Indications and contraindications for peritoneal dialysis

 

Indications for peritoneal dialysis

Peritoneal dialysis can be prescribed to almost any patient with chronic end-stage renal disease, regardless of age. The patient's preference for peritoneal dialysis or refusal of hemodialysis is crucial in choosing peritoneal dialysis as the initial mode of dialysis, except for absolute medical contraindications. Peritoneal dialysis may be particularly suitable for those who live far away from the hemodialysis center or have transportation problems to that center.

 Peritoneal dialysis is the only alternative for patients with vascular access to hemodialysis that is difficult or impossible, such as those with extensive venous thrombosis, severe ischemia of the extremities, or a history of multiple arteriovenous fistulas. The difficulty of maintaining the vascular approach in infants and young children is also why peritoneal dialysis is the preferred method of dialysis in this age group. Riverside Nephrology Physicians provide the best Peritoneal Dialysis treatment in USA.

Contraindications to peritoneal dialysis

a) The absolute contraindications of peritoneal dialysis are:

the impossibility of performing the peritoneal approach;

refusal of dialysis by the patient;

peritoneal membrane dysfunction, which prevents adequate peritoneal dialysis;

severe neuropsychiatric disorders of the patient, which affect his ability to perform correct exchanges (dementia);

major inoperable defects of the abdominal wall (hernias, eventrations), which prevent adequate dialysis or increase the risk of infections.

The relative contraindications of peritoneal dialysis are:

Abdominal hernias, hiatus, and hemorrhoids may worsen during peritoneal dialysis, so it is advisable to have them surgically resolved before initiating it. Untreated abdominal hernias can affect the drainage of dialysis fluid and the effectiveness of peritoneal dialysis.

Morbid obesity makes peritoneal dialysis catheter implantation and postoperative healing more difficult. Achieving the proper peritoneal dialysis parameters can also be difficult (large volumes of dialysis are required). In addition, peritoneal dialysis may cause or aggravate respiratory, metabolic, joint, and digestive problems in these patients.

Patients with severe malnutrition may have problems healing their abdominal wound after catheter insertion, problems with peritoneal dialysis, and an increased risk of worsening nutrition due to loss of protein in dialysis.

In patients with reduced visual acuity or locomotor disorders (neuro-muscular or articular) of the hands, self-administration of peritoneal dialysis is difficult. However, this can be done by another person in the entourage (family member, nurse).

Some patients, such as those with chronic respiratory disease, severe polycystic kidney disease, may have difficulty tolerating the prescribed dialysis volume.

Patients with chronic inflammatory bowel disease (Crohn's disease, ulcerative colitis) or ischemia have an increased risk of peritonitis, worsening ischemia, or intestinal perforation during peritoneal dialysis.

Infections of the abdominal wall and skin may cause contamination of the outlet of the peritoneal catheter, diseases of the subcutaneous tunnel, and peritonitis. There is also an increased risk of infection in digestive or urinary stoma patients.

An episode of diverticulitis can be complicated by peritonitis. Therefore, a history of recurrent diverticulitis is a relative contraindication for peritoneal dialysis.

Other contraindications maybe, on a case-by-case basis: depression, non-compliance with treatment, occupation, or inappropriate patient lifestyle.

Advantages and disadvantages of peritoneal dialysis

 Unlike hemodialysis, in which an artificial, extracorporeal dialysis membrane is used, peritoneal dialysis uses a biological membrane located intracorporeal - peritoneal membrane. It is a form of dialysis at home, much simpler and cheaper than hemodialysis, which can be used at any age. Currently, approximately 11% of patients with chronic end-stage renal disease are being treated with peritoneal dialysis. In Romania, this percentage is close to 30%.Peritoneal dialysis and hemodialysis are equivalent inpatient survival and hospitalization rate. However, the two methods have relative advantages and disadvantages.

The advantages of peritoneal dialysis compared to hemodialysis are:

better control of volume and blood pressure (at least in the first years of peritoneal dialysis) due to uniform, continuous ultrafiltration of blood;

better preservation of residual renal function, probably due to the stability of blood pressure;

Patients with peritoneal dialysis require treatment with Erythropoietin at significantly lower doses than hemodialysis patients, probably due to better preservation of residual renal function and the absence of blood loss during hemodialysis.

reducing the risk of hematogenous viral infections ( viral hepatitis, HIV) due to lack of vascular access and extracorporeal circulation;

possibly a better quality of life than hemodialysis, giving patients more freedom to organize their professional life and leisure. Riverside Nephrology Physicians provide the best hemodialysis center treatment in USA.

Peritoneal dialysis does not require vascular access, sophisticated equipment, filters, or anticoagulation, and the medical staff is more minor. Consequently, the costs of peritoneal dialysis are, on average, 25% lower than those of hemodialysis.