Nkf pd - dr. osama el shahat

1. Peritoneal Dialysis
the forgotten modality
Dr. Osama El-Shahat
Consultant Nephrologist
Head of Nephrology Department
New Mansoura General Hospital (international)-(Egypt)
ISN Educational Ambassador

2. 1st steps towards peritoneal
dialysis.
Ancient Egypt were probably the first people to get a look at the peritoneum
The word preitoneum refers to the Greek word “peritononion” and means to stretch.

3. PD … the modality first used for the treatment of KI

4. Managing New Patient with ESRD
“Complementary Not Competitive” Coles 1998
“The right modality at the right time. Peter Blake, MD, John Burkart, MD
Early referral of patient
With CKD to renal center
Pre-emptive
Transplantation
PD as first option if medically suitable
Allowing for patient chioce
Patient education
program
HD Transplant
PD

5. Why to start with PD ?
Preservation of RRF
Higher Hb concentration
Less risk of acquiring blood borne infections e.g. HCV
Better quality of life
Travel , employment
It allows expansion with limited resources
Lower staff / patient ratio
saves vascular access
 preferred for children (APD)

6. Patient selection
Positive Negative
Selecting RRT modalities is influenced by a number of
considerations such as
 Patient Preference .
 Availability And Convenience.
 Underlying Medical Problems and Comorbid Conditions.
 Socioeconomic and Dialysis Center Factors.
 The Patient's Home Situation
 Medical staff Training.

8. PD- Requirements
PD .catheters PD. solution

9. Technique &Types of Chronic PD
1. Fill Phase (<15 minutes)* Disconnect
2. Dwell phase (4-8 hours)
3.Drain phase (<20 minutes)
 CAPD (Continuous Ambulatory Peritoneal Dialysis)
 APD (Automated Peritoneal Dialysis)
 CCPD (Continuous Cycling Peritoneal Dialysis)
 IPD (Intermittent Peritoneal Dialysis)
 NIPD (Nocturnal Intermittent Peritoneal Dialysis)
 TPD (Tidal Peritoneal Dialysis)

10. Automated Peritoneal Dialysis(APD)
Indications
1. Children
2. Inadequate solute or fluid removal
3. High intraperitoneal pressure Hernia
4. Polycystic disease
5. (Recurrent) dialysate leaks
6. Loss of appetite
7. Lifestyle
Disadvantages
More difficult to learn Disturbed sleep
Attached to machine Sexual problems
More expensive

12. Complications of PD therapy
infectious Non infectious
Peritonitis TunnelExit site
Acute Chronic

13. Catheter Malfunction
.
Diagnosis:
Abdominal X ray Frontal and Lateral
views To visualize catheter position
Prevention:
It is optimized by
proper positioning of the catheter upon
implantation
avoiding constipations

14. Hyperglycaemia
Hyperlipidemia
Malnutrition
Hypokalemia
Hypermagnesaemia
Metabolic Disturbances:

15. Such variation from 2% to 80% !
Can not be for medical reasons?
PD utilization in various countries
worldwide (from USRDS data 1999).

16. Conclusions
In conclusion, PD continues to be underutilized in many
countries, including the United States. There are many
factors that contribute to this underutilization (e.g.,
modality, system, and patient-related factors).
Clin J Am Soc Nephrol 6: 447–456, 2011

17. Damanhor
PD program in Egypt

18. Transports
Hospitalisation
Pharmaceuticals
(e.g. EPO)
Equipment costs
(Lease, depreciation,
maintenance)
Disposables
Labor
Water Treatment
Infrastructure
Transports
Hospitalisation
Pharmaceuticals
(e.g. EPO)
Equipment costs
Disposables
Labor
Infrastructure
Schematic RRT Cost Comparison
Available Modalities

20. PD in Mansoura

21. PD in Mansoura

22. Conclusion
Integrated care approach is the optimal treatment for ESRD
 PD is the modality of choice to start RRT if kidney Tx not
available.
PD is the solution for overcrowded dialysis units
PD is underutilize in Egypt , more effort from nephrologists ,
government and local companies to support PD program in
Egypt.

23. Thank YOU