Q.630. What are the available types of P.D.?PERITONEAL DIALYSIS
PERITONEAL DIALYSIS
Q.630. What are the available types of P.D.?
A. P.D.: 🠞 2 Non-A.P.D. 🠞
(1) Ac. P.D. = I.P.D.
(intermittent P.D.). 30 كيس مرتين في الأسبوع
(2) CAPD.
🠞 4 A.P.D.: 🠞
(1) CCPD.
(2) INPD.
(3) TPD.
سِيبْ شِوَيَّه.
(4) Optimized P.D. ☕ . واحده زياده بالنهار مع الشاي
Q.631. Describe the various types of P.D.?
PD: continuous or intermittent. Continuous ambulatory P.D. (CAPD): multiple
exch. dur. day (us. 3) foll. by overnight dwelling Modification: one
nighttime exch. é exchange device, resulting in [2 overnight
exchanges + 3 exchange during day]. Automated P.D.(APD): consist of continuous
cycler P.D. (CCPD),
nightly intermittent P.D. (NIPD) & tidal P.D. (TPD). CCPD: Long
daytime dwell + several cycles overnight. Minority of those undergoing
CCPD don’t have daytime dwell & others must hv daytime/mid-day
exchange. Some intermittent
techniques, e.g. nightly intermittent P.D.
(NIPD) or
intermittent P.D. (IPD), have ttt periods ("wet" abdomen) alternating é times durtion which Pr. cavity hs bn drained of Dzt ("dry" abdomen).Tidal P.D. (TPD): exchange in which
Pr. cavity always contains at least some Dzt (1/2
full)🠞 incr. comfort & facilitates
drainage in some ptns. Ptn. may or may not have a day-time dwell.
Intermittent regimen typically utilize multiple short dwells & automated
technology to operate at near maximum solute
clearance rates. Of the intermittent techniques, TPD is infrequently
used as it’s v. expensive (needs a large No. of Dzt) & technically difficult to perform. Incr.
solute clearances hv also not bn confirmed. Most frequently, TPD is used to 🠋drainage problems in selected ptns. As recomm. in European Best Practice guidelines, it can also be used in those é inflow/outflow pain & in ptn. é slow Pr. drainage. Continuous flow P.D. (CFPD): another
technique in which two Pr. Cth. or one cth. é two
ports provide continuous inflow & outflow of Dzt.
Since Dzt is constantly refreshed, clearances similar to that
obtained é
daily HDX can be obtained. CFPD was 1st introduced decades ago, but was subsequently
abandoned due to technical & financial limitations. There has been
a renewed interest in this technique because of frequently inadequate
clearances é other PD modalities
& introduction of technical innovations that may make CFPD
feasible.
Q.632. Compare CAPD vs APD as a P.D. modality?
CAPD
& APD seem to provide similar clinical
outcomes incl. M.R. Both modalities 🠞 similar [mortality & hospitalization rates,
risk of peritonitis, & fluid leaks]. APD may be associated é
relatively more time for work &
social 😉 activities.
Relative effect of CAPD & APD on Kru is controversial. Observational
study showed: higher risk of complete loss of R. function in 1st
y. associated é APD
comp. to CAPD. However, no difference was detected in
the systemic review é this study.
Q.633. Explain how to start P.D. prescription?
At the start of
DX when ptn have some Kru , most ptns cd do any PD
technique and us. able to achieve Kt/V & vol. control targets.
However, once Kru is negligible,
modality choice may need to match Pr. transport ch.ch. to optimize solute
clearance & U.F. It’s important to individualize ptn’s dwell times
& vol., so that target dose of PD can be achieved. PD
is considered adequate in most ptn if weekly total
Kt/V for urea is at least 1.7 & if considering Cr. Cl.: weekly Cr. Cl.:
at least 50-60 L/w./1.73 m2
B.S.A. (é some variation
based upon transporter status) .
Attainment of these goals must be documented & then monitored over time.
It’s often necessary, to incr. ptn’s DX prescription (by🠉No. of exch. or
dwell vol.) as Kru is lost or there’s a decrease in net
permeability of Pr. membrane.
Q.634. What
is the role of peritoneal equilibration test in P.D. prescription?
1st
step: determine Pr membrane transport ch. ch. using PET Based upon published norms. Dwell time
is then matched to transport type in effort to🠉daily clearances & U.F. while 🠋 glucose absorption. Rapid
transporters: Consider, the problem in "rapid"
transporters of Cr. fr. blood to Dzt. They achieve almost total
equilibration between pl. & Dzt for urea & cr. in few h.s.
They’re also rapid absorbers of Dzt glucose🠊 removing the osmotic
stimulus to U.F.. Net effect
= they begin to absorb Dzt with glucose leading, after 2-3h. h., to dcrease
in U.F. vol. & net solute clearance.(as the solutes tht hv diffused into Dzt are also
absorbed back into systemic circulation).
In this setting,
standard CAPD, which utilizes prolonged dwell times, might not
produce sufficient fluid or solute removal. This would necessitate more
frequent hypertonic Dzt
(2.5 or 4.25 % dextrose), potentially inducing hyperglycemia, hypertriglyceridemia,
and/or wt gain fr. 🠉 glucose absorption, or icodextrin. A better alternative in many cases is multiple short
dwells é standard Dzt
as é NIPD. Slow transporters: Us.
need long dwell times to adequately remove small solutes.
U.F. is not a problem, since glucose is also slowly
absorbed.
Q.635. What
is the effect of residual renal function (Kru) on P.D.
prescription?
Ptns
typically have some Kru when they’re started on maintenance DX. In this setting,
it may not be as important to match dwell time é transporter type, since the urine volume can replace the
need for U.F. & the minimal renal solute excretion augments that due
to DX. However, as Kru gradually dcrease over time, matching
of dwell time to transport type becomes increasingly important.
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