II. Epidemiology

  1. Accounts for 18% of Dialysis for ESRD in the United States

III. Efficacy

  1. Similar overall mortality rates with Peritoneal Dialysis as with Hemodialysis
  2. Hemodialysis is preferred for solute/electrolyte and volume management
  3. When asked, ESRD patients prefer Peritoneal Dialysis
    1. Rubin (2004) JAMA 291:697-703 [PubMed]

IV. Indications

  1. Hemodynamically unstable patient
  2. Difficult vascular access for shunt placement
  3. Mild ESRD

V. Mechanism

  1. Based on osmotic pressure gradient between blood and dialysate (chiefly Glucose concentration)
  2. Dialysate is infused via a peritoneal access port

VI. Types

  1. Continuous Ambulatory Peritoneal Dialysis (CAPD)
    1. Infuse 2 liters dialysate and allow to dwell for 4-6 hours, then repeat four times daily
    2. Volume infused/day: 8 liters
    3. Volume withdrawn/day: 10 liters
  2. Intermittent Peritoneal Dialysis (IPD)
    1. Rapid dialysate cycling (hourly)
  3. Continuous Cycling Peritoneal Dialysis (CCPD)
    1. Rapid dialysate exchanges overnight (uses an automated device)

VII. Complications

  1. Infection
    1. See Dialysis-Related Spontaneous Bacterial Peritonitis
  2. Catheter infections
    1. Findings
      1. Peritoneal access site may present with localized pain, erythema, swelling or discharge
      2. Most commonly infected with Staphylococcus aureus or Pseudomonas aeruginosa
      3. Ultrasound to evaluate for abscess and to direct Incision and Drainage
    2. Management
      1. Incision and Drainage (if needed)
      2. Antibiotics: Cephalexin, Ciprofloxacin or Dicloxacillin
  3. Catheter leaks
    1. Leaks present with abdominal wall edema and clear drainage from catheter skin entry margin
    2. Temporize with Hemodialysis (and stop Peritoneal Dialysis until leak resolves)
    3. Consult nephrology and general surgery
    4. Obtain cultures of dialysate fluid and consider empiric antibiotics
  4. Abdominal Hernias
    1. Due to increased abdominal pressure from dialysate
    2. Referral to general surgery due to incarceration risk
  5. Hydrothorax (rare)
    1. Typically right-sided
    2. Confirmed with methylene blue in dialysate
    3. Temporize with Hemodialysis (and stop Peritoneal Dialysis until leak resolves)
    4. Consult nephrology and thoracic surgery

VIII. References

  1. Glauser (2013) Crit Dec Emerg Med 27(10): 2-12

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Ontology: Peritoneal Dialysis (C0031139)

Definition (MSH) Dialysis fluid being introduced into and removed from the peritoneal cavity as either a continuous or an intermittent procedure.
Definition (NIC) Administration and monitoring of dialysis solution into and out of the peritoneal cavity
Concepts Therapeutic or Preventive Procedure (T061)
MSH D010530
ICD9 54.98
ICD10 1060
SnomedCT 151055004, 71192002
LNC LP149602-7, LA10059-6
English Dialyses, Peritoneal, Peritoneal Dialyses, Dialysis, Peritoneal, Peritoneal Dialysis Therapy, peritoneal dialysis, peritoneal dialysis (treatment), dialysis peritoneal, dialysis peritoneal dialysis, peritoneal dialyses, Peritoneal dialysis, PD - Peritoneal dialysis, Peritoneal dialysis (procedure), Peritoneal dialysis, NOS, Peritoneal Dialysis, Dialysis;peritoneal
Japanese 腹膜透析, フクマクトウセキ
Swedish Påsdialys
Czech peritoneální dialýza, Peritoneální dialýza
Finnish Vatsakalvodialyysi
Russian BRIUSHINNYI DIALIZ, DIALIZ PERITONEAL'NYI, БРЮШИННЫЙ ДИАЛИЗ, ДИАЛИЗ ПЕРИТОНЕАЛЬНЫЙ
Croatian PERITONEJSKA DIJALIZA
Polish Dializa otrzewnowa
Hungarian Peritonealis dialysis
Norwegian Posedialyse, Peritonealdialyse
Spanish diálisis peritoneal (procedimiento), diálisis peritoneal, SAI, diálisis peritoneal, Diálisis peritoneal, Diálisis Peritoneal
Portuguese Diálise peritoneal, Diálise Peritoneal
Dutch peritoneale dialyse, Dialyse, peritoneale
French Dialyse péritonéale
German Peritonealdialyse
Italian Dialisi peritoneale