Chapter

Peritoneal dialysis

Simon Davies

in Oxford Textbook of Medicine

Published on behalf of Oxford University Press

Published in print May 2010 | ISBN: 9780199204854
Published online May 2011 | e-ISBN: 9780199570973 | DOI: http://dx.doi.org/10.1093/med/9780199204854.003.210702_update_001
Peritoneal dialysis

Show Summary Details

Preview

Peritoneal dialysis is achieved by repeated cycles of instillation and drainage of dialysis fluid within the peritoneal cavity, with the two main functions of dialysis—solute and fluid removal—occurring due to the contact between dialysis fluid and the capillary circulation of the parietal and visceral peritoneum across the peritoneal membrane. It can be used to provide renal replacement therapy in acute kidney injury or chronic kidney disease.

Practical aspects—choice of peritoneal dialysis as an effective modality for renal replacement in the short to medium term (i.e. several years) is, for most patients, a lifestyle issue. Typically, a patient on continuous ambulatory peritoneal dialysis (CAPD) will require three to five exchanges of 1.5 to 2.5 litres of dialysate per day. Automated peritoneal dialysis (APD) and use of the glucose-polymer dialysis solution icodextrin eables flexibility of prescription that can mitigate the effects of membrane function (high solute transport). Between-patient variability in membrane function influences patient survival.

Peritonitis—this remains the most common complication of peritoneal dialysis, presenting with cloudy dialysis effluent, with or without abdominal pain and/or fever, and confirmed (usually) by demonstrating a leucocyte count greater than 100 cells/µl in the peritoneal fluid. Empirical antibiotic treatment, either intraperitoneal or systemic, with cover for both Gram-positive and Gram-negative organisms, should be commenced immediately while awaiting specific cultures and sensitivities.

Encapsulating peritoneal sclerosis—this is a life-threatening complication of peritoneal dialysis, particularly if of long duration (15–20% incidence after 10 years) and if complicated by severe peritonitis, characterized by severe inflammatory thickening, especially of the mesenteric peritoneum, resulting in an encapsulation and progressive obstruction of the bowel. Extensive enterolysis is the only successful treatment in severe cases, but mortality is high.

Chapter.  3637 words.  Illustrated.

Subjects: Nephrology

Full text: subscription required

How to subscribe Recommend to my Librarian

Buy this work at Oxford University Press »

Users without a subscription are not able to see the full content. Please, subscribe or login to access all content.