Issue link: https://viewer.e-digitaledition.com/i/188367
++++++++++++++++++++++++++++ +++ + +++ NEPhRoloGy CoRNER+ ++++++++++++++++++++++++++++ Developing Peritoneal Dialysis By Pierre J. Souraty, MD P ERITONEAl DIAlYSIS (PD) is a dialy- sis modality available as a renal replacement therapy for patients with end-stage renal disease (ESRD). As such, it antedates hemodialysis, as the first report of a peritoneal dialysis dates back to 1923. The technique faced more challenges compared with hemodialysis, due to infectious complications and the lack of a practical, permanent peritoneal access point. W hat is peritonea l dia lysis? How is it made? A re there different techniques? And are there absolute contraindications? Peritoneal dialysis is the method by which toxins and excess fluids are removed from the body by instilling a specific solution into the abdomen, to be in the contact of its lining for a set period of time, and then draining the solution and any excess fluid. PD is now essentially found in two main forms: continuous ambulatory peritoneal dialysis (CAPD), or "manual PD," and automated peritoneal dialysis (APD), or "machine PD." Both produce comparable results; differences relate mainly to patient preference and lifestyle. The only absolute contraindication to PD is a peritoneum that cannot be used secondary to extensive adhesions, fibrosis or malignancy. PD does have many advantages. It has been shown to preserve residual renal function longer than hemodialysis; in Kansas it can be considered more suitable for people with congestive heart failure as it is a daily, continuous, more gentle fluid removal; it frees patients from having to travel to a dialysis unit, as the procedure is typically performed at home; and there are fewer restrictions on diet and fluids compared with hemodialysis. Despite these advantages, PD has a poor image, due to potential complications and drawbacks — particularly the much-feared peritonitis. While peritonitis is a very serious condition that usually necessitates hospitalization and emergency surgery in non-PD patients, PD-related peritonitis is an outpatient condition usually treated with regional antibiotics and patient education. Nonetheless, it remains a serious complication that may lead to failure of the peritoneal membrane as a dialysis medium and also contributes to mortality. All in all, PD and hemodialysis should be considered valid alternatives for patients reaching ESRD status, and either modality would be appropriate if it fits the patient's lifestyle. Access placement in ambulatory settings has been shown to be a safe, efficient and cost-effective alternative to surgical, in-hospital placement, and, more importantly, it allows a PD program to grow, as evidenced by multiple studies. One study demonstrated that PD programs would decline if outpatient placements stopped. As a large, rural state, Kansas is an ideal location for the development of a home-based PD program. The distances to dialysis centers for much of our patient population often entail the commitment of significant blocks of time. Patients who have to drive considerable distances to a dialysis center require more time for the treatment process. Adverse weather can also make travel treacherous. The Kansas Vascular Access Center (KVAC) has recently started offering fluoroscopically assisted, minimally invasive outpatient PD catheter placement under local anesthesia. This offers the advantages of ease and flexibility of scheduling and the possibility of early initiation of PD, which would forestall long-term PD catheter placement until it is truly needed, as well as prevent expensive hospitalization or general anesthesia risks. The ultimate goal is to give Kansas' dialysis population a viable, economical and practical alternative that will accommodate diverse lifestyles and improve quality of life. P i e r r e J. S o u r a t y, M D, i s a nephrologist with Kansas Nephrology Physicians, P.A. and an interventional nephrologist with Kansas Vascular Access Center. Contact him at his office at 316-263-7285 or at the Kansas Vascular Access Center at 316-440-3900, or visit www.kansasnephrology.com for more information. ■ mDNEWS.COm ■ MD News Greater Kansas | 11