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Common Complications during Peritoneal Dialysis 

Common Complications during Peritoneal Dialysis 

Last week, I wrote about common complications during hemodialysis. Tonie, one of my readers, requested a blog about common complications during peritoneal dialysis. Folks, fair is fair in my book [Great pun, don’t you think?] or as my father used to say, “What’s good for the goose is good for the gander.” In other words, sure Tonie, if I can write about hemodialysis complications, I can do the same for peritoneal dialysis. 

Let’s start at the beginning, as usual. What is peritoneal dialysis? According to the Mayo Clinic

“Peritoneal dialysis (per-ih-toe-NEE-ul die-AL-uh-sis) is a way to remove waste products from your blood when your kidneys can’t adequately do the job any longer. This procedure filters the blood in a different way than does the more common blood-filtering procedure called hemodialysis. 

During peritoneal dialysis, a cleansing fluid flows through a tube (catheter) into part of your abdomen. The lining of your abdomen (peritoneum) acts as a filter and removes waste products from your blood. After a set period of time, the fluid with the filtered waste products flows out of your abdomen and is discarded. 

These treatments can be done at home, at work or while traveling….” 

The National Institute of Diabetes and Digestive and Kidney Disease tells us there is more than one kind of peritoneal dialysis. 

“You can choose the type of peritoneal dialysis that best fits your life: 

  • continuous ambulatory peritoneal dialysis (CAPD) 
  • automated peritoneal dialysis 

The main differences between the two types of peritoneal dialysis are 

  • the schedule of exchanges 
  • one uses a machine and the other is done by hand 

If one type of peritoneal dialysis doesn’t suit you, talk with your doctor about trying the other type. 

CAPD doesn’t use a machine. You do the exchanges during the day by hand. 

You can do exchanges by hand in any clean, well-lit place. Each exchange takes about 30 to 40 minutes. During an exchange, you can read, talk, watch television, or sleep. With CAPD, you keep the solution in your belly for 4 to 6 hours or more. The time that the dialysis solution is in your belly is called the dwell time. Usually, you change the solution at least four times a day and sleep with solution in your belly at night. You do not have to wake up at night to do an exchange. 

During an exchange, you can read, talk, watch television, or sleep. 

Automated peritoneal dialysis. A machine does the exchanges while you sleep. 

With automated peritoneal dialysis, a machine called a cycler fills and empties your belly three to five times during the night. In the morning, you begin the day with fresh solution in your belly. You may leave this solution in your belly all day or do one exchange in the middle of the afternoon without the machine. People sometimes call this treatment continuous cycler-assisted peritoneal dialysis or CCPD.” 

This sounded so much more attractive to me than hemodialysis that I wondered why more patients didn’t choose these types of treatment. There must be reasons. The Cleveland Clinic informs us what they are… and answers Tonie’s question. 

“Some people develop skin infections around the catheter. You’re also at risk for peritonitis, an infection that occurs when bacteria get inside the abdomen through the catheter. You may experience fever, abdominal pain, nausea and vomiting. 

Using the abdominal catheter and pumping your belly full of fluid can weaken abdominal muscles over time. You may develop a hernia. This condition occurs when an organ like the small intestine pokes through the abdominal muscles. You may feel a bulge near the belly button or in the groin area between the abdomen and upper thigh. Your doctor can repair a hernia with surgery. 

During peritoneal dialysis, your body absorbs dextrose, a sugar, from the dialysis solution. Over time, this extra sugar can lead to weight gain.” 

My husband, Bear, was reading over my shoulder and asked me if this catheter was like the PowerPort I had during chemotherapy. Azura Vascular Care explains it’s not, 

“PD catheter placement is typically performed as a minimally invasive procedure in an outpatient setting…. Percutaneous catheter placement is performed using fluoroscopy—an imaging technique that uses X-rays to help your vascular specialist view the inside of your abdomen…. This procedure requires only local anesthesia and sedation…. 

Your vascular specialist begins by using a fine needle to make a series of small punctures in your skin to access the peritoneum…. The PD catheter is then passed through a small tunnel in your belly into the peritoneum and secured in place. 

A PD catheter is made of silicone or another soft, flexible medical-grade material….Your catheter will have cuffs on it to prevent it from shifting and moving around, and that helps keep bacteria out of the tunnel and exit site. The PD catheter exit site is typically placed to the left or right of your belly button, you should discuss your personal placement preferences with your vascular specialist…. As you recover, your tissue will grow around and fill in part of the exit site as well to prevent the catheter from moving. 

After the PD catheter has been inserted, your vascular specialist will place sutures around the catheter on the outside of your abdomen and cover the site with a sterile dressing. 

PD catheter placement can usually be performed in under one hour…. However, you may spend additional time in the recovery room before going home so your vascular access team can monitor you for complications after the procedure.” 

Note from me: Some nephrologists and radiologists are trained in this surgery. 

Other complications may be: 

“Peritoneal Dialysis related infections, including peritonitis, exit‐site infections (ESI), and tunnel infections, are important complications, resulting in significant morbidity and risk of death.  

Early complications related to peritoneal access are divided into mechanical (bleeding, visceral perforation, dialysate leaks, catheter dysfunction, hernia formation, cuff extrusion) and infectious (early peritonitis, surgical wound, tunnel and exit site infections). 

…. Holding fluid in your abdomen for long periods may strain your muscles. 

Inadequate dialysis. Peritoneal dialysis can become ineffective after several years. You might need to switch to hemodialysis.” 

Thank you to Dialysis Care Centers (DCC) for this information. 

Good topic, Tonie. I’m glad you suggested it. 

Final note: SlowItDownCKD 2022 is out in print now! AND it’s free on Kindle Unlimited. I do request reviews, though. 

Until next week, 

Keep living your life! 

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