People who have chronic kidney disease (CKD) may not have early symptoms to alert them to the deadly condition. This doesn’t detract from the fact that the incidences of CKD are growing, fuelled largely by diseases associated with an aging population, hypertension, and increasing rates of diabetes largely related to obesity. Traditionally, health programmes for the prevention of chronic diseases have mainly focused on hypertension, diabetes and cardiovascular disease. However, the increase in the prevalence of chronic kidney disease progressing to the ESRD and the consequent financial burden of renal replacement therapy in both developed as well as developing nations has highlighted the importance of CKD and its risk factors.
Treatments at hand
The treatment options available for ESRD patients include kidney transplant and dialysis. Since there is a shortage of kidney donors, dialysis is a well-accepted therapy option. Again, there are two types of dialysis options available: hemodialysis and peritoneal dialysis.
Hemo dialysis (HD) is a machine dialysis therapy done at hospitals where a patient’s blood is cleansed outside of the body. It is performed under medical supervision and requires a patient to visit a hospital about three times a week.
Peritoneal dialysis (PD), on the other hand, involves using the peritoneal membrane (lining of the abdomen) within the body for dialysis and can be easily done at home by patients themselves. With peritoneal dialysis, people now have some choices in treating advanced and permanent kidney failure. The PD first became a practical and widespread treatment for kidney failure in the 1980s, and since then a lot of research has been done to make it more effective and minimise any side-effects.
Since there is no need to schedule dialysis sessions at a dialysis centre, PD gives the patients a high level of control and comfort. By learning about the treatment, one can work with family members to get the best possible results and lead an active life.
the advantages
w PD is a daily continuous dialysis, allowing for better preservation of residual kidney function as compared to hemodialysis (HD) — which is conducted three times a week in a hospital or clinic.
w Peritoneal dialysis is a home therapy. It can be done in remote areas, helping the masses to avail it.
w For children below eight, continuous ambulatory peritoneal dialysis (CAPD) is the preferred form of treatment — as their weak bodies do not adapt well to HD.
w There are less dietary constraints for patients undergoing PD as compared to HD.
w Unlike hemodialysis, there is no re-use of disposables in PD with the quality of CAPD solutions being consistent across the world.
w PD is a machine-free dialysis and uses the abdominal lining or peritoneal membrane as a natural filter to remove waste from the bloodstream, and, therefore, works inside the body.
How PD works
In PD, a soft tube called a catheter is used to fill the abdomen with a special solution called dialysis solution. The walls of the abdominal cavity are lined with peritoneum, which allows waste products and extra fluid to pass from the blood into the dialysis solution. The solution contains a sugar called dextrose that pulls extra fluid into the abdominal cavity. These wastes and fluid then leave the body when the dialysis solution is drained. The process of draining and filling is called an exchange and takes about 10 minutes for infusion and 20-30 minutes for draining (total 30 to 40 minutes per exchange). A typical schedule calls for three to four exchanges a day, each with eight to six hours of dwell time — the period for which the dialysis solution is in the abdomen.
The writer is Assistant Professor, MD DM (Nephrology), AIIMS
Source: The Asian Age
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