Peritoneal Dialysis Scholarly Journal

Peritoneal dialysis may be a home-based renal replacement therapy for patients with end-stage renal disorder, offering a degree of autonomy and lifestyle flexibility. After placement of a catheter into the greater peritoneal sac under either general or local anesthetic , the patient is instructed the way to perform dialysis exchanges during which dialysate is instilled into the peritoneal cavity. These exchanges can be performed either manually (continuous ambulatory peritoneal dialysis (CAPD)), or using a machine (automated peritoneal dialysis (APD)). During the dialysis exchange, small solutes (e.g. urea, potassium, creatinine) diffuse from the circulation into the dialysate and are removed when the effluent is drained out. With CAPD, the quality approach is to perform four exchanges during the 24-hour period using 2 litres of dialysate on each occasion, although the prescription are often varied according to individual requirements. With APD, the dialyzer performs repeated exchanges overnight, and therefore the patient has additional daytime exchanges. Water is removed via the osmotic effect of the glucose within the dialysate, although other osmotic agents also can be used, including icodextrin, a glucose polymer, and amino acids. The most common complication is peritonitis; other problems include mechanical difficulties with the catheter, and insufficient removal of water or solute.    

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