What is dialysis ?
The role of the kidneys is to maintain equilibrium in the body by cleaning the blood of waste products produced by the cells (urea, creatinine, uric acid, etc.) and by eliminating excess mineral salts (sodium, potassium, etc.) from dietary intake.
Patients deprived of kidney function can live thanks to dialysis, generally called "artificial kidney", because dialysis can both clean blood of its waste products and restore normal concentrations of mineral salts.
The artificial kidney, like normal kidneys, cleans the blood through a filtering membrane that lets through the waste products and mineral salts that are small molecules, but retains the larger albumin and proteins molecules that must be preserved.
There are two main types of artificial kidney:
- Hemodialysis that uses an artificial filtering membrane outside the patient’s body (extracorporeal membrane)
- and peritoneal dialysis that uses the peritoneum, a filtering membrane inside the patient’s body (intracorporeal membrane).
What is Peritoneal Dialysis ?
Unlike hemodialysis, peritoneal dialysis uses a membrane inside the body, the peritoneum, to filter waste products from the blood; this technique is always used at the patient’s home and thus requires a period of training beforehand.
A catheter first needs to be inserted in the abdomen in the umbilical region. This small tube is used to fill the abdominal cavity with a fluid (dialyzate) delivered in a plastic bag.
This fluid progressively absorbs the waste products from the patient’s body through the peritoneum; the fluid is then drained and replaced with a new bag of dialyzate.
There are two main methods of peritoneal dialysis:
- continuous ambulatory peritoneal dialysis (CAPD) is carried out during the day with renewal of the dialyzate bags three or four times. In elderly patients who no longer have the necessary dexterity, a nurse can assist with renewal of the bags.
- automated peritoneal dialysis (APD) is carried out at night using a machine that will automatically renew the dialyzate over a period of around eight hours.
This technique is reserved for autonomous patients capable of managing the entire treatment, as the nurses are not available at night.
It has the advantage of leaving the patient entirely free of his movements during the day and is particularly popular with young patients with professional activities who are waiting for a kidney transplant.
Whether continuous or ambulatory, peritoneal dialysis is a very gentle treatment method that must be repeated every day or every night to be sufficiently effective. The gentle nature of the treatment explains why this type of dialysis is often better tolerated, particularly by elderly or fragile patients.
However, it is not possible in all patients; patients who are considerably overweight or who do not have an intact peritoneum due to abdominal surgery cannot use peritoneal dialysis.
Home Peritoneal Dialysis
AURA plays a major role in the care of patients treated at home with peritoneal dialysis in the Ile de France region.
It treats around 350 home peritoneal dialysis patients: 160 under automated peritoneal dialysis and 190 under ambulatory peritoneal dialysis.
After learning the technique in the AURA training center (training center in self-care dialysis and home dialysis using hemodialysis or peritoneal dialysis) or in other training centers run by partner hospitals that have signed a cooperation agreement with AURA, patients continue to be followed-up in their homes by the same medical teams.
Likewise, when their state of health requires hospitalization, patients are referred to the AURA hospitalization unit, or to a unit in one of the partner hospitals.
Thus, AURA belongs to a vast care network that provides safe, coordinated and continuous care thanks to the medical, nursing and technical teams that accompany patients throughout all stages of their illness and whatever the developments.