Types of Peritoneal Dialysis
There are two main types of peritoneal dialysis - Continuous Ambulatory Peritoneal Dialysis (CAPD) and Automated Peritoneal Dialysis (APD). CAPD is performed manually by the patient several times a day. It involves draining the used dialysate from the abdomen and infusing fresh dialysate through a peritoneal catheter. APD uses a machine that automatically performs dialysate exchanges while the patient sleeps.
Continuous Ambulatory Peritoneal Dialysis
CAPD is the most common type, accounting for over 80% of all peritoneal dialysis treatments. It allows patients to perform dialysis at home or work with flexibility in their daily routine. A catheter is surgically placed in the abdominal cavity. Several times a day, the patient drains the used dialysate containing wastes from the body and replaces it with fresh dialysate. This exchange process cleanses the blood and maintains fluid and electrolyte balance. CAPD takes 30-45 minutes for each exchange, usually done 4 times a day including an overnight exchange.
Automated Peritoneal Dialysis
APD uses a mechanical pump called a cycler to automatically perform multiple exchanges of dialysate during sleep. The cycler is programmed to drain and refill the peritoneal cavity with fresh dialysate according to the prescribed schedule, usually 6-8 times at night. Many patients find APD more convenient as it does not disrupt daytime activities. However, being connected to the cycler through the night may impact sleep for some. APD offers flexibility with options for daytime exchanges as well.
Peritoneal Dialysis Procedure
A Peritoneal Dialysis procedure involves placing a surgically implanted catheter in the abdomen. This thin tube, called a peritoneal catheter or Tenckhoff catheter, provides access to the peritoneal membrane lining the abdominal cavity. The initial surgery is minimally invasive and performed under local anesthesia on an outpatient basis. After 1-2 weeks of recovery, dialysis can begin. At each exchange, fluid called dialysate is introduced through the catheter into the abdomen. Wastes and extra fluid from the blood diffuse across the peritoneal membrane into the dialysate fluid. After 30-60 minutes, the used dialysate containing these toxins is drained out. Fresh dialysate is then instilled to restart the cleansing process.
Advantages of Peritoneal Dialysis
Peritoneal dialysis offers several benefits over in-center hemodialysis. It can be performed in the comfort of home, giving independence and flexibility to carry out daily activities. This improves quality of life. Treatment is continuous, mimicking natural kidney function more closely compared to the intermittent hemodialysis schedule. Peritoneal dialysis also has fewer fluid restrictions, lower cost, and fewer dietary limitations allowing patients to lead a more normal lifestyle. There is no need for vascular access, reducing the risks of infection, clotting or access failure seen with hemodialysis. Overall, peritoneal dialysis is well-tolerated and an effective renal replacement therapy for patients with end-stage kidney disease.
Disadvantages of Peritoneal Dialysis
However, peritoneal dialysis does have some disadvantages. The peritoneal membrane can develop infections scar tissue over time reducing its effectiveness. This limits the duration peritoneal dialysis can be used, typically 2-3 years on average. Obstructions or leaks in the catheter can also occur requiring it to be replaced surgically. Performing multiple exchanges daily at home is inconvenient and adherence to the schedule important. Peritoneal dialysis also does not remove larger uremic toxins from the bloodstream as efficiently as hemodialysis possibly impacting some patient outcomes. The hermetic catheter cannot get wet, limiting showering or participation in some recreational activities.
Complications of Peritoneal Dialysis
Common infections affecting the peritoneal cavity include peritonitis, exit site infections and tunnel infections. Peritonitis, an inflammation of the peritoneum, is the main complication occurring in about 1 in 5 patients annually. It requires prompt treatment with antibiotics to prevent catheter removal. Other issues include mechanical problems like catheter migration, leakage or blockage requiring radiological or surgical intervention to fix. Long-term dialysis can cause encapsulating peritoneal sclerosis, a serious complication causing membrane thickening and scarring impairing diffusion. Fluid overload, electrolyte disturbances and metabolic bone disease remain risks that must be monitored and managed. Overall, with careful technique and adherence to guidelines, most peritoneal dialysis complications are preventable and treatable.
Peritoneal Dialysis in Business
From a commercial standpoint, peritoneal dialysis represents a huge healthcare opportunity. Over 100,000 new patients globally start renal replacement therapy annually and peritoneal dialysis is preferable for many. Major players develop and sell sophisticated cyclers, tubing sets, dialysate solutions and catheters. Chronic kidney disease management involves pharmaceuticals, medical devices, laboratory testing and hospital services generating substantial healthcare spending. As kidney failure rates rise globally due to lifestyle diseases, the incidence of end-stage renal disease and need for dialysis options will grow. Peritoneal dialysis offers a convenient and scalable solution positioning it as an important growth area within the larger kidney care sector. Businesses eye prospects to expand access to care and drive ongoing innovation to overcome technical limitations. Overall, peritoneal dialysis represents an important treatment modality and strong commercial presence within nephrology.
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