Peritoneal dialysis

At any one time in the UK, 400-800 people per million of the population need renal replacement in the form of dialysis

• prevalence of dialysis in the UK is highly age dependent - for adults aged 70-80 years it is between 1600 and 2000 people per million
• for about 40% of adults on dialysis a kidney transplant is the treatment of choice; this percentage is higher in children. If patients do not have a kidney transplant, dialysis is needed for the rest of the patient's life

Peritoneal dialysis may be used to manage both acute and chronic renal failure as an alternative to haemodialysis.

The patient's own peritoneum provides a semi-permeable membrane across which plasma fluid and solutes exchange with dialysis fluid. The surface area of an adult's peritoneum is approximately 2 square metres so relatively effective dialysis may be achieved.

• peritoneal dialysis can be delivered safely and effectively at home or at another location of the patient's choice
• patients administer it themselves although children, and some adults, might need help from their families or carers
• patients must have a clean and hygienic place to exchange dialysis fluid and/or set up dialysis delivery devices either to have dialysis throughout the day (continuous ambulatory peritoneal dialysis [CAPD]) or overnight while they are asleep (automated peritoneal dialysis [APD] and assisted automated peritoneal dialysis [aAPD]). A small room or shed will be needed to store deliveries of dialysis fluid.

The proportion of people with chronic kidney disease using peritoneal dialysis ranges from 0-30% in adults, possibly because of variation in local practice and resources, and is as high as 56% in children.

Offer all people with stage 5 CKD a choice of peritoneal dialysis or haemodialysis, if appropriate, but consider peritoneal dialysis as the first choice of treatment modality for:

• children 2 years old or younger
• people with residual renal function
• adults without significant associated comorbidities

Reference:

• 1) NICE (July 2011). Peritoneal dialysis - Peritoneal dialysis in the treatment of stage 5 chronic kidney disease