When both our kidneys fail, as they would quickly in some injuries or infections, and slowly due to chronic diseases like hypertension and diabetes, they could no longer filter out waste products and excess water nor keep important nutrients in our body.
This is when we need dialysis – a process whereby a machine or solution is used to help us clear waste products and excess water from our bodies when our kidneys no longer could.
There are two ways we can do this : haemodialysis and peritoneal dialysis.
In peritoneal dialysis (PD), dialysis is done inside your body using a membrane (peritoneum) that separates the important organs in your abdomen from the abdominal wall that acts as a natural filter.
When dialysis solutions are allowed to flow into your abdominal cavity through a catheter, waste products and excess water in the surrounding blood vessels will flow out through the membrane into the solution. After 4 to 6 hours, the solution (which now contains waste products and excess water in the body) will be drained out through the same catheter and replaced with a fresh bag of solution.
This can be done at home, with or without the help of a machine.
Continuous Ambulatory Peritoneal Dialysis (CAPD) is the type of peritoneal dialysis done without a machine. Solutions are allowed to flow in and out of the abdomen with the help of gravity.
Another type of peritoneal dialysis, called Continuous Cycler-Assisted Peritoneal Dialysis (CCPD) is done with the help of a machine. If you choose CCPD, 3 to 5 exchanges of dialysis solutions are done while you sleep.
When morning comes, you will exchange the dialysis solution in your abdomen for a bag of fresh solution that will last you an entire day.
In haemodialysis, your blood is allowed to flow out of your body into a machine that filters out waste products and excess water. Those who choose haemodialysis would usually need to visit haemodialysis centres 3 times a week for their sessions.
While it is possible to do this at home (if you have the machine), most haemodialysis procedures are done in haemodialysis centres, as the machines are expensive and its use require supervision by trained nurses.
Which is More Common?
In Malaysia, haemodialysis is more common. The latest available data from the National Renal Registry in year 2008 reported that out of about 19,000 patients currently on dialysis, 2083 patients are on peritoneal dialysis.
Although clinical studies have shown that peritoneal dialysis and haemodialysis are comparable in terms of mortality and morbidity, a possible reason most people in Malaysia go for haemodialysis is the fact that haemodialysis is subsidised by the government in its hospitals and haemodialysis centres set up by non-governmental organisations (NGOs), while peritoneal dialysis is only free in government hospitals. Currently, 90% of PD in the country is done by government hospitals.
In countries like Taiwan and Hong Kong, where their respective governments actively promote peritoneal dialysis, the percentage of people with kidney failure on peritoneal dialysis is much higher.
How do We Choose?
While the effectiveness of both types of dialysis is comparable, peritoneal dialysis is still viewed as the second alternative reserved for those who had failed haemodialysis.
However, as peritoneal dialysis allows those who practise it more mobility and independence (you can exchange the dialysis solution, which takes about 30 minutes, and go about your daily routine until the next exchange), patients who are young, have good eyesight and good dexterity should be encouraged to choose peritoneal dialysis.
While infection rates are higher in peritoneal dialysis in the past, the development of better instruments, technique, and dialysis solutions have decreased rates tremendously in the last five years.
Can We Switch From One Type of Dialysis to the Other?
For people who are on peritoneal dialysis, switching between CAPD and CCPD can be done easily. However, switching from haemodialysis to peritoneal dialysis and vice versa will be more difficult as both of them require different surgical procedures to prepare the patients for dialysis.
More info on DIALYSIS here.
12:30 PM Buah Pinggang