Movement of solutes and water between 2 compartments across semipermeable membrane (peritoneal lining)
Surface area of peritoneal membrane is 1-2 m²
1 compartment is peritoneal capillary bed
High concentration of uremic toxins
Blood flow via inferior epigastric, intercostal, and lumbar arteries
Other component is peritoneal cavity
Where PD solution (dialysate) is infused
Solutes
Move down concentration gradients via diffusion
Urea and potassium move from high concentration in peritoneal capillary bed to low concentration dialysate in peritoneal cavity
Moved via convection (a.k.a. solute drag)
Movement of solutes with water (small proteins)
Water
Moves across membrane in response to osmotic/colloid gradient force
Dialysate hypertonic/hypercolloid
Pulls water from peritoneal capillary bed to peritoneum
Utilization
PD utilized as renal replacement therapy (RRT) in ~ 200,000 end-stage renal disease (ESRD) patients
9.5% of patients in USA; 11% of patients worldwide
Advantages c/w hemodialysis (HD)
Lower cost
Fewer hospitalizations
Lower need for interventions to maintain access
Greater patient independence
Greater autonomy of care
Lower potential for infectious disease outbreak c/w HD
HIV/hepatitis outbreaks at HD centers
No need for subsequent needle sticks after placement
Survival advantage
Better preservation of residual kidney function
Preservation of endocrine and metabolic function
Some residual kidney function preserves Na+ and water clearance
No access-related heart failure
No hypotension during HD (intradialytic hypotension)
Can cause myocardial stunning
Better lifestyle
No need for frequent travel to HD center
Less prohibitive dietary considerations
Can travel/vacation more easily
PREPROCEDURE
Indications
Contraindications
Preprocedure Imaging
Getting Started
PROCEDURE
Patient Position/Location
Procedure Steps
Alternative Procedures/Therapies
POST PROCEDURE
Things to Do
Things to Avoid
OUTCOMES
Problems
Complications
Expected Outcomes
Selected References
Esagian SM et al: Surgical versus percutaneous catheter placement for peritoneal dialysis: an updated systematic review and meta-analysis. J Nephrol. 34(5):1681-96, 2021
Ma Y et al: Association between different peritoneal dialysis catheter placement methods and short-term postoperative complications. BMC Nephrol. 22(1):151, 2021
Zang Z et al: Different techniques for peritoneal dialysis catheter implantation: a systematic review and network meta-analysis. Perit Dial Int. 41(6):522-32, 2021
Zou Y et al: Assessment of complications and short-term outcomes of percutaneous peritoneal dialysis catheter insertion by conventional or modified Seldinger technique. Ren Fail. 43(1):919-25, 2021
Morris CS: Interventional radiology placement and management of tunneled peritoneal dialysis catheters: a pictorial review. Radiographics. 40(6):1789-806, 2020
Crabtree JH et al: Creating and maintaining optimal peritoneal dialysis access in the adult patient: 2019 update. Perit Dial Int. 39(5):414-36, 2019
Tanasiychuk T et al: The ideal position of the peritoneal dialysis catheter is not always ideal. Int Urol Nephrol. 51(10):1867-72, 2019
Lee J et al: Radiological Tenckhoff catheter insertion for peritoneal dialysis: a cost-effective approach. J Med Imaging Radiat Oncol. 62(2):174-8, 2018
Gallieni M et al: Type of peritoneal dialysis catheter and outcomes. J Vasc Access. 16 Suppl 9:S68-72, 2015
Abdel-Aal AK et al: Best practices consensus protocol for peritoneal dialysis catheter placement by interventional radiologists. Perit Dial Int. 34(5):481-93, 2014
Bagul A et al: Laparoscopic peritoneal dialysis catheter (PDC) insertion: does it really make a difference? J Nephrol. 27(2):127-34, 2014
Kuru S et al: Sclerosing encapsulating peritonitis with perforation of the gastrointestinal tract: a serious complication of continuous peritoneal dialysis. Ann Saudi Med. 32(6):660-1, 2012
Singh SK et al: Peritoneal dialysis catheter malfunction because of encasement by an extraluminal fibrin sheath. Perit Dial Int. 32(2):218-20, 2012
Dell'Aquila R et al: Rational choice of peritoneal dialysis catheter. Perit Dial Int. 27 Suppl 2:S119-25, 2007
Rabindranath KS et al: Automated vs continuous ambulatory peritoneal dialysis: a systematic review of randomized controlled trials. Nephrol Dial Transplant. 22(10):2991-8, 2007
Related Anatomy
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Related Differential Diagnoses
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References
Tables
Tables
KEY FACTS
Preprocedure
Procedure
Post Procedure
Outcomes
TERMINOLOGY
Abbreviations
Peritoneal dialysis (PD)
Definitions
Mechanism of action
Movement of solutes and water between 2 compartments across semipermeable membrane (peritoneal lining)
Surface area of peritoneal membrane is 1-2 m²
1 compartment is peritoneal capillary bed
High concentration of uremic toxins
Blood flow via inferior epigastric, intercostal, and lumbar arteries
Other component is peritoneal cavity
Where PD solution (dialysate) is infused
Solutes
Move down concentration gradients via diffusion
Urea and potassium move from high concentration in peritoneal capillary bed to low concentration dialysate in peritoneal cavity
Moved via convection (a.k.a. solute drag)
Movement of solutes with water (small proteins)
Water
Moves across membrane in response to osmotic/colloid gradient force
Dialysate hypertonic/hypercolloid
Pulls water from peritoneal capillary bed to peritoneum
Utilization
PD utilized as renal replacement therapy (RRT) in ~ 200,000 end-stage renal disease (ESRD) patients
9.5% of patients in USA; 11% of patients worldwide
Advantages c/w hemodialysis (HD)
Lower cost
Fewer hospitalizations
Lower need for interventions to maintain access
Greater patient independence
Greater autonomy of care
Lower potential for infectious disease outbreak c/w HD
HIV/hepatitis outbreaks at HD centers
No need for subsequent needle sticks after placement
Survival advantage
Better preservation of residual kidney function
Preservation of endocrine and metabolic function
Some residual kidney function preserves Na+ and water clearance
No access-related heart failure
No hypotension during HD (intradialytic hypotension)
Can cause myocardial stunning
Better lifestyle
No need for frequent travel to HD center
Less prohibitive dietary considerations
Can travel/vacation more easily
PREPROCEDURE
Indications
Contraindications
Preprocedure Imaging
Getting Started
PROCEDURE
Patient Position/Location
Procedure Steps
Alternative Procedures/Therapies
POST PROCEDURE
Things to Do
Things to Avoid
OUTCOMES
Problems
Complications
Expected Outcomes
Selected References
Esagian SM et al: Surgical versus percutaneous catheter placement for peritoneal dialysis: an updated systematic review and meta-analysis. J Nephrol. 34(5):1681-96, 2021
Ma Y et al: Association between different peritoneal dialysis catheter placement methods and short-term postoperative complications. BMC Nephrol. 22(1):151, 2021
Zang Z et al: Different techniques for peritoneal dialysis catheter implantation: a systematic review and network meta-analysis. Perit Dial Int. 41(6):522-32, 2021
Zou Y et al: Assessment of complications and short-term outcomes of percutaneous peritoneal dialysis catheter insertion by conventional or modified Seldinger technique. Ren Fail. 43(1):919-25, 2021
Morris CS: Interventional radiology placement and management of tunneled peritoneal dialysis catheters: a pictorial review. Radiographics. 40(6):1789-806, 2020
Crabtree JH et al: Creating and maintaining optimal peritoneal dialysis access in the adult patient: 2019 update. Perit Dial Int. 39(5):414-36, 2019
Tanasiychuk T et al: The ideal position of the peritoneal dialysis catheter is not always ideal. Int Urol Nephrol. 51(10):1867-72, 2019
Lee J et al: Radiological Tenckhoff catheter insertion for peritoneal dialysis: a cost-effective approach. J Med Imaging Radiat Oncol. 62(2):174-8, 2018
Gallieni M et al: Type of peritoneal dialysis catheter and outcomes. J Vasc Access. 16 Suppl 9:S68-72, 2015
Abdel-Aal AK et al: Best practices consensus protocol for peritoneal dialysis catheter placement by interventional radiologists. Perit Dial Int. 34(5):481-93, 2014
Bagul A et al: Laparoscopic peritoneal dialysis catheter (PDC) insertion: does it really make a difference? J Nephrol. 27(2):127-34, 2014
Kuru S et al: Sclerosing encapsulating peritonitis with perforation of the gastrointestinal tract: a serious complication of continuous peritoneal dialysis. Ann Saudi Med. 32(6):660-1, 2012
Singh SK et al: Peritoneal dialysis catheter malfunction because of encasement by an extraluminal fibrin sheath. Perit Dial Int. 32(2):218-20, 2012
Dell'Aquila R et al: Rational choice of peritoneal dialysis catheter. Perit Dial Int. 27 Suppl 2:S119-25, 2007
Rabindranath KS et al: Automated vs continuous ambulatory peritoneal dialysis: a systematic review of randomized controlled trials. Nephrol Dial Transplant. 22(10):2991-8, 2007
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