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Tuesday, February 5, 2013

Peritoneal Dialysis Indications and Contraindications

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Peritoneal dialysis (PD) PD is a form of dialysis in which a dialysis solution is instilled in the peritoneal cavity, periodically drained, and exchanged with fresh solution through a single, indwelling peritoneal catheter. It is a established form of renal replacement therapy that is used around the world. United States Renal Data System (USRDS) data from 1998 to 2002 indicate that the prevalent PD population decreased by 3.5% per year, with only 8% of prevalent dialysis patients being treated with PD in 2002. In contrast to the experience in the United States, the prevalent number of patients with end-stage renal disease receiving PD has exceeded 60% in other countries, such as in Mexico and Hong Kong. The cause for these differences is likely multifactorial and is related to access to PD, physician expertise, patient mix, and reimbursement.

Indications:
1. PD continues to be the preferred dialysis modality for infants and young children

2. Patients with severe hemodynamic instability on hemodialysis

3. Patients with difficult vascular access

Contraindications:
1. The one absolute contraindication to chronic PD is an unsuitable peritoneum due to the presence of extensive adhesions, fibrosis, or malignancy.

2. Abdominal hernias

3. Presence of colostomy, ileostomy, nephrostomy, or ileal conduit

4. Recurrent chronic backache with preexisting disc disease

5. Severe psychological and social problems

6. Severe diverticular disease of the colon

7. Severe neurologic disease, movement disorder, or severe arthritis preventing self care. (caregivers can be trained to perform the peritoneal dialysis)

8. Severe chronic obstructive pulmonary disease

9. Malnutrition

Studies investigating differences in patient mortality between PD and hemodialysis (HD) have been conflicting. Most reports have shown no significant difference in survival between PD and non-diabetic HD patients.



National Kidney Foundation has great handbook. To view please Click Here
For information on nutrition and peritoneal dialysis please Click Here