Other techniques include dialysis and transplantation. All three methods are effective, but choosing the appropriate one depends on a number of factors that relate to both the patient and the availability of technical, human and material resources.
All three methods use some type of filter for blood clearance.
In dialysis the filter is fully artificial.
In transplantation it is 100% natural (transplanted kidney) and in peritoneal dialysis it is natural, yet placed in a different part of the body.
How is peritoneal dialysis performed?
The peritoneum is the biological membrane that covers the internal abdominal wall, and then folds and fully covers the internal organs.
This creates a space, the so-called peritoneal space, that looks and behaves like a slightly inflated balloon we hold in our hands. The technique involves the injection of the right volume and composition electrolyte solution in the peritoneal cavity, so as to provide the body with the necessary substances and to eliminate excess contents and water.
When treatment is completed and harmful substances and excess fluid are exchanged, the solution is removed and replaced with fresh. Access to the peritoneum is achieved with a peritoneal catheter which is a special stent made of biocompatible materials with specific morphology. It is implanted either surgically or through puncture or laparoscopically at a suitable position inside the peritoneal cavity. Fluids are infused either manually or with the use of equipment.
The manual method uses dialysate bags that the patient handles himself. Fluids must be infused and then excreted from the peritoneum usually four times every 24 hours.The automated method uses a machine programmed to follow fluid infusion and drainage cycles over a certain period of time, so as to allow 4 to 6 exchanges during the night while the patient is asleep.
What should the patient do?
Α thorough training session at the Peritoneal Dialysis Department of a hospital, and must be informed, and provided with instructions to face any problem that may occur.He can be in contact with the unit on a 24-hour basis for advice or anything else he may need, and can be admitted if the problem is difficult to handle.
Strict adherence to the instructions provided by the unit’s personnel and meticulous care on the patient’s behalf during treatment can ensure that treatment will continue over time.
Over time, however, the peritoneum hardens and the treatment outcome is less successful; something that requires a change of method.
Advantages of this method include:
- Critical participation of the patient in treatment
- More freedom in fluid intake
- Prevention of hypotensive episodes thus allowing longer preservation of residual renal function.
- Maintaining diuresis for a longer time, especially if the method is chronologically speaking, the first option for renal replacement.
- Use of this method for ensuring autonomy in case the patient wishes to travel in areas where there are no dialysis units or in inaccessible and remote areas where scheduled dialysis methods cannot be supported.
- Use of this method in patients with no vascular access options.
Disadvantage of this method:
This method’s disadvantage is that over time the peritoneum hardens due to the heavy burden and does not perform as well as in the beginning. Due to insufficient dialysis, the patient needs to change treatment method.
Also, it is not advisable for patients with impaired vision and mobility problems, especially in the hands. The method’s reduced availability is also an obstacle.