Peritoneal dialysis
Encyclopedia
Peritoneal dialysis is a treatment for patients with severe chronic kidney disease
. The process uses the patient's peritoneum
in the abdomen
as a membrane across which fluids and dissolved substances (electrolyte
s, urea
, glucose
, albumin
and other small molecules) are exchanged from the blood
. Fluid is introduced through a permanent tube in the abdomen and flushed out either every night while the patient sleeps (automatic peritoneal dialysis) or via regular exchanges throughout the day (continuous ambulatory peritoneal dialysis). PD is used as an alternative to hemodialysis
though it is far less commonly used in many countries, such as the United States. It has comparable risks but is significantly less costly in most parts of the world, with the primary advantage being the ability to undertake treatment without visiting a medical facility. The primary complication of PD is infection due to the presence of a permanent tube in the abdomen.
is surgically inserted with one end in the abdomen and the other protruding from the skin. Before each infusion the area must be cleaned, and flow into and out of the abdomen tested. A large volume of fluid is introduced to the abdomen over the next ten to fifteen minutes. The total volume is referred to as a dwell while the fluid itself is referred to as dialysate. The dwell can be as much as 2.5 litres, and medication can also be added to the fluid immediately before infusion. The dwell remains in the abdomen and waste products diffuse across the peritoneum from the underlying blood vessels. After a variable period of time depending on the treatment (usually 4-6 hours), the fluid is removed and replaced with fresh fluid. This can occur automatically while the patient is sleeping (automated peritoneal dialysis, APD), or during the day by keeping two litres of fluid in the abdomen at all times, exchanging the fluids four to six times per day (continuous ambulatory peritoneal dialysis, CAPD).
The fluid used typically contains sodium
, chloride
, lactate
or bicarbonate
and a high percentage of glucose
to ensure hyperosmolarity. The amount of dialysis that occurs depends on the volume of the dwell, the regularity of the exchange and the concentration of the fluid. APD cycles between 3 and 10 dwells per night, while CAPD involves four dwells per day of 2-2.5 litres per dwell, with each remaining in the abdomen for 4-8 hours. The viscera accounts for roughly four-fifths of the total surface area of the membrane, but the parietal peritoneum is the more important of the two portions for PD. Two complementary models explain dialysis across the membrane - the three pore model (in which molecules are exchanged across membranes which filter molecules, either protein
s, electrolytes or water, based on the size of the pore) and the distributed model (which emphasizes the role of capillaries
and the solution's ability to increase the number of active capillaries involved in PD). The high concentration of glucose drives the exchange of fluid from the blood with glucose from the peritoneum. The solute flows from the peritoneal cavity to the organs, and thence into the lymphatic system
. Individuals differ in the amount of fluid absorbed through the lymphatic vessels, though it is not understood why. The ability to exchange fluids between the peritoneum and blood supply can be classified as high, low or intermediate. High transporters tend to diffuse substances well (easily exchanging small molecules between blood and the dialysis fluid, with somewhat improved results frequent, short-duration dwells such as with APD) while low transporters filter fluids better (transporting fluids across the membrane into the blood more quickly with somewhat better results with long-term, high-volume dwells such) though in practice either type of transporter can generally be managed through the appropriate use of either APD or CAPD.
Though there are several different shapes and sizes of catheters that can be used, different insertion sites, number of cuffs in the catheter and immobilization, there is no evidence to show any advantages in terms of morbidity, mortality or number of infections, though the quality of information is not yet sufficient to allow for firm conclusions.
or hypotension
while excessive fluid retention can result in hypertension
and edema
. Also monitored is the color of the fluid removed: normally it is pink-tinged for the initial four cycles and clear or pale yellow afterwards. The presence of pink or bloody effluent suggests bleeding inside the abdomen while feces indicates a perforated bowel
and cloudy fluid suggests infection. The patient may also experience pain or discomfort if the dialysate is too acidic, too cold or introduced too quickly, while diffuse pain with cloudy discharge may indicate an infection. Severe pain in the rectum
or perineum
can be the result of an improperly placed catheter. The dwell can also increase pressure on the diaphragm
causing impaired breathing, and constipation
can interfere with the ability of fluid to flow through the catheter.
A potentially fatal complication estimated to occur in roughly 2.5% of patients is encapsulating peritoneal sclerosis, in which the bowels become obstructed due to the growth of a thick layer of fibrin
within the peritoneum.
The fluid used for dialysis uses glucose
as a primary osmotic agent, but this may lead to peritonitis
, the decline of kidney
and peritoneal membrane function and other negative health outcomes. The acid
ity, high concentration and presence of lactate
and products of the degredation of glucose in the solution (particularly the latter) may contribute to these health issues. Solutions that are neutral, use bicarbonate
instead of lactate and have few glucose degradation products may offer more health benefits though this has not yet been studied.
due to the potential to introduce bacteria to the abdomen; peritonitis is best treated through the direct infusion of antibiotic
s into the peritoneum with no advantage for other frequently used treatments such as routine peritoneal lavage or use of urokinase
. The tube site can also become infected; the use of prophylactic nasal mupirocin
can reduce the number of tube site infections, but does not help with peritonitis. Infections can be as frequent as once every 15 months (0.8 episodes per patient year). Compared to hemodialysis, PD allows greater patient mobility, produces fewer swings in symptoms due to its continuous nature, and phosphate
compounds are better removed, but large amounts of albumin
are removed which requires constant monitoring of nutritional status. The costs and benefits of hemodialysis and PD are roughly the same - PD equipment is cheaper but the costs associated with peritonitis are higher. There is insufficient research to adequately compare the risks and benefits between CAPD and APD; a Cochrane Review
of three small clinical trial
s found no difference in clinically important outcomes (i.e. morbidity or mortality
) for patients with end stage renal disease
, nor was there any advantage in preserving the functionality of the kidneys. The results suggested APD may have psychosocial advantages for younger patients and those who are employed or pursuing an education.
Other complications include hypotension
(due to excess fluid exchange and sodium removal
), low back pain
and hernia
or leaking fluid due to high pressure within the abdomen. PD may also be used for patients with cardiac instability as it does not result in rapid and significant alterations to body fluids, and for patients with insulin
-dependent diabetes mellitus
due to the inability to control blood sugar
levels through the catheter. Hypertriglyceridemia
and obesity
are also concerns due to the large volume of glucose in the fluid, which can add as many as 1200 calorie
s to the diet per day. Of the three types of connection and fluid exchange systems (standard, twin-bag and y-set; the latter two involving two bags and only one connection to the catheter, the y-set uses a single y-shaped connection between the bags involving emptying, flushing out then filling the peritoneum through the same connection) the twin-bag and y-set systems were found superior to conventional systems at preventing peritonitis.
. In the United Kingdom
, South Korea
and Mexico
PD was more common than the world average, with Mexico conducting most of its dialysis (75%) through PD, while Japan
and Germany
had rates lower than the world average.
Renal failure
Renal failure or kidney failure describes a medical condition in which the kidneys fail to adequately filter toxins and waste products from the blood...
. The process uses the patient's peritoneum
Peritoneum
The peritoneum is the serous membrane that forms the lining of the abdominal cavity or the coelom — it covers most of the intra-abdominal organs — in amniotes and some invertebrates...
in the abdomen
Abdomen
In vertebrates such as mammals the abdomen constitutes the part of the body between the thorax and pelvis. The region enclosed by the abdomen is termed the abdominal cavity...
as a membrane across which fluids and dissolved substances (electrolyte
Electrolyte
In chemistry, an electrolyte is any substance containing free ions that make the substance electrically conductive. The most typical electrolyte is an ionic solution, but molten electrolytes and solid electrolytes are also possible....
s, urea
Urea
Urea or carbamide is an organic compound with the chemical formula CO2. The molecule has two —NH2 groups joined by a carbonyl functional group....
, glucose
Glucose
Glucose is a simple sugar and an important carbohydrate in biology. Cells use it as the primary source of energy and a metabolic intermediate...
, albumin
Albumin
Albumin refers generally to any protein that is water soluble, which is moderately soluble in concentrated salt solutions, and experiences heat denaturation. They are commonly found in blood plasma, and are unique to other blood proteins in that they are not glycosylated...
and other small molecules) are exchanged from the blood
Blood
Blood is a specialized bodily fluid in animals that delivers necessary substances such as nutrients and oxygen to the cells and transports metabolic waste products away from those same cells....
. Fluid is introduced through a permanent tube in the abdomen and flushed out either every night while the patient sleeps (automatic peritoneal dialysis) or via regular exchanges throughout the day (continuous ambulatory peritoneal dialysis). PD is used as an alternative to hemodialysis
Hemodialysis
In medicine, hemodialysis is a method for removing waste products such as creatinine and urea, as well as free water from the blood when the kidneys are in renal failure. Hemodialysis is one of three renal replacement therapies .Hemodialysis can be an outpatient or inpatient therapy...
though it is far less commonly used in many countries, such as the United States. It has comparable risks but is significantly less costly in most parts of the world, with the primary advantage being the ability to undertake treatment without visiting a medical facility. The primary complication of PD is infection due to the presence of a permanent tube in the abdomen.
Best practices
Best practices for peritoneal dialysis state that before peritoneal dialysis should be implemented, the patient's understanding of the process and support systems should be assessed, with education on how to care for the catheter and to address any gaps in understanding that may exist. The patient should receive ongoing monitoring to ensure adequate dialysis, and be regularly assessed for complications. Finally, the patient should be educated on the importance of infection control and an appropriate medical regimen established with their cooperation.Method
The abdomen is cleaned in preparation for surgery, and a catheterCatheter
In medicine, a catheter is a tube that can be inserted into a body cavity, duct, or vessel. Catheters thereby allow drainage, administration of fluids or gases, or access by surgical instruments. The process of inserting a catheter is catheterization...
is surgically inserted with one end in the abdomen and the other protruding from the skin. Before each infusion the area must be cleaned, and flow into and out of the abdomen tested. A large volume of fluid is introduced to the abdomen over the next ten to fifteen minutes. The total volume is referred to as a dwell while the fluid itself is referred to as dialysate. The dwell can be as much as 2.5 litres, and medication can also be added to the fluid immediately before infusion. The dwell remains in the abdomen and waste products diffuse across the peritoneum from the underlying blood vessels. After a variable period of time depending on the treatment (usually 4-6 hours), the fluid is removed and replaced with fresh fluid. This can occur automatically while the patient is sleeping (automated peritoneal dialysis, APD), or during the day by keeping two litres of fluid in the abdomen at all times, exchanging the fluids four to six times per day (continuous ambulatory peritoneal dialysis, CAPD).
The fluid used typically contains sodium
Sodium
Sodium is a chemical element with the symbol Na and atomic number 11. It is a soft, silvery-white, highly reactive metal and is a member of the alkali metals; its only stable isotope is 23Na. It is an abundant element that exists in numerous minerals, most commonly as sodium chloride...
, chloride
Chloride
The chloride ion is formed when the element chlorine, a halogen, picks up one electron to form an anion Cl−. The salts of hydrochloric acid HCl contain chloride ions and can also be called chlorides. The chloride ion, and its salts such as sodium chloride, are very soluble in water...
, lactate
Lactate
Lactate may refer to:*The act of lactation*The conjugate base of lactic acid...
or bicarbonate
Bicarbonate
In inorganic chemistry, bicarbonate is an intermediate form in the deprotonation of carbonic acid...
and a high percentage of glucose
Glucose
Glucose is a simple sugar and an important carbohydrate in biology. Cells use it as the primary source of energy and a metabolic intermediate...
to ensure hyperosmolarity. The amount of dialysis that occurs depends on the volume of the dwell, the regularity of the exchange and the concentration of the fluid. APD cycles between 3 and 10 dwells per night, while CAPD involves four dwells per day of 2-2.5 litres per dwell, with each remaining in the abdomen for 4-8 hours. The viscera accounts for roughly four-fifths of the total surface area of the membrane, but the parietal peritoneum is the more important of the two portions for PD. Two complementary models explain dialysis across the membrane - the three pore model (in which molecules are exchanged across membranes which filter molecules, either protein
Protein
Proteins are biochemical compounds consisting of one or more polypeptides typically folded into a globular or fibrous form, facilitating a biological function. A polypeptide is a single linear polymer chain of amino acids bonded together by peptide bonds between the carboxyl and amino groups of...
s, electrolytes or water, based on the size of the pore) and the distributed model (which emphasizes the role of capillaries
Capillary
Capillaries are the smallest of a body's blood vessels and are parts of the microcirculation. They are only 1 cell thick. These microvessels, measuring 5-10 μm in diameter, connect arterioles and venules, and enable the exchange of water, oxygen, carbon dioxide, and many other nutrient and waste...
and the solution's ability to increase the number of active capillaries involved in PD). The high concentration of glucose drives the exchange of fluid from the blood with glucose from the peritoneum. The solute flows from the peritoneal cavity to the organs, and thence into the lymphatic system
Lymphatic system
The lymphoid system is the part of the immune system comprising a network of conduits called lymphatic vessels that carry a clear fluid called lymph unidirectionally toward the heart. Lymphoid tissue is found in many organs, particularly the lymph nodes, and in the lymphoid follicles associated...
. Individuals differ in the amount of fluid absorbed through the lymphatic vessels, though it is not understood why. The ability to exchange fluids between the peritoneum and blood supply can be classified as high, low or intermediate. High transporters tend to diffuse substances well (easily exchanging small molecules between blood and the dialysis fluid, with somewhat improved results frequent, short-duration dwells such as with APD) while low transporters filter fluids better (transporting fluids across the membrane into the blood more quickly with somewhat better results with long-term, high-volume dwells such) though in practice either type of transporter can generally be managed through the appropriate use of either APD or CAPD.
Though there are several different shapes and sizes of catheters that can be used, different insertion sites, number of cuffs in the catheter and immobilization, there is no evidence to show any advantages in terms of morbidity, mortality or number of infections, though the quality of information is not yet sufficient to allow for firm conclusions.
Complications
The volume of dialysate removed and weight of the patient are normally monitored; if more than 500ml of fluid are retained or a litre of fluid is lost across three consecutive treatments, the patient's physician is generally notified. Excessive loss of fluid can result in hypovolemic shockHypovolemia
In physiology and medicine, hypovolemia is a state of decreased blood volume; more specifically, decrease in volume of blood plasma...
or hypotension
Hypotension
In physiology and medicine, hypotension is abnormally low blood pressure, especially in the arteries of the systemic circulation. It is best understood as a physiologic state, rather than a disease. It is often associated with shock, though not necessarily indicative of it. Hypotension is the...
while excessive fluid retention can result in hypertension
Hypertension
Hypertension or high blood pressure is a cardiac chronic medical condition in which the systemic arterial blood pressure is elevated. What that means is that the heart is having to work harder than it should to pump the blood around the body. Blood pressure involves two measurements, systolic and...
and edema
Edema
Edema or oedema ; both words from the Greek , oídēma "swelling"), formerly known as dropsy or hydropsy, is an abnormal accumulation of fluid beneath the skin or in one or more cavities of the body that produces swelling...
. Also monitored is the color of the fluid removed: normally it is pink-tinged for the initial four cycles and clear or pale yellow afterwards. The presence of pink or bloody effluent suggests bleeding inside the abdomen while feces indicates a perforated bowel
Gastrointestinal perforation
Gastrointestinal perforation is a complete penetration of the wall of the stomach, small intestine or large bowel, resulting in intestinal contents flowing into the abdominal cavity. Perforation of the intestines results in the potential for bacterial contamination of the abdominal cavity...
and cloudy fluid suggests infection. The patient may also experience pain or discomfort if the dialysate is too acidic, too cold or introduced too quickly, while diffuse pain with cloudy discharge may indicate an infection. Severe pain in the rectum
Rectum
The rectum is the final straight portion of the large intestine in some mammals, and the gut in others, terminating in the anus. The human rectum is about 12 cm long...
or perineum
Perineum
In human anatomy, the perineum is a region of the body including the perineal body and surrounding structures...
can be the result of an improperly placed catheter. The dwell can also increase pressure on the diaphragm
Thoracic diaphragm
In the anatomy of mammals, the thoracic diaphragm, or simply the diaphragm , is a sheet of internal skeletal muscle that extends across the bottom of the rib cage. The diaphragm separates the thoracic cavity from the abdominal cavity and performs an important function in respiration...
causing impaired breathing, and constipation
Constipation
Constipation refers to bowel movements that are infrequent or hard to pass. Constipation is a common cause of painful defecation...
can interfere with the ability of fluid to flow through the catheter.
A potentially fatal complication estimated to occur in roughly 2.5% of patients is encapsulating peritoneal sclerosis, in which the bowels become obstructed due to the growth of a thick layer of fibrin
Fibrin
Fibrin is a fibrous, non-globular protein involved in the clotting of blood. It is a fibrillar protein that is polymerised to form a "mesh" that forms a hemostatic plug or clot over a wound site....
within the peritoneum.
The fluid used for dialysis uses glucose
Glucose
Glucose is a simple sugar and an important carbohydrate in biology. Cells use it as the primary source of energy and a metabolic intermediate...
as a primary osmotic agent, but this may lead to peritonitis
Peritonitis
Peritonitis is an inflammation of the peritoneum, the serous membrane that lines part of the abdominal cavity and viscera. Peritonitis may be localised or generalised, and may result from infection or from a non-infectious process.-Abdominal pain and tenderness:The main manifestations of...
, the decline of kidney
Renal function
Renal function, in nephrology, is an indication of the state of the kidney and its role in renal physiology. Glomerular filtration rate describes the flow rate of filtered fluid through the kidney...
and peritoneal membrane function and other negative health outcomes. The acid
Acid
An acid is a substance which reacts with a base. Commonly, acids can be identified as tasting sour, reacting with metals such as calcium, and bases like sodium carbonate. Aqueous acids have a pH of less than 7, where an acid of lower pH is typically stronger, and turn blue litmus paper red...
ity, high concentration and presence of lactate
Lactate
Lactate may refer to:*The act of lactation*The conjugate base of lactic acid...
and products of the degredation of glucose in the solution (particularly the latter) may contribute to these health issues. Solutions that are neutral, use bicarbonate
Bicarbonate
In inorganic chemistry, bicarbonate is an intermediate form in the deprotonation of carbonic acid...
instead of lactate and have few glucose degradation products may offer more health benefits though this has not yet been studied.
Risks and benefits
PD is less efficient at removing wastes from the body than hemodialysis, and the presence of the tube presents a risk of peritonitisPeritonitis
Peritonitis is an inflammation of the peritoneum, the serous membrane that lines part of the abdominal cavity and viscera. Peritonitis may be localised or generalised, and may result from infection or from a non-infectious process.-Abdominal pain and tenderness:The main manifestations of...
due to the potential to introduce bacteria to the abdomen; peritonitis is best treated through the direct infusion of antibiotic
Antibiotic
An antibacterial is a compound or substance that kills or slows down the growth of bacteria.The term is often used synonymously with the term antibiotic; today, however, with increased knowledge of the causative agents of various infectious diseases, antibiotic has come to denote a broader range of...
s into the peritoneum with no advantage for other frequently used treatments such as routine peritoneal lavage or use of urokinase
Urokinase
Urokinase , also called urokinase-type plasminogen activator , is a serine protease . Urokinase was originally isolated from human urine, but is present in several physiological locations, such as blood stream and the extracellular matrix...
. The tube site can also become infected; the use of prophylactic nasal mupirocin
Mupirocin
Mupirocin is an antibiotic originally isolated from Pseudomonas fluorescens NCIMB 10586, developed by Beecham....
can reduce the number of tube site infections, but does not help with peritonitis. Infections can be as frequent as once every 15 months (0.8 episodes per patient year). Compared to hemodialysis, PD allows greater patient mobility, produces fewer swings in symptoms due to its continuous nature, and phosphate
Phosphate
A phosphate, an inorganic chemical, is a salt of phosphoric acid. In organic chemistry, a phosphate, or organophosphate, is an ester of phosphoric acid. Organic phosphates are important in biochemistry and biogeochemistry or ecology. Inorganic phosphates are mined to obtain phosphorus for use in...
compounds are better removed, but large amounts of albumin
Albumin
Albumin refers generally to any protein that is water soluble, which is moderately soluble in concentrated salt solutions, and experiences heat denaturation. They are commonly found in blood plasma, and are unique to other blood proteins in that they are not glycosylated...
are removed which requires constant monitoring of nutritional status. The costs and benefits of hemodialysis and PD are roughly the same - PD equipment is cheaper but the costs associated with peritonitis are higher. There is insufficient research to adequately compare the risks and benefits between CAPD and APD; a Cochrane Review
Cochrane Collaboration
The Cochrane Collaboration is a group of over 28,000 volunteers in more than 100 countries who review the effects of health care interventions tested in biomedical randomized controlled trials. A few more recent reviews have also studied the results of non-randomized, observational studies...
of three small clinical trial
Clinical trial
Clinical trials are a set of procedures in medical research and drug development that are conducted to allow safety and efficacy data to be collected for health interventions...
s found no difference in clinically important outcomes (i.e. morbidity or mortality
Mortality rate
Mortality rate is a measure of the number of deaths in a population, scaled to the size of that population, per unit time...
) for patients with end stage renal disease
End stage renal disease
End stage renal disease may refer to:* End-stage renal disease, also known as chronic kidney disease , specifically the fifth stage of CKD...
, nor was there any advantage in preserving the functionality of the kidneys. The results suggested APD may have psychosocial advantages for younger patients and those who are employed or pursuing an education.
Other complications include hypotension
Hypotension
In physiology and medicine, hypotension is abnormally low blood pressure, especially in the arteries of the systemic circulation. It is best understood as a physiologic state, rather than a disease. It is often associated with shock, though not necessarily indicative of it. Hypotension is the...
(due to excess fluid exchange and sodium removal
Hyponatremia
Hyponatremia is an electrolyte disturbance in which the sodium concentration in the serum is lower than normal. In the vast majority of cases, hyponatremia occurs as a result of excess body water diluting the serum sodium and is not due to sodium deficiency. Sodium is the dominant extracellular...
), low back pain
Low back pain
Low back pain or lumbago is a common musculoskeletal disorder affecting 80% of people at some point in their lives. In the United States it is the most common cause of job-related disability, a leading contributor to missed work, and the second most common neurological ailment — only headache is...
and hernia
Hernia
A hernia is the protrusion of an organ or the fascia of an organ through the wall of the cavity that normally contains it. A hiatal hernia occurs when the stomach protrudes into the mediastinum through the esophageal opening in the diaphragm....
or leaking fluid due to high pressure within the abdomen. PD may also be used for patients with cardiac instability as it does not result in rapid and significant alterations to body fluids, and for patients with insulin
Insulin
Insulin is a hormone central to regulating carbohydrate and fat metabolism in the body. Insulin causes cells in the liver, muscle, and fat tissue to take up glucose from the blood, storing it as glycogen in the liver and muscle....
-dependent diabetes mellitus
Diabetes mellitus
Diabetes mellitus, often simply referred to as diabetes, is a group of metabolic diseases in which a person has high blood sugar, either because the body does not produce enough insulin, or because cells do not respond to the insulin that is produced...
due to the inability to control blood sugar
Blood sugar
The blood sugar concentration or blood glucose level is the amount of glucose present in the blood of a human or animal. Normally in mammals, the body maintains the blood glucose level at a reference range between about 3.6 and 5.8 mM , or 64.8 and 104.4 mg/dL...
levels through the catheter. Hypertriglyceridemia
Hypertriglyceridemia
In medicine, hypertriglyceridemia denotes high blood levels of triglycerides, the most abundant fatty molecule in most organisms. It has been associated with atherosclerosis, even in the absence of hypercholesterolemia . It can also lead to pancreatitis in excessive concentrations In medicine,...
and obesity
Obesity
Obesity is a medical condition in which excess body fat has accumulated to the extent that it may have an adverse effect on health, leading to reduced life expectancy and/or increased health problems...
are also concerns due to the large volume of glucose in the fluid, which can add as many as 1200 calorie
Calorie
The calorie is a pre-SI metric unit of energy. It was first defined by Nicolas Clément in 1824 as a unit of heat, entering French and English dictionaries between 1841 and 1867. In most fields its use is archaic, having been replaced by the SI unit of energy, the joule...
s to the diet per day. Of the three types of connection and fluid exchange systems (standard, twin-bag and y-set; the latter two involving two bags and only one connection to the catheter, the y-set uses a single y-shaped connection between the bags involving emptying, flushing out then filling the peritoneum through the same connection) the twin-bag and y-set systems were found superior to conventional systems at preventing peritonitis.
Frequency
In a 2004 worldwide survey of patients in end stage renal disease, approximately 11% were receiving PD, compared to the much more common hemodialysisHemodialysis
In medicine, hemodialysis is a method for removing waste products such as creatinine and urea, as well as free water from the blood when the kidneys are in renal failure. Hemodialysis is one of three renal replacement therapies .Hemodialysis can be an outpatient or inpatient therapy...
. In the United Kingdom
United Kingdom
The United Kingdom of Great Britain and Northern IrelandIn the United Kingdom and Dependencies, other languages have been officially recognised as legitimate autochthonous languages under the European Charter for Regional or Minority Languages...
, South Korea
South Korea
The Republic of Korea , , is a sovereign state in East Asia, located on the southern portion of the Korean Peninsula. It is neighbored by the People's Republic of China to the west, Japan to the east, North Korea to the north, and the East China Sea and Republic of China to the south...
and Mexico
Mexico
The United Mexican States , commonly known as Mexico , is a federal constitutional republic in North America. It is bordered on the north by the United States; on the south and west by the Pacific Ocean; on the southeast by Guatemala, Belize, and the Caribbean Sea; and on the east by the Gulf of...
PD was more common than the world average, with Mexico conducting most of its dialysis (75%) through PD, while Japan
Japan
Japan is an island nation in East Asia. Located in the Pacific Ocean, it lies to the east of the Sea of Japan, China, North Korea, South Korea and Russia, stretching from the Sea of Okhotsk in the north to the East China Sea and Taiwan in the south...
and Germany
Germany
Germany , officially the Federal Republic of Germany , is a federal parliamentary republic in Europe. The country consists of 16 states while the capital and largest city is Berlin. Germany covers an area of 357,021 km2 and has a largely temperate seasonal climate...
had rates lower than the world average.
Improvised dialysis
Peritoneal dialysis can be improvised in conditions such as combat surgery or disaster relief using surgical catheters and dialysate made from routinely available medical solutions to provide temporary renal replacement for patients with no other options.External links
- Treatment Methods for Kidney Failure - National Institute of Diabetes and Digestive and Kidney DiseasesNational Institute of Diabetes and Digestive and Kidney DiseasesThe National Institute of Diabetes and Digestive and Kidney Diseases , of the U.S. National Institutes of Health, conducts and supports research on many of the most serious diseases affecting public health...