Peritoneal Dialysis in South Africa

Peritoneal dialysis is an alternative treatment to hemodialysis. It is not a common form of dialysis. Although it can be performed at home, it has many risks and expenses. Peritoneal dialysis is not recommended if the patient has scarring in the peritoneal membrane or any other inflammatory bowel diseases.

How is Peritoneal Dialysis Performed?
A catheter is placed in the abdomen usually 10 to 14 days before the dialysis begins.
There are some peritoneal dialysis catheters that can be used immediately, however, it involves complications.

Peritoneal dialysis is known as exchange. An exchange involves the drainage of the dialysis fluid known as dialysate from the peritoneum and introduction of fresh dialysate into the peritoneum. Patients may require about four to six exchanges every day.

There are three steps involved in peritoneal dialysis:

• Fill: The dialysate fills the peritoneal cavity inside the patient’s abdomen. The peritoneum is rich in minute blood vessels; therefore there is a constant supply of blood that can be filtered by osmosis and diffusion.
• Dwell: When the fluid fills the peritoneal cavity, excess fluids and waste products in the blood pass through the peritoneal membrane and into the dialysate.
• Drain: After some time, the dialysis fluid is drained out and new dialysis fluid replaces it.

The patient’s physical condition, diet and medications are monitored on a regular basis. If required, changes can be made in the treatment plan of the patient, and the number of exchanges, time between exchanges or the solution amounts may be altered.

What are the two main types of Peritoneal Dialysis?
The two main types of peritoneal dialysis are:

• Continuous Ambulatory Peritoneal Dialysis (CAPD)
  During this procedure, the dialysate solution is retained in the peritoneum for four to six hours. Then, the dialysate is drained out of the peritoneum and again a fresh dialysate solution is filled in. This method is most commonly used for peritoneal dialysis.
• Continuous Cycling Peritoneal Dialysis (CCPD)
  During this procedure, the dialysate solution is automatically filled and drained from the peritoneum with the help of a machine. The duration of this process is 10 to 12 hours, and it is mostly performed at night when the patient is asleep.