Talk:Peritoneal dialysis

Wiki Education Foundation-supported course assignment
This article was the subject of a Wiki Education Foundation-supported course assignment, between 22 November 2021 and 19 December 2021. Further details are available on the course page. Student editor(s): WjungUCSF. Peer reviewers: ZenForest2561.

Above undated message substituted from Template:Dashboard.wikiedu.org assignment by PrimeBOT (talk) 06:24, 17 January 2022 (UTC)

brilliant article :)
Really in depth, but nevertheless very well understandable. Thank you to all contributers! Regards 84.164.3.193 11:32, 16 November 2006 (UTC)

There is one element that i found missing in the article - cost of treatment. My father was on CAPD for 2 years before he died. In India medical treatment is considered less expensive. In spite of the fact that i am working overseas where income levels are higher, i found it very difficult to cope with the cost of treatment. I think the cost of treatment is much beyond the reach of an average middle-class indian citizen. 41.209.122.56 07:05, 14 December 2006 (UTC)

Does anyone have any comments on PD in a diabetic? Is the glucose based formula a concern?

The glucose is a concern in a lot of diabetic patients. Often (if needed) insulin is added to the bag of fluid or the patient injects themself with extra insulin. Some patients (as the case is with someone close to me) can not even use the highest (4.25%) solution because of the resulting high blood sugars. DemonicSymphony (talk) 04:56, 22 February 2008 (UTC)

41.209.122.77 08:23, 19 September 2007 (UTC)My father was a diabetic and also had Hypertension. Yet he was on CAPD for 2 years. I do not think this is a concern. 41.209.122.77 08:23, 19 September 2007 (UTC)

I also feel it is costly and my entire savings have gone for a toss. It is better to go for a transplant.

41.209.122.77 08:33, 19 September 2007 (UTC) I have to agree with your comments. For my father, after being on peritoneal dialysis for sometime, i consulted a doctor to discuss about transplant. But by then, his assessment was that he is too weak to undergo a transplant. As per my understanding, once you are on PD, you need to take a high protein diet because body protein also gets eliminated through the PD solution as a side effect. But the complaint from my father was "How can you eat food when your stomach feels so full with all those dialysis solution." So over a period of time he became more weak and hence had to rule out transplant41.209.122.77 08:33, 19 September 2007 (UTC)

PD first choice?
I ran across this article and saw that it says that PD is the first choice for treatment of kidney failure. I am a PD patient and I can tell you this is inaccurate. Kidney Transplant is considered to be the optimal choice. That is why I have edited this part of the article. —Preceding unsigned comment added by 205.143.139.82 (talk) 20:01, 29 September 2007 (UTC)

AWAK merger
The Automated wearable artificial kidney page does not have enough real content to stand on its own. Once all the advertising/marketing spam is removed, there will be very little content left in it. Given that it is a form of peritoneal dialysis, I think whatever relevant parts exist should be merged into a section here (future therapies or something). Chaldor (talk) 05:42, 23 September 2008 (UTC)
 * Ignore, I found a more appropriate article to move to. Chaldor (talk) 06:09, 23 September 2008 (UTC)

Sugar Strengths
In the article it uses the numbers (1.5, 2.5 and 4.5) which are correct from the baxter(american) website, It should be noted somewhere on the page that the fluid in the UK is (1.36, 2.27, 3.86) Product Catalog for UK numbers -Orangatuan

Infection Protection
I have been to 4 different Renal Units in England and none of them have even mentioned using surgical masks, if there is a cause to worry about infection they get use to place an iodine soaked clamshell over the connectors in question Product Page -Orangatuan

Changed "Dialect Chemical" to "Dialysis Fluid" —Preceding unsigned comment added by 63.134.128.211 (talk) 21:35, 2 June 2009 (UTC)

Suggested Changes to Peritoneal Dialysis Article
We would like to suggest significant edits to this entry to add more detail sourced to third-party medical literature. We look forward to feedback.

(Replaces current introduction)

Peritoneal dialysis removes wastes and fluids from the blood by using the lining of the abdominal cavity (peritoneal membrane or peritoneum) as a filter. Wastes and fluids move from the blood vessels in the peritoneum into a solution that is placed in the abdominal cavity. Peritoneal dialysis is a continuous therapy, meaning it is designed to work all day, every day. Peritoneal dialysis has been used as a treatment option for ESKD since the 1960s. At the end of 2004, there were more than 1,300,000 patients on dialysis worldwide, with 11% being treated with peritoneal dialysis.

(New Section: How Peritoneal Dialysis Works)

Peritoneal dialysis removes wastes and excess fluid from the body using the peritoneal membrane as a natural filter. The peritoneal membrane lines the peritoneal or abdominal cavity and surrounds the stomach, spleen, liver, and intestines.

During peritoneal dialysis, a solution is placed in the peritoneal cavity, and wastes and excess fluid move from the blood vessels in the peritoneal membrane into a solution. The time when the solution is in the peritoneal cavity and dialysis is occurring is the called the dwell. After the dwell is completed, the solution is drained from the body and replaced with fresh solution in a procedure called an exchange. Dwell time is when dialysis is occurring. Most adults use 2 to 3 liters (approximately 2 to 3 quarts) of solution for each dwell. The amount of solution and the duration of the dwells are adjusted to each patient’s individual needs and may change over time.

The peritoneal dialysis solution flows in and out of the peritoneal cavity through a thin, soft plastic tube called a catheter. The catheter is placed through the abdominal wall into the peritoneal cavity by minor outpatient surgery, typically 10 to 14 days before peritoneal dialysis is started. The end of the catheter that is outside the body is attached to a device called a transfer set that is used for connection of the catheter to the solution and drain bags. When not being used the catheter is easily concealed under clothing. --Renaldialysis (talk) 14:22, 21 August 2009 (UTC)

Additional Suggested Changes to Peritoneal Dialysis Article
We would like to suggest some additional edits to the article to provide more detailed information regarding types of peritoneal dialysis and solutions available for use.

Types of peritoneal dialysis
There are two main types of peritoneal dialysis that differ primarily in how and when the exchanges are performed:

– Continuous Ambulatory Peritoneal Dialysis (CAPD)

– Automated Peritoneal Dialysis (APD)

In CAPD, exchanges are performed during the day. A typical CAPD schedule usually involves four to five exchanges each day. The CAPD system includes a fresh bag of solution, an empty drain bag, and tubing that connects to the catheter. Gravity is used to fill the peritoneal cavity with fresh solution and drain the used solution. CAPD exchanges take about 30 minutes to complete. The dwell times during the day are usually 4 to 6 hours, with a longer dwell time overnight (8 to 10 hours) to allow for uninterrupted sleep. Exchanges can be performed in any clean area – at home, work, or while traveling. For patient comfort, solution can be warmed to body temperature before each exchange.

In APD, exchanges are performed automatically by a machine called a cycler, usually while the patient sleeps. Each exchange and the following dwell is referred to as a cycle. The cycler is programmed to control when solution is drained and refilled and the duration of the dwells. The cycler warms the peritoneal dialysis solution to body temperature and the machine sounds an alarm if there are any problems during the exchange. A typical APD schedule includes three to five cycles over an 8 to 10-hour period at night. The dwell times at night while connected to the cycler typically vary from 90 minutes to 3 hours and there may be a long dwell during the day (12 to 16 hours) that lasts until the patient reconnects to the cycler the next night. APD cyclers are small in size and relatively light weight (25 to 30 pounds) and can be placed on a nightstand or small table.

During the dwell times of CAPD and APD, individuals are free to go about their normal daily activities such as sleeping, working, housecleaning, golfing, shopping, exercising, preparing meals, gardening and traveling. --Renaldialysis (talk) 19:11, 31 August 2009 (UTC)

Additional Suggested Changes to Peritoneal Dialysis Article
We would like to suggest some additional edits to the article to provide more detailed information regarding types of peritoneal dialysis and solutions available for use.

Performing peritoneal dialysis
Patients who choose peritoneal dialysis will be trained to safely and effectively perform the therapy. Training usually takes 1 to 2 weeks and is provided by specially trained staff in the dialysis clinic. Routine care will include regular visits to the clinic to meet with the health care team, including the physician, nurse, social worker, and dietitian.

In addition to performing peritoneal dialysis exchanges, patients will be responsible for daily monitoring of their weight and blood pressure to make sure fluid removal is adequate; they may make small changes to the peritoneal dialysis prescription as directed by the physician. Patients also must perform specific care of the catheter as instructed and inspect the peritoneal dialysis catheter area daily for signs of infection.

The peritoneal dialysis prescription is individually tailored to best meet the waste and fluid removal needs of each patient. The type of peritoneal dialysis, the amount of solution, the number of exchanges, and the length of the dwells are determined by many factors including body size, the amount of remaining kidney function, and how rapidly the peritoneal membrane transports wastes across the peritoneal membrane into the dialysis solution. Routine tests are used to monitor the patient’s clinical status, and the results of these tests will be used to change the peritoneal dialysis prescription as needed for optimal removal of wastes and excess fluid.

Who can be treated with peritoneal dialysis
People with End Stage Kidney Disease should talk with their doctor about their treatment options so they can decide which treatment best suits their medical condition and lifestyle.

Peritoneal dialysis is not an appropriate therapy for all patients with End Stage Kidney Disease, but studies show that the majority of patients are able to be treated with peritoneal dialysis. ,, Among patients whose medical condition allows them to be treated with peritoneal dialysis, about half of those who learn about both PD and HD as possible treatments will choose peritoneal dialysis. , Peritoneal dialysis can be used in patients of any age or weight, and in those with diabetes.

Patients who should not use peritoneal dialysis include those with abdominal problems that prevent peritoneal dialysis from being effective or increase the risk of infection. Also, peritoneal dialysis should not be chosen when the patient and/or the patient’s caregiver are either unable or unwilling to learn how to correctly perform the therapy. Renaldialysis (talk) 16:37, 8 September 2009 (UTC)

Additional Suggested Changes to Peritoneal Dialysis Article
We would like to suggest some additional edits to the article to provide more detailed information regarding types of peritoneal dialysis solutions, benefits of peritoneal dialysis, and considerations and potential problems with peritoneal dialysis. It is a somewhat longer post because the sections reference one another so we do not want to post one without the other.

Peritoneal dialysis solutions
Several types of peritoneal dialysis solutions are available. The solution types will be selected by the physician based on the patient’s needs and may be changed over time. Not all solutions are available in every country.

Standard peritoneal dialysis solutions contain dextrose (glucose or sugar), which is an osmotic agent, that drives the removal of excess fluid from the blood. The removal of excess fluid during dialysis is known as ultrafiltration. The amount of dextrose (1.5%, 2.5%, or 4.25%) determines how much fluid is removed; the higher the dextrose concentration the greater the fluid removal.

Other osmotic agents are Extraneal (icodextrin) and amino acids. See important safety information about icodextrin in “Considerations and potential problems with peritoneal dialysis.”

Other types of peritoneal dialysis solutions contain a different buffer, the substance that controls the amount of acid in the peritoneal cavity. Standard peritoneal dialysis solutions contain the buffer lactate. Other solutions contain bicarbonate or a combination of bicarbonate and lactate.

Benefits of peritoneal dialysis
Peritoneal dialysis is a safe and effective therapy that is well tolerated by most patients. Studies have shown that peritoneal dialysis patients have a high level of satisfaction with their therapy.

Peritoneal dialysis offers many lifestyle benefits to those who are willing to learn and perform the therapy. Because the treatments are performed at home, patients usually don’t need to travel to the dialysis center more than once a month. Receiving treatments at home also allows more time for family and friends.

Patients have some flexibility in the times when they perform their exchanges, which makes it easier to participate in family responsibilities and social activities. Many patients on peritoneal dialysis continue working.

Although most patients perform their peritoneal dialysis exchanges at home, it is possible to perform them anywhere, at work, in a hotel, at a friend’s house, as long as a clean room free of drafts is available. Patients who wish to travel can do so by making arrangements to have dialysis solutions and supplies shipped to other locations.

Studies have shown that patients treated with peritoneal dialysis keep their remaining (or residual) kidney function longer than those treated with conventional hemodialysis. The benefits of keeping even a small amount of kidney function include better control of blood pressure. and improved survival.

Unlike hemodialysis, no needles are used with peritoneal dialysis.

Considerations and potential problems with peritoneal dialysis
Lifestyle and responsibility

Patients must be willing to perform exchanges several times each day, every day as well as related procedures, for example, catheter care. Space must be available in the home to store peritoneal dialysis solutions and supplies. For APD, space is needed near the bed for the cycler.

Body image

Some patients find it difficult to have a permanent peritoneal dialysis catheter and are concerned about how the catheter and the solution in the abdomen affects their appearance. Some also are concerned about how the catheter will affect sexual activity and the relationship with their partner. Peritoneal dialysis tends to stretch the abdomen and give it a rounded appearance, which can be counteracted by exercises that strengthen the abdominal muscles.

Fluid overload

Fluid overload means too much fluid in the body. Patients with fluid overload may experience an increase in body weight, swollen ankles, and/or shortness of breath. All patients on dialysis need to restrict their fluid intake because the amount of excess fluid removed by dialysis is limited.

Discomfort

Some patients find that the dialysis solution in their abdomen makes them feel full or bloated. Others experience discomfort when solution is flowing into or draining from the peritoneal cavity. Discomfort during solution flow may disappear with time, and there are ways to minimize or avoid discomfort.

Infection

Two types of infection directly related to peritoneal dialysis are peritonitis and infections where the catheter exits the abdomen (exit-site infections). Peritonitis is an infection usually caused by bacteria that have entered the peritoneum, often through the catheter. A patient with peritonitis usually experiences abdominal pain and a cloudy appearance to the drained dialysis solution. Patients are taught how to lower the chances of peritonitis by avoiding contamination when performing exchanges. Peritonitis is treated with antibiotics that often are added to the dialysis solution. Occasionally, a patient who has several episodes of peritonitis may need to have the peritoneal dialysis catheter replaced.

An infected exit site is inflamed, red, and sore, and there may be drainage from the site. Good exit site care, as explained during training, can significantly reduce the chances of getting an infection. Exit-site infections are treated with antibiotics. Occasionally, the infection spreads along the catheter inward through the abdominal wall. If this occurs, it may be necessary to remove the catheter and place a new catheter. A temporary period of hemodialysis may be required.

Effectiveness of peritoneal membrane

In a small number of patients, the effectiveness of the peritoneal membrane in removing excess fluid and wastes may decline. Possible causes are repeated infections and the long-term effects of dextrose in the peritoneal dialysis solutions. It may be possible to modify the peritoneal dialysis prescription to adjust for this change or in some cases a permanent transfer to hemodialysis may be required.

Icodextrin: Important Safety Information

Patients who use the icodextrin peritoneal dialysis solution need to be aware of important risk information if they have high blood sugar or diabetes and use glucose monitors to measure their blood glucose levels. Using icodextrin peritoneal dialysis solution may cause a false (incorrect) high blood sugar reading or may hide a blood sugar reading that is actually very low. Only glucose-specific monitors and test strips should be used. More information is available at: http://www.glucosesafety.com/.--Renaldialysis (talk) 17:55, 16 September 2009 (UTC)


 * The above should be incorporated into the article as they explain why it isn't more widely used. I've seen PD fail with life threatening complications. Also was looking for survival rates on dialysis of all kinds and didn't see this but personally know that people can live for decades but some do for only a few years. 72.228.177.92 (talk) 00:51, 6 September 2010 (UTC)

Combinations?
Is PD ever combined with hemodialysis? That is, does anyone do PD most days, and then hemodialysis every now and again? It seems like this could give you a 'best of both worlds' (well, and the 'worst of both', as well). WhatamIdoing (talk) 18:41, 1 October 2009 (UTC)
 * :) WLU (t) (c) Wikipedia's rules: simple/complex 00:36, 6 October 2009 (UTC)

Need to know more about issue related to PD
Hi,

My father has recently started using PD. One thing that we see is in last 1 Month there was a problem in discharging the fluid. it just got stopped. then some injection was given as they said it is needed to dissolve some proteins or fibers.

So, I would like to know is this the common issue seen by other PD patients. is it something to worry about, etc.

Regards, Gaurav — Preceding unsigned comment added by 59.92.166.172 (talk) 15:19, 6 October 2011 (UTC)

1.5% solution
Hi

my dad has run out of the 1.5% solution. Is it ok for him to use the 2.5% for a while until we get the 1.5% for him to use at night time???? His pressure and sugar for this pass week is high why do u tink if he is using the 2/5 nd 1.5 as indicated. — Preceding unsigned comment added by 190.197.26.147 (talk) 19:56, 25 June 2012 (UTC)

We cannot offer medical advice. Please see the medical disclaimer, and contact an appropriate medical professional. -- John of Reading (talk) 20:45, 25 June 2012 (UTC)

how about a section on the history/development of PD?
I think that might be worthwhile. 166.182.248.229 (talk) 19:55, 10 February 2021 (UTC)

UCSF Wikipedia Elective December 2021
Making edits and revamp of article for course. The following are my intended edits

[done] Rearrange sections to be line up with manual of style of surgeries and procedures: -see https://en.wikipedia.org/wiki/Wikipedia:Manual_of_Style/Medicine-related_articles#Surgeries_and_procedures -note this is roughly the outline followed by hemodialysis wikipedia page
 * 1) Overall

[done] Flag citations [ ] Add citations -There are a few statements without citations. Although some are known complications it's best to have a source to verify it.
 * 1) Complications

[done] Split epidemiology into subregions. [done] Expand on policy in the USA -Using this section in place of "society and culture". I will expand the policies in the USA that affects PD uptake.
 * 1) Epidemiology

I may not have time to create or edit but would suggest -updating policies in other localities affecting epidemiology -organize Complications sections with subheadings similar to hemodialysis and expand on each subheading — Preceding unsigned comment added by WjungUCSF (talk • contribs) 22:21, 8 December 2021 (UTC)
 * 1) Suggested future changes

UCSF Wikipedia Elective December 2021 Peer Review
I am providing a peer review of my classmate's work in this course.

I like that you've paid attention to the general structure of the page and standardized it. You've already done a lot of work on this page, but if you have time it might make the page even more informative to include some of the sections on the "hemodialysis" page (e.g. "Equipment").
 * 1) Overall

I think you're making great progress on making the citations for this section more robust. There are a lot of facts in this section, and I agree that it is probably better to err on the side of providing more rather than less citations. You might be able to find a comprehensive source that provides basic information about dialysis that can be used for multiple facts in this section.
 * 1) Complications

I like that you're exploring international differences in epidemiology, and broadening the perspective of this article. I wonder if these statistics might be better represented in a table form?
 * 1) Epidemiology

Overall, this is great! I think you're really helping to build up this article into a robust resource for those seeking more information on peritoneal dialysis! ZenForest2561 (talk) 23:43, 8 December 2021 (UTC)

Response to peer Review Dec 2021
Thank you for your comments. Response in italics

Overall

I like that you've paid attention to the general structure of the page and standardized it. You've already done a lot of work on this page, but if you have time it might make the page even more informative to include some of the sections on the "hemodialysis" page (e.g. "Equipment").

Will consider.

Complications

I think you're making great progress on making the citations for this section more robust. There are a lot of facts in this section, and I agree that it is probably better to err on the side of providing more rather than less citations. You might be able to find a comprehensive source that provides basic information about dialysis that can be used for multiple facts in this section.

Found a textbook which will use for citations of complication

Epidemiology

I like that you're exploring international differences in epidemiology, and broadening the perspective of this article. I wonder if these statistics might be better represented in a table form?

''Will opt to use subheadings and provide context. The statistics for different regions are not compiled in a standard way unfortunately, e.g. some report nations some report geographical regions.'' — Preceding unsigned comment added by WjungUCSF (talk • contribs) 03:35, 17 December 2021 (UTC)