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Peritoneal Dialysis II: Peritoneal Dialysis Systems and Complications01:25

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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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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, 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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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: Turning Choice Into Reality.

Rhodri Pyart1, Kieron Donovan2, Christopher Carrington2

  • 1Department of Nephrology and Transplantation, University Hospital of Wales, Cardiff, United Kingdom rhodri.pyart@wales.nhs.uk.

Peritoneal Dialysis International : Journal of the International Society for Peritoneal Dialysis
|July 12, 2018
PubMed
Summary

Many patients choosing peritoneal dialysis (PD) do not start it due to unplanned hemodialysis (HD) starts, leading to worse survival. Improving PD catheter insertion and service may enhance PD utilization and patient outcomes.

Keywords:
Percutaneousacute start

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Area of Science:

  • Nephrology
  • Renal Replacement Therapy
  • Dialysis Modalities

Background:

  • Peritoneal dialysis (PD) utilization varies significantly across UK renal centers.
  • Limited data exist on patients choosing PD but failing to initiate the therapy.
  • This study investigates outcomes for patients who selected PD at a center with mini-laparotomy catheter insertion and no acute-start PD service.

Purpose of the Study:

  • To explore the outcomes of patients who chose PD.
  • To identify reasons why patients failed to start PD.
  • To analyze the impact of modality choice on patient survival.

Main Methods:

  • Retrospective analysis of 658 patients over 12 years who chose PD after predialysis education.
  • Data collection included demographics, RRT start modality, transplantation, survival, and reasons for PD failure.
  • Comparison of outcomes between patients starting PD and those starting hemodialysis (HD).

Main Results:

  • Out of 2,749 patients receiving predialysis education, 658 (24%) chose PD.
  • Less than half (48%) of eligible patients initiated PD; 273 started PD.
  • The primary reason for not starting PD was acute kidney function decline necessitating an unplanned HD start.
  • Transplant-censored survival at 3 years was worse for patients starting HD compared to PD.
  • Fewer than 50% of HD starters later transitioned to PD.

Conclusions:

  • Unanticipated kidney function decline leading to unplanned HD initiation contributes to poorer outcomes for patients failing to start PD.
  • The timing and method of PD catheter insertion are critical factors.
  • Service improvements are identified to enhance PD catheter insertion and patient selection for PD.