Renal Replacement Therapy_Peritoneal dialysis

Posted by e-Medical PPT Sunday, October 21, 2012
Introduction of PD
Solute and water transport via peritoneal membrane
Solute movement via diffusion + convection
Less problems of bio-incompatibility
Loss of protein(10g/day) and middle molecules

Advantages of Peritoneal Dialysis
Better preservation of residual renal function
Cardio protective effect
Less freq. severe arrythmia(33% vs. 4%)
Higher employment
Less prevalent anti-HCV/HBV
Better survival after kidney transplantation
More economic

Apparatus of PD
Conventional PD solution
Glucose based solutions with lactate as buffer
High conc. Of glucose and lactate
 Safe, effective and cheap
 Easily metabolized
Low pH
Hyperosmolality
A variety of GDPs formed during heat sterilization

Critics about conventional PD solutions
1. Negative influence to peritoneal cell function : phagocytosis, intracellular killing, and LT, cytokine and prostaglandin production
2. Dilution of 2L of dialysis solution in itself
3. High concentration of glucose
4. High concentration of lactate
5. Poor biocompatibility

Modes of Peritoneal Dialysis
Continuous ambulatory PD (CAPD)
Continuous Cycler-assisted PD (CCPD)
Nightly PD (NPD)
Intermittent PD (IPD)
Tidal PD
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