The concept of peritoneal dialysis
The diagnosis of "uremia" (translated from the Greek. urine in the blood) for a long time, sounded like a death sentence for people suffering from kidney failure. Only in the middle of the XX century, it became possible to their rescue and rehabilitation. Currently, besides transplantation, there are two main types of substitution of impaired renal function - extracorporeal called intracorporeal hemodialysis - peritoneal dialysis.
Dialysis (from the Greek. of dialysis - separation) - release of colloids from dissolved therein low molecular weight substances and salts using semi-permeable membranes. In our country, it is mainly used dialysis method in which the blood is purified by using an artificial kidney apparatus "being filtered" through an artificial semipermeable membrane. In many cases, however, preferably peritoneal dialysis when cleaning takes place directly in the patient's abdominal cavity.
Indications for use of peritoneal dialysis are:
- chronic renal failure
- acute renal failure
- prevention of the progression of the accumulation of toxins in destructive processes in the abdominal cavity (peritonitis, pancreatitis)
- severe congestive heart failure
- acute poisoning barbiturates, hypnotics and sedatives nebarbiturovogo number, aniline and nitrobenzene, chlorinated hydrocarbons, organophosphorus compounds
Contraindications to peritoneal dialysis
However, there are limitations in the use ofperitoneal dialysis. Contraindications to the formulation of the catheter is fecal peritonitis, the presence of drainage in the abdomen, inflammation of the anterior abdominal wall. Efficacy of peritoneal dialysis is low, if the volume of the abdomen is reduced due to adhesions, tumors or large polycystic kidneys. For high and obese people with a complete lack of urine is preferable to hemodialysis.
The mechanism of action of peritoneal dialysis
The first attempts to help patients with uremia byperitoneal dialysis undertaken since the beginning of the century, but the rapid development it has received in 70 years. Currently, the world's peritoneal dialysis are 16 percent of patients with chronic renal failure.
Why dialysis was chosen preciselyabdomen? The answer is very simple. It seems that the very nature of it is designed as a backup body cleansing. The peritoneum is the largest serous membrane in the human body.
The mechanism of action is based peritoneal dialysison what behaves as the peritoneum semipermeable membrane filtration of matter from the blood. ultrafiltration rate of water removal from the body in peritoneal dialysis is adjusted by changing the concentration of glucose in the dialysis solution. The higher the glucose content of the solution, the more ultrafiltration.
The essence of this method lies in the fact thatdialysis solution is introduced through the catheter into the abdominal cavity and left for 5-6 hours. During this time equilibrium is attained at a concentration of toxins in the patient's blood and the dialysate. The patient thus can carry out their normal activities. Then, the dialysate is drained and replaced with fresh solution. Replacement produce 4-5 times a day every day and continuously.
For peritoneal dialysisIt uses a system consisting of two bags with solutions of the two measuring cylinders at the inlet and outlet of the abdominal cavity and the container of the discharged solution. This method makes it possible to some extent replace the cleansing function of the kidneys. A person with kidney or invalid even without peritoneal dialysis procedure may live for years passing regularly.
Advantages of peritoneal dialysis
Depending on the ability to balance theosmotically active substances distinguish membranes with fast, slow and average glucose absorption rate. Fortunately, most people have the peritoneum at an average rate of absorption, it is best suited for continuous ambulatory peritoneal dialysis. Extremes, as always, are undesirable. By the way, before the start of dialysis, peritoneal type of the patient can not be determined.
When peritoneal dialysis is usedbiological membrane - peritoneum, which eliminates the problem. Perhaps that is why during the peritoneal dialysis patients noted a better preservation of residual renal function than patients on hemodialysis. This method is recommended for people with significant residual renal function and those with functional recovery is still possible.
In peritoneal dialysis, you can achieve almost the normalization of water metabolism and nutrition. This method allows patients to live with very few restrictions in diet and water regime.
Peritoneal dialysis can be performed at home under the auspices of the periodicity of the nurses. A person can live in a family, to lead an active lifestyle, children have the opportunity to go to school.
Obviously, technically peritoneal dialysis, hemodialysis is much easier, cheaper, more accessible to patients and, most importantly, more physiologic.