Indications
Peritoneal dialysis solutions are sterile fluids used in peritoneal dialysis, a treatment for kidney failure. They are used for people whose kidneys can no longer remove waste products and extra water from the blood, either as long-term home treatment (such as continuous ambulatory peritoneal dialysis) or in hospital for sudden kidney failure.
How It Works
The fluid is run into the abdomen through a soft tube (catheter). The lining of the abdomen, called the peritoneum, acts as a natural filter. Waste products such as urea and creatinine and extra salts pass from the blood into the fluid, and the sugar (dextrose) in the fluid draws out extra water. After a set time, called the dwell time, the used fluid is drained out and replaced with fresh fluid. The solutions also contain sodium, calcium, magnesium, chloride and a buffer such as lactate to help correct the body’s salt and acid balance.
Dosage and Administration
The type of solution, its strength, the volume, the number of exchanges per day and the dwell times are set by the kidney specialist for each person. Exchanges are done in hospital by trained nurses, or at home by patients and carers after proper training. Always use a strict clean (aseptic) technique. Do not change your prescription on your own. Warm the bag only by the method you were taught, never in a microwave or hot water.
Interactions
Dialysis can remove some medicines from the body, so doses of certain drugs may need changing. People with diabetes may need their Insulin or other diabetes medicines adjusted because of the sugar in the fluid. Blood potassium changes can affect people taking Digoxin. Medicines may sometimes be added to the bag only on a doctor’s instruction.
Contraindications
- Recent abdominal surgery, injury or open wounds of the abdominal wall
- Extensive scarring or adhesions inside the abdomen
- Abdominal wall defects or hernias that cannot be repaired
- Severe inflammatory bowel disease or certain bowel conditions
- Severe breathing problems that would worsen with fluid in the abdomen
- Very high lactic acid levels, for lactate-based solutions
Side Effects
The most important problem is peritonitis, an infection of the abdominal lining. Other effects include infection at the catheter exit site, a feeling of fullness or discomfort, back pain, hernia, high blood sugar, weight gain, high blood fats, fluid overload with swelling, dehydration with low blood pressure, and changes in blood salts such as potassium and calcium.
Get urgent medical help if the drained fluid is cloudy, or if you have abdominal pain, fever, chills, redness or pus at the catheter site, severe breathlessness, chest pain, marked swelling or dizziness and fainting.
Pregnancy and Lactation
Peritoneal dialysis may be continued in pregnancy and breastfeeding if the kidney specialist decides it is needed, with close monitoring and adjusted prescriptions.
Precautions and Warnings
Check each bag before use: do not use it if it leaks or the fluid is cloudy or discoloured. Keep a record of weight, blood pressure and fluid balance as advised. Regular blood tests check salts, sugar and dialysis adequacy. Report any change in the drained fluid promptly.
Overdose
Using too strong a solution or too many exchanges can cause dehydration, low blood pressure or high blood sugar; too little can cause fluid overload. Contact the dialysis unit if you are unsure about your exchanges.
Therapeutic Class
Peritoneal dialysis solution (renal replacement therapy)
Storage
Store as directed on the pack, usually below 30°C in a clean, dry place, away from direct sunlight. Do not freeze. Keep out of the reach of children.
Prepared by the Oshud Alo team from standard drug references. For information only; always follow your doctor's advice.