Possible problems with peritoneal dialysis
Peritoneal dialysis (PD) is not always trouble-free. Patients may experience both psychological and physical problems, discussed below
Some kidney patients get tired of the responsibility of doing their peritoneal dialysis every day. If this is a problem, talk to your peritoneal dialysis nurse who may be able to help you incorporate more flexibility into your routine.
Some peritoneal dialysis patients find it difficult to accept a permanent PD catheter. They worry that the catheter may affect their sexual activity and their relationship with their partner.
Peritoneal dialysis nurses can help with tips on how to disguise the PD catheter.
Peritoneal dialysis tends to stretch the abdomen, giving it a rounded appearance.
Keeping fit and doing exercises to strengthen the abdominal muscles will help counteract this. PD nurses can give advice on suitable exercises.
Fluid overload occurs when there is too much fluid in the body. It is characterized by a sudden increase in body weight, swollen ankles, and/or shortness of breath. Generally dialysis patients need torestrict their fluid intaketo prevent fluid overload. Peritoneal dialysis patients, however, have more flexible fluid allowances than Haemodialysis patients.
Dehydration occurs when there is too little fluid in the body. It can be caused by excess fluid loss due to diarrhea or sweating. It is characterized by dizziness, feeling sick, or a sudden decrease in weight. Dehydration is far less common than fluid overload in dialysis patients.
Some PD patients find that having the dialysis fluid in their abdomen is uncomfortable. They feel full or bloated. Others suffer from backache or experience shoulder pain, especially when draining in or out. Very rarely, some patients experience discomfort when fresh fluid is drained in.
Renal units can give advice on how to minimize or avoid discomfort.
One of the most common problems with peritoneal dialysis, especially among new patients, is poor drainage of the dialysis fluid. The most common causes are:
- Constipation. The pressure of the peritoneal dialysis fluid in the abdomen can cause movement of the bowel to slow down, increasing the likelihood of constipation. Constipation can cause the bowels to press against the catheter and interrupt drainage. It can also displace the catheter inside the peritoneal cavity. To avoid constipation, peritoneal dialysis patients may need to change their diet. In some cases, the patient's doctor may prescribe a laxative.
- Catheter displacement. Sometimes the PD catheter moves into the wrong position. It may "float" back into the right place naturally. If not, a minor operation or manipulation under X-ray may be required to correct its position.
In some patients, the peritoneal dialysis fluid leaks out around the catheter exit site. If this occurs, it may be necessary to decrease the volume of fluid in each exchange or stop peritoneal dialysis temporarily and have Haemodialysis for a short period of time until the leak has resolved. Occasionally, it may be necessary to place a new catheter at a different site. In some people, fluid leaks into the genitals and causes swelling. In men, this is called scrotal leak. If this occurs, peritoneal dialysis must be temporarily stopped until the leak has healed and a period of temporary Haemodialysis may be required.
An infected exit site is inflamed, red, sore, and discharges pus. It can be treated with antibiotics. Occasionally, the infection spreads inward, following the catheter tube along the "tunnel" through the abdominal wall. This type of infection is called a tunnel infection. If this occurs, it may be necessary to remove the catheter and put a new one in. A temporary period of Haemodialysis may be required.
Prevention of infections is extremely important. Patients need to follow the procedures covered during the initial PD training in order to care for their exit site. Good hygiene, and keeping the catheter taped down on the skin to protect the catheter, can significantly reduce the chances of getting an infection.
A hernia is the protrusion of an organ (most commonly the bowel) through muscle wall, causing swelling. Sometimes a hernia may be undetected at the time a peritoneal catheter is put in. This may become a problem later as the constant pressure of dialysis fluid on the hernia may cause it to become bigger and painful. Surgery may be required to correct the problem. In some cases Haemodialysis may be needed for a short time to allow healing after the operation. Alternatively, small volume PD exchanges may be recommended. Until patients have healed completely, they should not lift heavy objects.
Peritonitis is an infection of the peritoneum, usually caused by bacteria entering through the catheter. This can happen when patients touch the open ends of the connections between the bag of dialysis fluid and the catheter. Sometimes, even though everything is kept clean, an infection can get into the abdomen from the outside.
The chances of getting peritonitis are greatly reduced by following correct dialysis exchange procedures. Peritonitis infections are not that common. On average, patients can expect to get less than one attack of peritonitis every year. Some patients never get one.
Peritonitis is easy to recognize. Dialysis fluid is normally clear. Peritonitis makes it cloudy. Some patients also experience abdominal pain and fever.
Adding antibiotics to fresh dialysis fluid is the method of treatment. Some patients are shown how to do this at home.
Occasionally, a patient may get several attacks of peritonitis in a row. When this happens, the PD catheter may need to be replaced and the abdomen 'rested' by not using peritoneal dialysis for 4 to 6 weeks. During this time, the patient usually needs to have Haemodialysis until PD is resumed.
Repeated attacks of peritonitis may damage the peritoneum and reduce the efficiency of the dialysis. If this happens, the patient will have to change to Haemodialysis for long-term treatment.
The extra weight of dialysis can cause back strain if your abdominal muscles are weak. A few simple exercises will strengthen both these muscles and those of your back.
Effectiveness of the peritoneum
In a small number of patients, the peritoneum may cease to be effective as a dialysis membrane. There are a number of possible causes for this, including repeated infections or the effect of the glucose in the dialysis fluid.
In this case a peritoneal dialysis may need to be supplemented with Haemodialysis, and later transferred permanently to Haemodialysis.
"At the beginning, I thought the tube was slightly nauseating, and it took a little time to get used to having such a direct opening into my insides. In order to make the tube less frightening, both to myself and to those about me, I was happy to talk about it, where it was inserted, and to show it to anyone who asked what it looked like." - Anita, a CAPD patient from Norway
May 1, 2006