Studies of peritoneal dialysis

Abstract

In these studies of peritoneal dialysis the following conclusion were made: (a) The addition of THAM to the dialysate promotes the excretion of both barbituric and salicylic acid - both into the dialysate and also by the kidneys. (b) Substantial quantities of THAM are absorbed by the peritoneum. (c) Glucose is absorbed in clinically significant quantities, and this has important repercussions in diabetic subjects. The use of dextrans is a useful alternative in the dialysis treatment of diabetics. (d) Apart from promoting the removal of unwanted metabolites and drugs, peritoneal dialysis also removes water from the patient. (e) The addition of THAM to the dialysate confers a major benefit to the patient with methyl alcohol poisoning, but other methods of treatment, particularly the administration of ethyl alcohol must be changed. (f) Positive bacterial cultures, which does not necessarily mean active peritoneal inflammation and infection, are common during peritoneal dialysis, but the incidence of this can be reduced by adding antibiotics to the dialysate. A safe antibiotic was found to be Ampicillin, and in patients with severe renal failure, therapeutic blood levels of this antibiotic could be achieved by the peritoneal route of administration. (g) Peritoneal dialysis affects respiratory function by reducing both the vital capacity and peak flow, though these effects are considerably lessened when only a small dialysing volume is used. (h) The pleural membrane is a useful alternative to the peritoneal membrane for dialysis exchange and surprisingly the interference of pulmonary function is not much worse than occurs after peritoneal dialysis. (i) The loss of protein and amino acids into the dialysate can be considerably lessened when amino acids solutions are added to the dialysate. (j) Finally abdominal paracentesis and lavage with a dialysis catheter is a useful diagnostic aid in certain clinically difficult surgical states. These conclusions have arisen from a series of investigations over the past five years during which a total of 460 patients have been treated with peritoneal dialysis for a variety of conditions. These conditions range from the treatment of over dosage, notably barbiturate and salicylate, to chronic renal failure. In all this experience peritoneal dialysis has been found to be an easy method requiring simple apparatus and the minimum of skilled technical help. It has been found that the judicious addition of other compounds to the dialysate frequently confers major advantages depending on the clinical circumstances. The associated problems of dialysis of infection and protein loss have been largely overcome, thus extending the range of usefulness of this technique of peritoneal dialysis. © 2008 International Society of Nephrology.