Peritoneal dialysis
Peritoneal dialysis may be the lesser-known cousin of hemodialysis but it has been around about as long and developed in parallel with hemodialysis. Unlike hemodialysis , which involves running the patient’s blood through a dialysis machine, often at a clinic or hospital department 2-4 times a week for several hours, peritoneal dialysis can be done at home with (relatively) minimal equipment or with home machinery.
Peritoneal dialysis uses the peritoneal membrane of the abdomen; thin, rich in blood supply and about two meters square, as a filter to remove waste products and excess water from the body. Initially its usefulness was limited by technology concerns. For one thing, the procedure involves accessing the abdominal cavity. In the beginning the materials used were difficult to sterilize, or involved adding and removing tubes from bottles, therefore introducing sources of infection. Peritonitis seemed at the time to be an almost inevitable consequence of peritoneal dialysis. When first developed, the abdomen had to be punctured for every round of dialysis, which was obviously invasive, and limited the use of peritoneal dialysis to acute settings.
In the 1950s flexible tubes were developed, and in the 1960s Dr. Henry Trenckhoff developed the Trenckhoff tube, an inert flexible tube placed with cuffs and a subcutaneous tunnel which could be left in place for long periods of time. This design and similar tubes greatly facilitated the use of peritoneal dialysis on a chronic basis. The additional development of closed plastic systems in the 1970s also made peritoneal dialysis a practical option. More recent advances have focused on improving dialysis solutions to make them less corrosive to the peritoneal cavity.
This led to the development of continuous ambulant peritoneal dialysis. The patient infuses a certain volume of dialysis solution into their abdomen and changes out the fluid every 4 hours or so. This is what the patient in our article is using. Later on, automated peritoneal dialysis came into play. In this process, a machine moves dialysis solution through the abdominal cavity while the patient sleeps or rests for about 10-15 hours a day, and the rest of the time the patient maintains some dialysant in their abdomen.
About 10% of dialysis patients in the US use peritoneal dialysis, in contrast to about 40% in the UK. Patients typically choose this form of dialysis because they dislike the concept of hemodialysis, they feel more in control with peritoneal dialysis, or find it more convenient to do the peritoneal dialysis at home, especially if a dialysis center is far away. Many patients have done both, and they seem to report little difference overall in symptoms from renal disease or from the treatment between the two methods.
