The whys and hows of peritoneal dialysis

Ambika Shaligram
Sunday, 15 April 2018

Nephrologist Dr Tarun Jeloka explains what peritoneal dialysis is and how it will help patients suffering from Chronic Kidney Disease 

Today, the focus of healthcare is primarily on heart ailments and cancer. However, what is increasingly becoming an epidemic and needs attention is the Chronic Kidney Disease (CKD). 

Kidneys play a vital role in maintaining the overall health and well-being of an individual. They help in keeping the fluid levels in check, balance the electrolytes (like sodium and potassium) and filter out the impurities and waste products. When there is a kidney dysfunction leading to Chronic Kidney Disease (CKD), it becomes imperative to manage it and treat it well. 

There are various reasons for CKD — diabetes and hypertension being the prominent ones. There are five different stages of CKD and the treatment is given accordingly. In the first three stages, the condition can be managed through medication and diet restrictions. But in stage 4 and 5 when the condition becomes severe, patients are recommended to undergo transplantation or dialysis. In patients where transplantation is not possible, dialysis is the most effective option which has proven to successfully manage CKD. Moreover, when it comes to dialysis, Peritoneal Dialysis (PD) has immensely benefited patients. 

Explaining the procedure, Dr Tarun Jeloka, Senior Consultant & HOD, Nephrology, Aditya Birla Memorial Hospital, says, “Peritoneal Dialysis acts as a natural filter for the body wherein the body’s membrane called peritoneum is used for the dialysis. It basically involves taking out wastes from the body with the help of a cleansing fluid called dialysate, which is put into the lining of the belly through a catheter. Through this tube, the fluid is then alternately washed in and out of the abdomen drawing out the impurities. Thus, in this form of dialysis, blood is not pumped out of the body.”
Dr Jeloka explains in details the procedure involved and the care to be taken... 

Can you explain to us what is peritoneum?
Peritoneum is a layer that covers the intestine and internal part of abdominal cavity.
How is it used in the dialysis process? 
The peritoneum has a rich supply of blood vessel. When the dialysis fluid gets in contact with the peritoneum, the blood vessels transport the toxins into the dialysis fluid. The dialysis fluid is then taken out which consists of the toxins. 
How is the waste pulled out from the body? 
There are two things which need to be removed — the toxins and the extra fluid (water in the body). The toxins are removed by the process of diffusion. In the dialysis fluid, there is no toxin. So, the toxin diffuses from blood into the dialysis fluid which is thrown out. However, the fluid or the extra water in the body is removed by the process of osmosis. Osmosis means removal of water into the dialysis fluid having high osmoles.
Is it true that peritoneal dialysis can be done at home by patients or their families and that they can be trained to do so under medic’s supervision? How long does it take to be trained? 
It takes 5-7 days to train a lay person in it. Of course, you can always extend the training process for better understanding.
Can you explain about the hygiene process to be employed while doing the peritoneal dialysis? Is there any particular way in which the instruments should be cleaned or washed? 
Hygiene is important. Otherwise there is a risk of introducing infections in the belly. It includes proper washing of hands before and during the procedure.
Can you explain the cost benefit of peritoneal dialysis as compared to the conventional dialysis? 
The maintenance cost of hemo dialysis and peritoneal dialysis is same for the patient.
Is the frequency of dialysis reduced if the patient opts for peritoneal dialysis?
The advantage of peritoneal dialysis is that it is more physiological and works 24x7. It can be done overnight or three to four  times during the day and each exchange takes about 40-45 minutes.
Do we have figures or statistics of the patients using peritoneal dialysis? 
Approximately 200 odd patients are using peritoneal dialysis in Pune.
Would this be termed as an advancement in the treatment procedure of patients suffering from Chronic Kidney Disease? 
Yes. It is certainly an advancement.

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