Do You Know About Peritoneal Dialysis in Patients With Chronic Renal Failure And Uremia?

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Peritoneal dialysis is an alternative treatment that utilizes the filtering function of the peritoneum to remove metabolites from the body. The specific process is as follows: First, the prepared peritoneal dialysis fluid is poured into the abdominal cavity through the pipeline, and then the peritoneal fluid diffuses and convects the high concentration of harmful factors into the abdominal cavity through its semi-filtering function. Finally, the factors that are beneficial to the human body will enter the body through the action of the filter membrane, and finally achieve the purpose of material exchange.

Types of peritoneal dialysis treatment in patients with uremia

For patients with chronic renal failure and uremia, the commonly used types of peritoneal dialysis are intermittent peritoneal dialysis, continuous ambulatory peritoneal dialysis (CAPD), and continuous circulating peritoneal dialysis.

1. Intermittent peritoneal dialysis: 5 to 7 days a week, 6000 to 10000 ml of dialysate per day, divided 8 times into the abdominal cavity, indwelling for 1 to 2 hours each time, dialysis for 10 to 12 hours per day. For chronic renal failure with significant fluid retention.

2. Continuous ambulatory peritoneal dialysis (CAPD): 5 to 7 days a week, 4 to 5 times a day, 1500 to 2000 ml of dialysate each time, into the peritoneal cavity, replaced every 3 to 4 hours, and 1 at night It can be left in the abdominal cavity for 10 to 12 hours. At present, a connection pipeline called "double bag" is used clinically. It is disposable. Patients only need to replace one bag at a time. At the same time, patients do not need to stay in bed during dialysis and can freely Activity.

3. Continuous circulating peritoneal dialysis The automatic circulating peritoneal dialysis machine is controlled by a computer program (now commonly referred to as APD in the world, namely Automatic Peritoneal Dialysis). When the patient sleeps at night, the end of the peritoneal dialysis tube indwelling in the abdominal cavity is connected to the automatic circulating peritoneal dialysis machine, and 8-12 liters of dialysate are continuously dialyzed for 9-10 hours. , and then separated from the machine, no need to replace the dialysate throughout the day (10 to 14 hours), and the patient can move freely.

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Who is suitable for peritoneal dialysis?

1. Elderly patients over 65 years old.

2. Patients with existing cardiovascular system diseases, such as angina pectoris, old myocardial infarction, cardiomyopathy, arrhythmia, intractable

3. Heart failure, low blood pressure or uncontrolled high blood pressure, etc.

4. Those who have had cerebrovascular accidents, such as cerebral hemorrhage or cerebral infarction.

5. Diabetic patients, especially those with fundus lesions or peripheral neuropathy.

6. Children.

7. Repeated vascular fistula failure.

8. Those with an obvious bleeding tendency.

Who is not suitable for peritoneal dialysis?

Patients with the following conditions should be carefully selected: abdominal wall infection, abdominal cavity, pelvic infection or abdominal drainage after enterostomy; chronic infarction-negative lung disease, respiratory insufficiency; middle or late pregnancy or large intra-abdominal tumor; Intestinal adhesions, intestinal paralysis, etc.; within 3 days after abdominal surgery; various abdominal hernias that have not been repaired; severe malnutrition, unable to supplement enough protein and calories; advanced malignant tumors; mental patients, or their family members and themselves disagree; liver disease Patients with sclerosing ascites and polycystic kidney disease generally do not use peritoneal dialysis as the first choice.

The advantages of peritoneal dialysis

1. The operation is simple, the application range is wide, no special equipment is required, and it can also be carried out in primary hospitals. Patients can do it by themselves at home, which basically does not affect work and is easy to carry. In addition, a systemic anticoagulant is not required, and the intraperitoneal heparin is less and not easily absorbed, which does not increase the risk of bleeding. It is suitable for dialysis patients with a bleeding tendency.

2. No cardiopulmonary bypass, no hemodynamic changes, stable dialysis, avoiding hypotension caused by a sharp decrease in blood volume, and no imbalance syndrome, so it is safer for the elderly, especially those with cardiovascular disease.

3. Protect residual renal function There are many studies showing that residual renal function in peritoneal dialysis patients declines at a significantly lower rate than in hemodialysis patients. Residual renal function is very important to improve the quality of life of dialysis patients and improve the survival period of dialysis patients.

4. The removal of middle molecular substances is better than that of hemodialysis, and the improvement of anemia and neuropathy is better than that of hemodialysis.

5. No vascular access is required. No need to puncture.

6. Does not depend on the machine, is simple and easy to operate, can be operated independently, and can live independently.

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The disadvantages of peritoneal dialysis

1. Infection: The possibility of abdominal infection. With current technology, the incidence of peritonitis has been greatly reduced.

2. Sugar load, hyperglycemia, hyperlipidemia, and weight gain may occur.

3. Loss of amino acids, vitamins, and proteins: During dialysis, a little protein and vitamins will be lost, so it needs to be supplemented from food. In addition to maintaining the original normal eating habits, you can take in more fish, meat, eggs, milk, etc., and the best source of vitamins is fruits and vegetables, which can be supplemented.

4. Cardiovascular and respiratory complications

Precautions for peritoneal dialysis: Strict aseptic operation is required, pay attention to whether there is wound leakage: record the dialysate input and outflow (if the outflow is less than the input, dialysis should be suspended to find the cause); observe the color and clarity of the outflow, and make Do routine examinations, bacterial culture and protein quantification; take immediate measures to control the signs of peritonitis.

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