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Peritoneal Dialysis

Renal Replacement Therapy : Peritoneal Dialysis

Is this form of dialysis common in Malaysia?
What is Peritoneal Dialysis?
What are the factors that influence the choice of CAPD?
What are the contraindications for CAPD?
What are the complications of Peritoneal Dialysis?
Support group

Is Kidney Transplantation done in Malaysia?

As up to 31/12/2006 there are about 1500 patients on this modality. Majority are on CAPD (Continuous Ambulatory Peritoneal Dialysis) rather than APD (automated PD).

What is Peritoneal Dialysis?

Peritoneal dialysis is another modality of dialysis. Here, dialysate is infused into the peritoneal space in the abdomen through a two-way catheter (the Tenckhoff catheter) which is inserted surgically. The membrane that lines the abdomen (the peritoneum) allows waste and fluid to pass from the blood into the dialysate. The dialysate is subsequently removed from the body.

In Continuous ambulatory peritoneal dialysis (CAPD), the patient connects a bag of dialysate fluid (between 2 to 3 L) to the Tenckhoff catheter. This dialysate remains in the abdomen for 4 to 6 hours, following which the dialysate will be drained out of the abdomen and fresh dialysate will be reinfused. For adequate dialysis, 4 to 6 such exchanges are required to be done manually in a day. The peritoneal dialysis solution is made up of various salts and sugar (glucose). The concentration of sugar in the dialysate determines the volume of fluid removed (ultrafiltration) from the patient.

An alternative method can be done using an automated machine.

What are the factors that influence the choice of CAPD?

These include psychosocial factors and medical factors.

Psychosocial factors include :

• Patient preference and motivation
• Concern with body image (young adults)
• Occupation
• Economic considerations
• Home and workplace environment
• Family support
• Distance from the nearest HD center

Medical factors include :

• Age
• Cerebrovascular and heart disease and ortopedik problems
• Blindness
• Severe pulmonary disease
• Previous extensive abdominal surgery
• Difficult in providing a vascular access for haemodialysis

What are the contraindications for CAPD?

• Extensive peritoneal fibrosis and adhesions arising from previous surgery or inflammatory bowel disease
• Poor eye sight - would require an assistant
• Any colostomy, ileal conduit, ileostomy etc
• Psychologically unstable patient
• Chronic obstructive airway disease
• Morbid obesity
• Severe diverticular disease of the colon

What are the complications of Peritoneal Dialysis?

The commonest cause is infections - either exit-site, tunnel infection or peritonitis.

Other complications include :

• Technical problems - hernias, leakage, inflow and outflow obstruction
• Metabolic problems - diabetes, hyperlipidemia, hypokalemia
• Malnutrition

Support group

Malaysian Society of Nephrology - www.msn.org.my.

National Kidney Foundation of Malaysia - www.nkf.org.my.

Last reviewed : 1 August 2008