There are three methods of renal replacement therapy for the treatment of chronic kidney disease (CKD). These include kidney transplantation, hemodialysis, and peritoneal dialysis. The patient may die if renal insufficiency is not treated.
Each treatment method should be recommended after careful consideration of the indications and contraindications for each patient. Kidney transplantation is the most effective method of renal replacement therapy. Unfortunately, not all CKD patients are eligible for surgery. Moreover, the lack of knowledge in society about transplantation results in a low number of donors reported. The most common method of renal replacement therapy is therefore dialysis.
Hemodialysis
The most common method of dialysis therapy is hemodialysis. However, it may have limitations for a dialysis patient. Usually, he or she has to come to the dialysis center for several hours every two days. Taking into account the time of the procedure itself, total
with preparation and travel, you have to spend almost a whole day on it. Such a situation may make it difficult for patients not only to work, but most of all it may limit normal life and the realization of plans and dreams. In addition, uremic toxins and excess fluid build up in the patient’s body between dialyses. In the case of hemodialysis, we deal with the so-called the effect of the saw teeth, i.e. the gradual accumulation of these substances between dialyses and their rapid removal during the procedure itself. As a result, hemodialysis patients with additional cardiovascular disease, especially the elderly, may not tolerate dialysis. Hemodialysis requires the creation of a dialysis access – an arteriovenous fistula or a central catheter through which blood will be collected and donated to the patient’s vessels. It is produced in a short but very precise surgical procedure. Although hemodialysis is a life-saving procedure, it does not provide the body with continuous cleansing.
Home (peritoneal) dialysis
The peritoneal dialysis method, developed in the mid-twentieth century and then modified in the late 70s, for the treatment of end-stage renal failure, ensures continuous purification of uremic toxins from the blood. In this method, it is necessary to create a dialysis access, which is a catheter inserted into the peritoneal cavity, which is part of the patient’s abdominal cavity. It happens during a short surgical procedure. The peritoneal dialysis catheter is used to replace the dialysis fluid. Removal
The substance occurs between the blood filling the peritoneal vessels and the dialysis fluid in the peritoneal cavity. In adults, it usually has a volume of two liters. The dialysis fluid stays in the peritoneal cavity all the time between changes, i.e. practically around the clock. Peritoneal dialysis is a renal replacement therapy method mainly performed at home. Dialysis patients have access to two methods of peritoneal dialysis:
CADO – Continuous Ambulatory Peritoneal Dialysis
ADO – Automatyczna Dializa Otrzewnowa.
CADO
The CAPD method is the patient’s own replacement of fluid at home, usually four times a day. It is necessary to strictly observe the basic rules of hygiene, wash hands and wear a face mask during the dialysis fluid exchange procedure. It involves connecting to a disposable set of bags, changing fluids and disconnecting.
This method allows you to lead an active working life – it allows you to perform an exchange during working hours.
ADO
In automatic peritoneal dialysis (ADO), the patient connects to a cycler in the evening before going to bed, which performs dialysis fluid changes at night, disconnects in the morning and can lead a normal lifestyle.
Availability of Home Dialysis
Peritoneal dialysis is a generally available method of renal replacement therapy. Its selection is made on the basis of individually considered indications and contraindications. It is fully reimbursed, as is hemodialysis. Dialysis fluids are provided
directly to the patient’s home. A patient undergoing peritoneal dialysis returns to the dialysis department for control visits every 6 weeks.
The integrated nephrological care scheme recommends peritoneal dialysis as the first method of dialysis treatment, followed by transplantation. It is as effective as hemodialysis in removing uremic toxins and water. Peritoneal dialysis provides continuous cleansing of the patient’s body. This method provides better protection for the residual function of the patient’s kidneys and vessels.
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