Ccpd

Peritoneal dialysis has been used as an intermittent form of clinic-bound application since the 1960s (Geberth 2011). Moncrief and Popovitch described continuous ambulatory peritoneal dialysis for the first time in 1976, and in 1978 the continuous ambulatory peritoneal dialysis (CAPD) described by Oreopoulos made continuous dialysis treatment possible (Hepp 2009).

CCPD was first presented in 1981 as a further development of CAPD by Diaz- Buxo (Bauer 2009).

The CCPD counts alongside the

• automated peritoneal dialysis (APD) and the
• nocturnal intermittent PD (NIPD)

on machine-assisted forms of peritoneal dialysis (Herold 2020).

In recent years, CCPD has become more and more established (Kasper 2015) and is now the most frequently used method of automated peritoneal dialysis (APD) (Bauer 2009).

It is used, but less frequently than continuous outpatient peritoneal dialysis CAPD. (Kuhlmann 2015).

The peritoneum is the dialysis membrane in CPPD.

Through the capillaries of the peritoneum, substances from the blood accumulate in the dialysis solution by diffusion and are eliminated.

Small molecular parts can either diffuse or be transported by convection into the dialysis solution or peritoneal cavity.

Large-molecular parts leave the capillaries by convection. This usually requires a longer residence time of the dialysate, which is the case with CPPD (Geberth 2011).

The water, on the other hand, is primarily removed osmotically by the hypertonic dialysis solution (Moor 2018).

The clearance services provided by the CPPD are in the:

• small molecule range are clearly above those of hemofiltration (HF) see also kidney replacement treatment
• medium molecular range above that of haemodialysis (HD) see also kidney replacement treatment. However, it must be taken into account that the majority of CPPD patients still have residual renal function, through which medium-molecular parts can also be excreted (Keller 2010) (Streicher 1982).

s. CAPD

Indications of CCPD:

• Patients with infectious diseases such as hepatitis C, HIV etc.
• younger children
• Professionals (Hepp 2009 / Kuhlmann 2015 / Stein 2012)

Advantages of the CCPD:

• the patient is independent during the day - due to the lack of bag changes
• a professional activity can be pursued or school lessons can be attended
• the peritonitis rate is slightly lower than in CAPD
• the incidence of hernias is not as high as in CAPD

(Kuhlmann 2015)

Disadvantages of CCPD:

• the CCPD causes higher costs
• the cost of materials is higher than with CAPD (Kuhlmann 2015)

Contraindications of peritoneal dialysis are e.g.:

• existing diseases with an increased risk of peritonitis
• chronic inflammatory bowel disease (CED)
• COPD
• non-curable hernias
• Protein deficiency
• Psychoses (Herold 2020)
• diverticulitis known from medical history
• body weight > 90 kg
• Lack of hygienic behaviour
• Difficulties in material storage (e.g. due to cramped housing conditions)
• Colostoma
• Nephrostoma
• high renal protein loss with malnutrition
• numerous preliminary operations with adhesions
• very large cystic kidneys (Hepp 2009)

Implementation:

For CPPD, a catheter is surgically, laparoscopically or percutaneously implanted into the abdominal cavity approximately 2 weeks before the start of dialysis using the Seldinger technique (Geberth 2011).

The CCPD itself is performed in the home environment. The patient is connected overnight to a peritoneal dialysis machine, the so-called cycler. The cycler changes the dialysis bags independently between 4 - 6 times during the night and exchanges 2 - 3 l of fluid.

The last bag of dialysate remains in the abdomen during the day. It usually consists of a polyglucose-containing solution, as this enables ultrafiltration even with residence times of > 10 h (Kuhlmann 2015).

1. Bauer I Y B (2009) Complications of peritoneal dialysis - germ spectrum, incidence of peritonitis and dependence on treatment parameters. Inaugural- Dissertation of the Medical Faculty of the Eberhard-Karls-University of Tübingen.
2. Geberth S et al (2011) Practice of dialysis according to the guidelines NKF KDOQITM, KDIGO, EDTA, DGfN. Springer publishing house 189 - 190
3. Hepp W et al (2009) Dialysis shunts: Basics - Surgery - Complications. Steinkopff Publishing House 48 - 62
4. Herold G et al (2020) Internal medicine. Herold Publishing House 645
5. Kasper D L et al (2015) Harrison's Principles of Internal Medicine. Mc Graw Hill Education 1824
6. Kasper D L et al (2015) Harrison's Internal Medicine. Georg Thieme Publisher 2243
7. Keller C K et al (2010) Practice of nephrology. Springer Publishing House 251
8. Kuhlmann U et al (2015) Nephrology: Pathophysiology - Clinic - Kidney replacement procedure. Thieme Publishing House 716 - 717
9. Stein R et al. (2012)Pediatric Urology in Clinic and Practice.Georg Thieme Verlag 214