What Nurses Need to know about Peritoneal Dialysis

• Peritoneal dialysis is considered to be the invisible, or least known, up-and-coming dialysis modality for patients diagnosed with End Stage Renal Disease.  
• The peritoneal dialysis cycle consists of draining, filling, and dwelling.  
• Peritonitis of infection of the peritoneal membrane (filter) is the main complication that can lead to hospitalization and peritoneal dialysis membrane failure and can be potentially life-threatening.  

When a patient is diagnosed with End–Stage Renal Disease (ESRD), hemodialysis is considered a mainstream dialysis modality. Meanwhile, peritoneal dialysis (PD) is considered the invisible, or least-known, up-and-coming dialysis modality.  

Peritoneal Dialysis vs. Hemodialysis 

In hemodialysis, the patient is connected to a machine through a catheter, arteriovenous graft, or a fistula. The hemodialysis machine cleans the patient’s blood by removing their waste and fluids. Hemodialysis is one of many dialysis modalities that can help to keep the ESRD patient alive, according to the Mayo Clinic.

PD provides a strong foundation for renal replacement therapy (dialysis), according to Baxter Health Corp. For years, PD has been viewed as more about patient convenience than therapy effectiveness. But it provides solid clinical results that can improve a patient’s chances of success in renal replacement therapy compared to incenter hemodialysis. 

How Does Peritoneal Dialysis Work?

In short, the PD cycle consists of draining, filling, and dwelling.  

It uses the pore-lined peritoneal membrane, which lines our abdominal cavity. The trained PD patient, or a PD nurse, initiates PD by filling the abdominal cavity with a glucose-based solution via a surgically placed PD catheter. Once the glucose-based solution dwells in the peritoneal membrane, the membrane functions as an internal filter, allowing the solution to pull waste and excess fluid from the blood, through the membrane pores, and into the abdominal sac. 

Once the PD dwelling cycle is completed, the patient drains the PD waste via the catheter into a waste receptacle.  

Why Talk About Peritoneal Dialysis?

• According to the 2012 United States Renal Data System, more patients with PD were transplanted than hemodialysis patients in the United States (Baxter, n.d.).  
• The Collaborative Transplant Study showed better survival of PD patients in the sub-cohort defined as high risk (Baxter, n.d.).  
• The risk of death was 44% lower for ESRD patients treated with PD compared to hemodialysis patients (Baxter, n.d.).  
• PD preserves the patient’s renal residual function, associated with improved survival compared to patients with little or no residual renal function (Baxter, n.d.).  
• The PD patient’s survival rate improved compared to hemodialysis patients using a Central Venous Catheter (CVC) (Baxter, n.d.).  
• The cost of hemodialysis per patient per year remains significantly higher than for PD ($87,945 for hemodialysis versus $71,630 for PD in 2011), according to a continuing education study published in 2023. 

However, it’s important to note the following contraindications of PD: 

• Uncorrected large abdominal hernia 
• Pleuroperitoneal shunt  
• Abdominal adhesions 
• Unkept home environment  
• Poor hygiene habits  
• Weak manual dexterity  
• Poor vision  
• Poor support system  
• Unable or unwilling to follow and adhere to strict training principles  
• No means of communication with the PD unit

Major Complications of Peritoneal Dialysis

Peritonitis, or infection of the peritoneal membrane (filter), is the main complication that can lead to hospitalization and PD membrane failure and be potentially life-threatening. The best way to minimize the risk of peritonitis is to ensure the ESRD patient is well-trained on PD and provide consistent monthly education and reminders.

The symptoms of peritonitis are severe abdominal pain, cloudy PD drainage, and elevated white cell count greater than 100 per ml. Peritonitis treatment is best treated by filling the abdominal cavity with intraperitoneal antibiotics prescribed by the nephrologist. 

The Bottom Line

There has been a discussion about the underdog dialysis modality: peritoneal dialysis (PD). This discussion has uncovered that PD is a viable and cost-effective means to treat end-stage renal disease and can provide life and improved opportunities for end-stage renal patients. 

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