Peritoneal Dialysis: A Treatm... Video Transcript

Participants

, Lisa Clark , Jai Radhakrish MD, MRCP (, Leonard Stern MD

Summary

As little as 40 years ago, a diagnosis of total kidney failure meant that death would soon follow. But thanks to major advances in medical technology, patients with kidney failure are living longer and healthier lives. Join our panelists as they discuss a life saving medical procedure called peritoneal dialysis.

Webcast Transcript

LISA CLARK: I'm Lisa Clark. Welcome, and thank you for joining us for this webcast. As little as 40 years ago, a diagnosis of total kidney failure meant that death would soon follow, but thanks to major advances in medical technology, patients with kidney failure are living longer, healthier lives. One of the major jobs of the kidney is to remove waste and toxins from the blood. It's possible through several types of dialysis. In this segment, we're going to take a look at peritoneal dialysis.

Joining us for this discussion, Dr. Leonard Stern. Welcome. And also Dr. Jai Radhakrishnan. Thank you for being here. Both men are Assistant Professors of Clinical Medicine at the College of Physicians and Surgeons of Columbia University. They both practice at the Columbia Presbyterian Medical Center, and Dr. Stern is the medical director of the peritoneal center at the hospital and the director of the new Columbia University Dialysis Center, so you are eminently qualified for this discussion.

I want to begin with a clarification. When does dialysis become necessary for any kidney patient?

LEONARD STERN, MD: The body is remarkably resilient, and you could be largely asymptomatic with loss of as much as 85% to 90% of kidney function, but when you reach about 10% of kidney function, you begin to get symptoms. Those symptoms may be related to appetite reduction, nausea, fatigue, and a variety of progressive symptoms that produce a syndrome which we call renal failure.

In years past, we waited until patients were symptomatic, and then we initiated dialysis. Our approach today is a bit different. When patients reach that 10% approximate level, we try to get them to start dialysis sooner, when they're asymptomatic, because we think their survival is improved.

LISA CLARK: Jai, there are two major types of dialysis, hemodialysis, which is through the bloodstream, and then peritoneal dialysis. Will you just highlight the chief differences for our audience?

JAI RADHAKRISHNAN, MD: The basic principle of dialysis is that you need a membrane through which the exchange of fluid and toxins can occur. In hemo-, or blood, dialysis, there is a machine with an external membrane inside the machine that does this exchange. In peritoneal dialysis, we use the body's own membrane, and we use what's called the peritoneal membrane -- that is the lining of all the organs inside the abdominal cavity through which the exchange occurs.

LISA CLARK: If you wouldn't mind describing the basics of peritoneal dialysis for us, Len? I know this is complicated, but try to help us understand.

LEONARD STERN, MD: With any form of dialysis, we need an access. In hemodialysis there is a blood access. In peritoneal dialysis the access is a tube called a Tenckhoff catheter, Tenckhoff named after the surgeon called Henry Tenckhoff, who invented this in 1969, and the tubes are generally placed by surgeons in the abdominal cavity. The tube is in potential space, because ordinarily our abdominal cavity is only filled with intestines. But this catheter is left in place, and the outside part can be connected through a series of specialized connectors to bags of rinsing fluid, and a rinsing solution is connected and it flows into the abdominal cavity, where it stays for a period of time and acts as a collector for waste products. The membrane can act as a barrier, and the waste products travel across the membrane into this fluid compartment, where they're retained, and after a few hours of time, this fluid is drained out -- it essentially becomes urine equivalent -- and then fresh fluid is placed in.