209. Fluid Matters- A Practical Dive into Peritoneal Dialysis
Oct 1, 2023
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Explore the complications and issues in peritoneal dialysis, including catheter problems, infections, and management. Learn about peritoneal dialysis-related complications like hyperglycemia, insufficient ultrafiltration, and emergency dialysis. Discover the complications of recapsulating peritoneal sclerosis, peritoneal dialysis peritoneitis, and the use of peritoneal dialysis in acute kidney injury.
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Quick takeaways
Complications in peritoneal dialysis can include catheter issues and problems with dialysate fluid, requiring prompt attention and appropriate management.
Peritoneal dialysis is a viable option in emergency situations, but has limitations in cases involving injuries and unhygienic conditions, and is less efficient in removing potassium compared to hemodialysis.
Deep dives
The Benefits of Peritoneal Dialysis
Peritoneal dialysis offers an alternative treatment option for end-stage kidney disease. It involves introducing a hypertonic solution into the peritoneal cavity through a catheter, which acts as a magnet, attracting fluid from the blood and removing waste products. This method provides a more flexible schedule compared to in-center hemodialysis, allowing patients to perform dialysis at home. It also helps maintain essential functions, such as blood pressure regulation and electrolyte balance.
Complications and Safety Measures in Peritoneal Dialysis
Complications in peritoneal dialysis can be categorized into issues with the catheter, complications with the dialysate fluid, infection, and problems concerning the peritoneum itself. Catheter-related complications include leaks, obstructions, and infections, which require prompt attention and appropriate management. Complications with the dialysate fluid include weight gain and high glucose levels, which can be managed through proper diet and moderate water intake. Insufficient ultrafiltration can lead to fluid overload, while ultrafiltration failure may require a shift to hemodialysis. Hydrothorax, a rare complication, and recapsulating peritoneal sclerosis are also discussed. Safety measures include assessing stability, checking for signs of infections and volume overload, and involving a nephrologist when in doubt.
Peritoneal Dialysis in Emergency Situations and Complications
Peritoneal dialysis can be a viable option in emergency situations where hemodialysis may not be immediately accessible. However, it has limitations in cases involving abdominal or thoracic injuries and in unhygienic field conditions. Complications like catheter obstruction, infections (peritonitis), and other complications like hydrothorax and recapsulating peritoneal sclerosis can arise. Prompt diagnosis, fluid analysis, and initiation of appropriate antibiotics are crucial in managing peritonitis. Peritoneal dialysis should be discontinued in certain conditions, such as recapsulating peritoneal sclerosis, and hemodialysis may be required. Additionally, peritoneal dialysis is less efficient in removing potassium compared to intermittent hemodialysis.
What complications should you watch our for in patients on peritoneal dialysis? Let this once elusive topic become your expertise! This episode was written by Dr. Shareef Akbari (Internal Medicine Resident) and reviewed by Dr. Bogdan Momciu (Nephrology) and Dr. Steven Montague (General Internal Medicine)
Infographic by Dr. Caitlyn Vlasschaert (Internal Medicine Resident) Sound editing by Margaret Sun (Internal Medicine Resident)