Nipd

NIPD (nocturnal intermittent peritoneal dialysis) counts alongside

• automated peritoneal dialysis (APD) and the
• continuous cycler-assisted peritoneal dialysis (CCPD)

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

The procedure for NIPD is very similar to that of continuous cycler-assisted peritoneal dialysis (CCPD) with the difference that the peritoneal cavity remains empty during the day (so-called "dry belly" [Kuhlmann 2015]) (Keller 2010).

Indications

The prerequisite for a NIPD is:

• a good renal residual function (Kasper 2015)
• especially suitable for patients with a high peritoneal permeability (so-called "fast transporters" see also Peritoneal Equilibration Test) (Keller 2010)

Further indications for peritoneal dialysis see CCPD

Advantages:

• patients are mobile during the day
• the cosmetic impairment is low (Herold 2020)
• the dialysis residence time is shortened by rapid mass transfer
• volume withdrawal is possible even at high glucose resorption rates (Geberth 2011)
• lower incidence of
  • Leakages
  • Hernias
  • Back pain (caused by the increased intra-abdominal pressure)
• in patients with high peritoneal transport rates there is - compared to CCPD - a better ultrafiltration
• low glucose absorption
• the incidence of peritonitis is lower in NIPD than in CAPD (Hörl 2003)

Disadvantages

• greater costs
• often insufficient clearance of smaller molecules (especially in patients without residual renal function or with so-called "low transporters" see also peritoneal equilibration test
• the clearance of uremic toxins with a higher molecular weight is worse than with CCPD
• short retention times result in a higher dialysis demand (Hörl 2003)

Implementation

For NIPD, 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).

NIPD itself is performed in the home environment. The patient is connected overnight to a peritoneal dialysis machine, the so-called cycler. The number of bag changes performed by the cycler is higher than for CCPD due to the short treatment time (Geberth 2011).

1. Geberth S et al. (2011) Dialysis practice:: According to the guidelines of: NKF (National Kidney Foundation), DHL (Deutsche Hochdruckliga), EDTA European Best Practice Guidelines), DGfN (German Society of Nephrology), KDIGOKidney Disease: Improving Global Outcome). Springer Publishing House 189
2. Herold G et al (2020) Internal medicine. Herold Publishing House 645
3. Hörl W H et al (2003) Dialysis procedures in clinic and practice: Technology and clinic. Thieme Publishing House 102
4. Kasper D L et al (2015) Harrison's Internal Medicine. Georg Thieme Publisher 2243
5. Keller C K et al (2010) Practice of nephrology: According to the guidelines of: NKF (National Kidney Foundation), DHL (Deutsche Hochdruckliga), EDTA European Best Practice Guidelines), DGfN (German Society of Nephrology), KDIGOKidney Disease: Improving Global Outcome). Springer Publishing House 251
6. Kuhlmann U et al (2015) Nephrology: Pathophysiology - Clinic - Kidney replacement procedure. Thieme Publishing House 716