Peritoneal Dialysis - Risks and Benefits

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 peritonitis due to the potential to introduce bacteria to the abdomen; peritonitis is best treated through the direct infusion of antibiotics 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 trials 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 calories 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.