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- Nierenzentrum Heidelberg am Universitätsklinikum Heidelberg, INF 162 69120 Heidelberg
The peritoneal dialysis department
Detoxification via the peritoneum
In peritoneal dialysis (PD), detoxification takes place via the peritoneum. For this purpose, the sterile dialysate is either filled in manually several times a day and left for several hours at a time or the dialysate is exchanged at night using a small device (so-called cycler or APD - automated PD).
Peritoneal dialysis is an accepted therapy in the treatment of patients with chronic kidney disease who require dialysis and is now recommended by some professional associations as the preferred renal replacement therapy. Irrespective of this, the proportion of peritoneal dialysis patients treated in Germany is disproportionately low at around 5 %; in international comparison, the figures are significantly higher.
The Heidelberg Kidney Center has been performing peritoneal dialysis since the early 1980s and has many years of expertise in this field.
Every year, around 50 new peritoneal dialysis catheter installations are carried out by the renal center, many of these as so-called contract services for external colleagues. Regular training courses are held for patients, nursing staff and doctors.
In addition to the high level of clinical expertise in all procedures offered in peritoneal dialysis, there is also a scientific focus on peritoneal dialysis. The scientific work in this field has been awarded several prizes. Specially trained and qualified staff, consisting of several nurses, doctors and social workers, are available for the treatment of peritoneal dialysis patients.
The renal center has a 24-hour on-call service for these patients. You are welcome to obtain further information in the peritoneal dialysis outpatient clinic.
The renal center currently offers 18 places for chronic dialysis patients, who are treated three times a week for around five hours in the morning or afternoon. We are currently treating over 80 patients with kidney failure requiring dialysis on a permanent outpatient basis, including patients with chronic hepatitis B and C.
Once patients with terminal renal failure have opted for the hemodialysis procedure, the vascular access (fistula) must first be surgically created in order to carry out the treatment. This requires a short inpatient stay for wound care and to instruct patients on how to handle their dialysis fistula.
The operation itself takes place on an outpatient basis at our cooperation partners at Heidelberg University Hospital, Vascular Surgery, Prof. Böckler or at St. Josef's Hospital in Heidelberg. The fistula should be created in good time before the planned first dialysis so that the wound can heal, the vessel can grow out and the first dialysis can then take place without complications. However, if an acute start to hemodialysis is necessary, an atrial catheter must be inserted to initiate dialysis. The patient can also be discharged home with this atrial catheter.
However, the risk of bloodstream infection (sepsis) is significantly higher compared to dialysis via a shunt, so an attempt should always be made to place a shunt in the long term. At our renal center, the rate of bloodstream infections of 0.0135 VC-associated infections/1000 catheter days is well below the benchmark recommended by the DGFN (1 infection per 1000 catheter days).
In addition to carrying out the dialysis treatment itself, we pay particular attention to avoiding uraemia-specific late damage. During each dialysis treatment, a specialist visit is made to clarify all current medical problems.
The function of the parathyroid gland and the electrolyte and phosphate balance are monitored regularly; cardiological and gastroenterological examinations as well as other imaging examinations are carried out at intervals.
Our services also include constant support from a social worker, a dietician and a clinical psychologist.
The aim of our efforts is to provide patients with optimal rehabilitation in their everyday lives and, if possible, in their professional lives. In principle, every patient who comes to our center for haemodialysis for the first time is evaluated for the possibility of inclusion on the transplant waiting list. We organize and manage the necessary examinations."
Peritoneal dialysis
A good alternative to renal replacement therapy
Peritoneal dialysis (peritoneal dialysis) has been established for many years as a good alternative in renal replacement therapy.
It is predominantly carried out as continuous outpatient peritoneal dialysis (PD). Approximately 5% of all patients nationwide are treated with peritoneal dialysis. At the Heidelberg Kidney Center, 30% of all chronic patients are treated with peritoneal dialysis. The major dialysis providers are available for PD, and automatic peritoneal dialysis (APD) is also performed.
In peritoneal dialysis, the peritoneum serves as the dialysis membrane. At the beginning of PD, a dialysis catheter is surgically inserted into the abdominal cavity. The catheter is inserted and removed intraoperatively in the presence of a PD doctor. After catheter insertion, the patient is trained under inpatient conditions. Sterile dialysate solution is then exchanged several times a day so that continuous and gentle dialysis is possible.
This procedure is therefore particularly suitable for patients with heart disease, but also for working people or patients who are dependent on a high degree of flexibility.
The advantages of this procedure lie in the gentle detoxification, high flexibility and mobility and is associated with better preservation of residual urine excretion. This has considerable advantages, particularly for patients who are registered for kidney transplantation. Among other things, these patients show a better primary functional uptake of the kidney transplant.
In contrast to hemodialysis, the patient does not present himself 3 times a week, but once every 6 weeks, for example. This is therefore a home dialysis procedure. PD must be carried out under clean environmental conditions. In principle, there is a risk of peritonitis as the catheter is connected to the peritoneum. The infection rate in our outpatient clinic is just under one peritonitis per 75 patient treatment months. If peritonitis occurs, it must be treated with antibiotics.
Specially trained staff are available for outpatient care and the outpatient clinic is open five days a week.
Outside of these hours, a PD doctor on call is available around the clock by telephone via the renal center gate.
Peritoneal dialysis employee
Martina Gerstle
Certified health and nursing professional
Peritoneal dialysis employee
Christiane Daumann
Certified health and nursing professional
