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PRINCIPLES OF DIALYSIS
Diffusion and Osmosis: The movement of solute
molecules from a solution of high concentration
to one of lower concentration is called diffusion.
Thus molecules such as urea, creatinine, vitamin
B12 and phosphates diffuse from blood to dialysate,
where the initial concentration is zero. Factors
affecting the diffusion are; concentration gradient between the blood and dialysis fluid
(the greater the gradient, faster the diffusion) and
the surface area and permeability of peritoneal
membrane (higher the value the faster the diffusion).
Ultra-filtration: The movement of solvent (water)
molecules across the peritoneal membrane controlled
by the pressure gradient is called ultra-filtration
(UF). High concentration of dextrose in
dialysis fluid causes the osmotic pressure for ultra-
filtration.
Convection: The solute molecules move in bulk
(solvent drag) with the UF of solvent (water). This
process is called convection.
Net ultra-filtration: This is the difference in volume
of fluid infused into the peritoneal cavity and
that drained out.
Lymphatic absorption: A significant amount of
water (with solutes) is also absorbed into the lymphatic.
PERITONEAL DIALYSIS CATHETERS
With the development of Tenckhoff catheter,
the long term PD was made possible. PD catheter
consists of three parts: External segment, Subcutaneous
tunnel segment (having two cuffs, the
outer one placed just under the skin at exit site
and the inner one at the external fascia of the peritoneum)
and Intra-abdominal segment with multiple
small holes and terminal opening in the peritoneal
cavity. PD catheter can be inserted by three
techniques: Percutaneous Seldinger technique,
Peritoneoscopy and Laparotomy.
PERITONEAL DIALYSIS FLUID
It is delivered in plastic bags with different
concentrations.11 (Table-1)
UF volume is dependent on three major factors;
Dialysate dextrose concentration (osmolarity),
Dwell time and Peritoneal membrane characteristics.
Many osmotic agents other than glucose
can also be used, like; gelatin, xylitol, sorbitol,
mannitol, fructose, dextrane, polyanion, amino
acids, glycerol and glucose polymers.

 

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