Peritoneal dialysis can be an excellent alternative to hemodialysis. Especially in the time of the COVID-19 pandemic. It provides not only a convenient, but above all safer, because without leaving home, form of renal replacement treatment.
Although they are not talked about as often as they are about cancer or heart disease, the reality is that kidney disease is common and extremely dangerous. The more that the kidneys rarely hurt, and if it does, it is mainly due to urological reasons or intense infection, while chronic diseases do not hurt.
Serious sequelae of untreated kidney disease
– 4,2 million Poles have kidney diseases, which is a larger population than those suffering from both diabetes, i.e. type 1 and 2 – these are approx. 3,2 million. Chronic kidney disease (CKD) is defined as when glomerular filtration is maintained below 60 ml / min / 1,73 sq m for at least three months. body surface. Unfortunately for CKD patients it usually does not cause any specific symptoms. In the group of special risk of developing the disease there are, among others, people with hypertension, diabetes, family history of these diseases. These people should systematically monitor kidney function, i.e. once at a strictly defined time, depending on age and risk, determine serum creatinine levels, perform a general urine test. – explains prof. dr hab. n. med. Ryszard Gellert, head of the Department of Nephrology and Internal Diseases, Medical Center of Postgraduate Education, Bielański Hospital in Warsaw, national consultant in the field of nephrology.
Chronic kidney disease leads to two very important consequences. On the one hand, they underlie the development of chronic renal failure and the related need for renal replacement therapy. On the other hand, these diseases are an independent risk factor for increased morbidity and mortality due to diseases of the cardiovascular system.
SARS-CoV-2 infection is a significant threat to people with CKD
– People with CKD become more infected, especially dialysis patients, and COVID-19 increases the mortality rate in this group. Some patients have not only chronic but also acute kidney disease, and acute renal failure in the course of SARS-CoV-2 infection in the intensive care unit or covid ward definitely worsens the prognosis. The kidney is an organ that can endure a lot for a long time, but once it can no longer withstand long-term stress, the risk of unsuccessful termination is very likely. A history of acute renal failure in covid disease increases the likelihood of advanced renal failure in the future, and therefore poses a risk of dialysis, if not premature death – warns prof. Gellert.
When renal replacement therapy is necessary
There are two options for dialysis in patients with advanced renal failure. This is hemodialysis or peritoneal dialysis. These methods are equivalent, and the patient should be able to choose how he wants to administer renal replacement therapy, of course after taking into account possible contraindications by the attending physician.
– In peritoneal dialysis, the patient’s own peritoneal membrane is used for dialysis. A special catheter is surgically inserted through the abdominal wall into the peritoneal cavity, into which the patient’s fluid is inserted to drain the patient and correct metabolic acidosis. Waste products that are unnecessary and should be excreted by the kidneys, the so-called uremic toxins also pass into this fluid. The fluid remains in the peritoneal cavity for some time and is then poured out. In this way, all unnecessary metabolites are removed, as well as excess water that the patient is not able to excrete himself. – explains prof. dr hab. n. med. Beata Naumnik, head of the XNUMXst Department of Nephrology and Transplantology with the Dialysis Center of the Medical University of Białystok, provincial nephrology consultant.
In turn, hemodialysis involves either the formation of an arteriovenous fistula or the placement of an intravascular catheter through which the patient’s vascular access is connected to an artificial kidney.
There are two methods of peritoneal dialysis: manual and automatic. The patient performs manual dialysis four times a day, the last time just before going to bed. The automatic technique means that the patient is connected to the apparatus in the evening, which regulates the cycles of the inlets and outlets into the peritoneum, while he sleeps during this time. Thanks to the latter method, he has the whole day at his disposal – he can learn, work and perform everyday activities freely, just like any healthy person.
It should be noted that peritoneal dialysis is a more physiological form of dialysis than hemodialysis, performed every other day for 4 hours.
At home, but under constant supervision
– The biggest benefit of peritoneal dialysis is that the patient can undergo dialysis house. Alone or with the help of a loved one. The hemodialysis patient must be given three times a week for at least 4 hours. report to a dialysis center. In the time of the COVID-19 pandemic, this poses an additional threat to it. Suffice it to mention that since the beginning of the epidemic, i.e. since March this year, only three peritoneal dialysis patients have been infected with the SARS-CoV-2 virus. On the other hand, only in one week of November, there were about 450 infected hemodialysis people nationwide and many deaths due to this. – comments prof. Naumnik.
Prof. Naumnik adds that patients undergoing peritoneal dialysis at home are not left to themselves during treatment. 24-hour telemonitoring of such patients is carried out and, if necessary, they receive specialist assistance, including technical assistance.
– The patient feels taken care of and not left alone. They usually come to the dialysis center only once every three months. So peritoneal dialysis is in the position pandemic the preferred and more convenient method of renal replacement therapy – summarizes prof. Naumnik.
I really wanted to be active, also professionally, despite the need for dialysis, until the kidney transplant. Luckily, I found doctors who advised me on peritoneal dialysis. I noticed its advantages very quickly. Despite the necessity of daily dialysis, I worked normally, and I am a stuntman, I went on business trips, practiced sports. The only downside is that you have to avoid water – swimming, swimming in the pool. Now I run a fanpage called “Future Life with Dialysis” on Facebook and I try to help people who need dialysis. I advise them to opt for peritoneal dialysis, if they have no contraindications.
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