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Peritoneal dialysis (PD) is a procedure that facilitates the exchange of solutes, waste products, electrolytes, and excess fluid between the blood in the peritoneal capillaries and a dialysis solution introduced into the peritoneal cavity.Principles of Peritoneal Dialysis (PD)Diffusion: Waste products such as urea and electrolytes move from high concentrations in the blood to low concentrations in the dialysate across the peritoneal membrane. This mechanism is driven by the concentration...
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Peritoneal dialysis (PD) is a medical process that removes waste products and excess fluid from the body using the peritoneal membrane as a natural filter.Peritoneal Dialysis MethodsSeveral methods can be used for peritoneal dialysis, including Acute Intermittent Peritoneal Dialysis, Continuous Ambulatory Peritoneal Dialysis, and Automated Peritoneal Dialysis, also known as Continuous Cyclic Peritoneal Dialysis.Acute Intermittent Peritoneal Dialysis (AIPD) is used for patients with uremic...
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Patients with end-stage renal disease (ESRD) or those experiencing drug overdose often require extracorporeal methods to eliminate accumulated drugs and metabolites. Hemoperfusion, hemofiltration, and dialysis are the primary techniques to rapidly remove harmful substances without disrupting the patient's fluid and electrolyte balance. For those with compromised renal function, dosage adjustments of concurrent medications may be necessary during extracorporeal drug removal.Dialysis is a process...
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Renal failure occurs when the kidneys lose their ability to filter waste products from the blood effectively. It can be classified into two types: acute renal failure (ARF) and chronic renal failure (CRF).
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Dialysis is a diffusion-based purification process that separates analyte molecules from a complex matrix. This is accomplished by allowing molecules in the solution to pass through a semipermeable membrane into a liquid on the other side. The membrane is usually made of cellulose acetate or cellulose nitrate, and the second liquid must be miscible with the solution. Ions (e.g., chloride or sodium) or organic molecules (e.g., glucose) can pass through the membrane pores, which generally have...
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Peritoneal dialysis, or PD, utilizes the peritoneal membrane as a filter to eliminate excess fluid and waste products. Effective nursing management is essential for ensuring patient safety, preventing complications, and promoting optimal function of the peritoneal dialysis process.Assessment and MonitoringNurses must thoroughly assess the patient before, during, and after each dialysis session. Regular monitoring includes vital signs, daily weight, fluid intake and output, and laboratory values...
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Peritoneal Dialysis in Western Countries.

Dirk G Struijk1

  • 1Division of Nephrology, Department of Medicine, Academic Medical Center, Amsterdam, The Netherlands; Dianet, Location Amsterdam, Amsterdam, The Netherlands.

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|August 19, 2016
PubMed
Summary

Peritoneal dialysis (PD) offers a cost-effective, quality-of-life-improving alternative to hemodialysis (HD) for end-stage renal failure. Non-medical factors, including inadequate education and infrastructure, hinder PD

Keywords:
CostsPeritoneal dialysisPeritoneal transportPeritonitisSolutions

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Area of Science:

  • Nephrology
  • Renal Replacement Therapy
  • Dialysis Technology

Background:

  • Peritoneal dialysis (PD) emerged in the 1960s as a treatment for end-stage renal failure.
  • PD is now an established therapy, complementary to hemodialysis (HD), accounting for 11% of global dialysis patients.
  • Despite comparable clinical outcomes and survival rates to HD, PD's adoption is declining in Western countries.

Purpose of the Study:

  • To review the historical development of PD.
  • To discuss peritoneal transport physiology and its impact on the peritoneal membrane.
  • To analyze factors influencing PD penetration, including medical and non-medical aspects.

Main Methods:

  • Historical review of PD development and major milestones.
  • Physiological analysis of peritoneal transport mechanisms.
  • Examination of changes in the peritoneal membrane over time.
  • Analysis of advancements in PD technology and management.
  • Evaluation of non-medical factors affecting PD adoption.

Main Results:

  • Continuous ambulatory PD (CAPD) significantly evolved the treatment modality.
  • Capillary endothelium is the rate-limiting barrier for solute and water transport in the peritoneum.
  • Peritoneal equilibrium tests monitor functional and anatomical changes in the peritoneal membrane.
  • Introduction of the Y-set and mupirocin prophylaxis reduced peritonitis incidence.
  • Declining PD use in the West is linked to inadequate patient/physician education, HD's ease of initiation, and infrastructure/reimbursement issues.

Conclusions:

  • PD is more cost-effective and offers a better quality of life globally than HD.
  • PD penetration is significantly lower than HD worldwide, with notable exceptions and regional variations.
  • Peritonitis remains a primary cause of morbidity in PD patients, influenced by environmental and socioeconomic factors.
  • Promoting a PD-first policy could benefit emerging countries with rising end-stage renal disease rates.