Do you know about peritoneal dialysis?

For uremic patients with chronic renal failure, it is like standing at a fork in the road with three paths to choose from: kidney transplantation, hemodialysis and peritoneal dialysis. Many patients have doubts and uncertainties, but they do not know where to go. These patients need more information exchange and psychological guidance. Unfortunately, many people, except specialists, do not understand peritoneal dialysis, and many clinicians have the impression that peritoneal dialysis is still at the same level as it was in the last century. In fact, the principle of peritoneal dialysis is similar to that of hemodialysis. Peritoneal dialysis uses the peritoneum, an autologous substance, as a semi-permeable membrane to instill “peritoneal dialysis fluid” into the abdominal cavity through a “peritoneal dialysis tube”, which contains metabolic waste and excess water on one side of the peritoneum and blood on the other. At this time, one side of the peritoneum is blood containing metabolic wastes and excess water, and the other side is sterile peritoneal fluid, through which the metabolic wastes and excess water from the blood enter the peritoneal fluid. After 3-4 hours of retention (8-10 hours at night), this peritoneal fluid containing waste and water is drained from the peritoneal cavity, and new peritoneal fluid is instilled by gravity. This way, the toxins and excess water can be continuously removed from the body by changing 3-5 times a day. Blood purification treatment such as peritoneal dialysis and hemodialysis is an effective means to improve the quality of survival of patients with end-stage renal disease. Actively promoting peritoneal dialysis and improving the capacity of peritoneal dialysis medical services in medical institutions can benefit more patients. Compared to hemodialysis, peritoneal dialysis is also “safe and effective” and has the advantages of being simple to perform, easy to manage and relatively inexpensive. Peritoneal dialysis is well suited to the Asian region, with Hong Kong, Singapore, Thailand and other countries making peritoneal dialysis the first choice for patients with end-stage renal disease, with a choice rate of more than 80% in Hong Kong, more than 50% in Thailand, and about 11% in China at present. In comparison, the main advantages of peritoneal dialysis are as follows: 1. Protection of residual kidney function: peritoneal dialysis is hemodynamically stable, and does not have the recurrent hypotension that often occurs in hemodialysis, which causes kidney ischemia; peritoneal dialysis does not expose the autoimmune system to a foreign body (hemodialysis filter, pipeline) environment like hemodialysis, which reduces the impact of the systemic inflammatory state on the kidneys; peritoneal dialysis can remove large molecules of toxins from the body, which may have a palliative effect on various immune-mediated glomerular diseases and provide better protection of the residual kidney. Patients with residual renal function are more likely to maintain hematocrit and blood pressure, thereby reducing the use of erythropoietin and antihypertensive drugs. Patients with primary renal failure and good residual renal function are candidates for peritoneal dialysis. For patients to be transplanted, protection of the residual kidney can improve the prognosis of kidney transplantation. 2, wide range of use: peritoneal dialysis has good cardiovascular stability, thus reducing dialysis complications due to the instability of the internal environment, and is the preferred mode of dialysis for patients with severe cardiovascular disease, cerebrovascular disease, diabetes and elderly patients; peritoneal dialysis does not use anticoagulant drugs, which is more suitable for patients with bleeding disorders and potential bleeding; peritoneal dialysis has relatively few dietary restrictions (water and salt restrictions are more stringent), and the patient’s nutritional status is better. The patient’s nutritional status is better, and the pain of hemodialysis puncture is eliminated; peritoneal dialysis does not require arteriovenous endovascular fistula, which avoids the difficulty of making autologous arteriovenous endovascular fistula in diabetic patients due to peripheral vascular lesions. 3, comprehensive dialysis, high efficiency: peritoneal dialysis is closer to the physiological state of dialysis, the removal of medium and large molecules of toxin substances and phosphorus is better. Therefore, peritoneal dialysis can improve the symptoms of uremia, and is especially good for renal anemia, renal bone disease and neuropathy. 4, peritoneal dialysis does not affect daily life: peritoneal dialysis can be carried out at home, the treatment time is flexible and can be adjusted according to the patient’s lifestyle. It is not necessary to visit the hospital frequently and does not affect work, study and travel, which is conducive to returning to society. 5, other advantages of peritoneal dialysis: because it is a home treatment, there is less chance of blood-borne diseases, such as AIDS, viral hepatitis B and C. Peritoneal dialysis long-term treatment is less expensive and cost-effective.