problems with sleep and muscle cramps.

In this stage, the kidney is working at a 50% performance and the idea is to help the patient keep their kidneys working as long as possible.

In this stage, a very controlled diet and medications are essential to make the kidney live longer. When it comes to medications ( the diet is very important even since stage 1) in this stage they become essential to control glucose levels and have a very good blood pressure in order to maintain the kidney working for as long as possible. The medications doctors prescribe in this stage are ACE (angiotensin converting enzyme) inhibitors and ARBs (angiotensin receptor blockers).

Stage 4:

Here the patient has a real problem that needs to be tackled as soon as possible and with the correct treatment. Their glomerular filtration rate is 15-30 ml/min. and treatments are now very viable options. Unfortunately, a patient with stage 4 CKD will have to get a kidney transplant in the near future. In this stage conditions like anemia, uremia, bone disease, high blood pressure, heart complications and cardiovascular diseases start to become present.

The symptoms in this stage are fatigue, hard kidney pain in the lower back, sleeping problems, nausea, vomiting, a  metallic taste in their mouth, bad breath, loss of appetite due to the flavor in their mouth, difficulty in concentrating and numbness or tingling in the toes or fingers.

In this stage, there are 3 different types of treatments which are Hemodialysis, Peritoneal dialysis and, Kidney transplant

Stage 5:

Unfortunately, at this stage, the person has no options and it is a terminal disease called end-stage renal disease (ESRD) that has a glomerular filtration rate of 15 ml/min or less. In this stage, the kidneys no longer work and don’t have the ability to do anything at all. In this stage dialysis or a kidney transplant will be needed to survive.  

It is very important to understand these five stages so patients and doctors can find out about the disease in the early stages and give patients the option of having a very good quality of life.

Be sure to also read this post about how to choose the right treatment in case of renal failure?