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Home peritoneal dialysis

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Abstract

The impetus for the successful performance of chronic peritoneal dialysis was made possible by Boen et al,1 with the development of a closed, automated system for peritoneal dialysis which reduced the incidence of peritonitis. It was subsequently demonstrated that patients could be maintained in excellent functional states for prolonged periods without protein or other depletional syndromes. The development of implantable, bacteriologically safe dialysis catheters has made it possible to treat patients successfully for as long as 7 years.

Chronic peritoneal dialysis is not only a suitable alternative to hemodialysis, but in some instances it may be preferable to hemodialysis or transplantation. The success of chronic peritoneal dialysis is a direct result of our ability to prevent peritoneal infection with a closed system of dialysis.

Selection of patients for home peritoneal dialysis

Selection criteria for chronic peritoneal dialysis vary depending on the dialysis and transplantation situation at a given institution. Although active transplantation and maintenance dialysis programs are available at the Cleveland Clinic, chronic peritoneal dialysis has evolved as a suitable alternative therapy for selected patients. Every patient accepted for chronic dialysis is carefully evaluated for possible training in home dialysis.

Based on experience at the Cleveland Clinic and other centers employing peritoneal dialysis, the conditions favoring chronic peritoneal dialysis may be listed as follows:

  1. Patients without a spouse or responsible family member.

  2. Patients unable to learn the technically more demanding home dialysis procedures.

  3. 3. Patients considered unsuitable for hemodialysis for medical reasons: advanced cardiovascular disease, old age, poor. . .


 

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