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Peritoneal Dialysis

What is Peritoneal Dialysis?

Peritoneal dialysis (PD) is a kidney replacement therapy for patients with End Stage Renal Disease (ESRD). Unlike hemodialysis, which uses a machine to filter blood outside the body, PD utilizes the lining of your abdomen (peritoneum) as a natural filter. This form of dialysis is performed at home.

When is Peritoneal Dialysis done?

Patients with ESRD can choose to undergo either Hemodialysis (HD) or Peritoneal Dialysis (PD). PD is preferred over HD in the following circumstances:

  • Patient preference – Convenience of doing dialysis at home and according to the patient’s schedule; ease of travel.
  • Lower risk of communicable infections – For example, COVID-19 or other respiratory viral infections.
  • Poor heart function – PD is a gentler form of dialysis, and therefore patients who have poor heart function tolerate PD better than HD.
  • HD vascular access problems – Patients with small veins that cannot be used to create AVF/AVG or those with multiple failed vascular accesses will need to switch to PD.

PD may not be a good option for patients who have had multiple prior abdominal or pelvic surgeries or who have active infections or cancers in the abdomen. PD is done at home, so the patient or caregiver will need to go through a training period during which PD nurses teach the dialysis steps and aseptic technique.

How is Peritoneal Dialysis done?

PD requires the surgical placement of a tube in the abdomen. Usually, about 2-3 weeks after surgery, dialysis can be started.

There are two forms of PD: CAPD (Continuous Ambulatory Peritoneal Dialysis), which is a manual form of PD, and APD (Automated Peritoneal Dialysis), which involves the use of a PD machine.

1. CAPD
  1. Steps involved in an exchange:
    • Drainage: Fluid in the abdomen from a prior exchange is drained.
    • Infusion: Specially formulated fluid is infused through the abdominal tube into the abdomen.
    • Dwell: The fluid dwells in the abdomen (3-6 hours) and draws out toxins and extra fluid from abdominal wall blood vessels.
    • Drainage: After a dwell period, this fluid (with toxins and extra fluid) is drained via the abdominal tube into a bag that is then discarded.
  2. PD is done every day.
  3. Usually, 3-5 exchanges are done in a day.
  4. Each exchange takes about 30 minutes to complete.
2. APD
  • The exchanges are done using a PD machine (called a cycler).
  • Usually, the patient connects the abdominal tube to the tubing set of the machine at night while the patient is asleep.
  • The cycler machine sucks fluid out of the abdomen and instils fresh fluid into the abdomen through the night with short dwells
  • The patient disconnects from the machine in the morning.
  • Additional manual exchanges may need to be done during the day (depending on various patient factors).
Complications of PD

There are several potential complications. Examples of more common complications include:

  • Acid reflux and feeling full easily – This is due to the fluid in the abdomen pushing up against the stomach.
  • Back pain
  • PD-associated infections – These can be intra-abdominal infections and/or infections at the site of the PD catheter. Often, these can be easily treated. In some cases, the catheter will need to be removed, and the patient will need to switch to HD.
  • Poor drainage of the PD fluid – This can occur for various reasons, including the movement of the catheter into the wrong position in the abdomen, wrapping of intra-abdominal fat around the catheter (these cases would require re-operation), and severe constipation.

 

 

 

Hemodialysis

Peritoneal Dialysis

Advantages

No training required

No work-load for patient/caregiver

Regular monitoring by medical staff

Covered by insurance

More flexibility with dialysis schedule

Independence from a center

Lower communicable infection risk

Gentler for the heart

Fewer dietary restrictions

Disadvantages

Dependence on HD center slot availability/timings

Have to travel to HD center

Communicable Infection risk

Access issues

Impact on social life/travel

Training requirements

Work-load for the patient/caregiver

Difficulty with some insurances

Space requirements

Need for clean environment for the dialysis at home

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Peritoneal Dialysis in Bangalore

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She is available and super active with her patients like as Isaid for me. She treats in a friendly manner and is very very flexible with hee patients. She takes very good care and in every visit of mine she has met me . I got super treatment during dialysis and the transplant happened with very ease and planned way.the outcome is great. Completed one year after that . I had been meeting her in video consultancy last 1 year. Thank you Doc for the support .

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Priyanka Ghoshal

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we had consulted her for my dad's creatine issue the Dr diagnosed the issue and prescribed good medication in a few weeks the creatine came down. strongly recommend this doctor. Manipal appointment system had some issues, but the doctor was kind enough to help us out of her way and guided us on how to get this appointment faster much, appreciated her efforts in caring for her patients

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Vinay Duby

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I would have given 10 stars to Dr Pallavi. Both me and my wife have been patients of Dr. Pallavi for more than 6 years now. She supported us throughout—before, during, and after our transplant. Dr. Pallavi has been much more than a doctor to both of us, probably a "health mentor" through all these years. While Dr. is excellent from a clinical standpoint, more impressive is her ability to listen to the patient and engage in a very pleasant and positive conversation to ensure that the (already tense) patient is at ease. I have personally seen her nephrology department grow in the hospital. All the best, Doc.............you are doing a wonderful job.

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Anil

Patient
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We are extremely grateful and blessed to be treated under the Most humble yet very competent and knowledgeable Dr Pallavi Patri at Manipal Sarjapur road. The way you treat your patients is commendable. Your concern and care , cheerful nature, and positive approach to the patient are beyond medicines. We were able to conquer the toughest phase of our life only because you helped us believe there was light on the other side. We want to thank you for being so humble and professional. The Nephro team under Doctor Pallavi is dedicated , committed and ready to help even with minor queries to provide ease to the patients. Dr, you are a true definition of efficiency and hard work. When life came in as a pause and a rude shock, you helped with a restart button ; to move ahead and forward in life with hope. Thank you, dear doctor!

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