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Intermittent Peritoneal Dialysis – IPD Explained

Intermittent peritoneal dialysis (IPD) is a kidney replacement therapy that uses the peritoneum as a natural filter membrane to remove waste products and excess fluid from the blood.

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Things worth knowing about "Intermittent Peritoneal Dialysis"

Intermittent peritoneal dialysis (IPD) is a kidney replacement therapy that uses the peritoneum as a natural filter membrane to remove waste products and excess fluid from the blood.

What is Intermittent Peritoneal Dialysis?

Intermittent peritoneal dialysis (IPD) is a form of peritoneal dialysis in which treatment is carried out during scheduled, time-limited sessions rather than continuously. It belongs to the group of renal replacement therapies and is used when the kidneys can no longer adequately perform their filtering function. The peritoneum – the thin membrane lining the abdominal cavity – acts as a natural, semipermeable filter.

Mechanism of Action

During IPD, a specially formulated dialysis solution (dialysate) is introduced into the abdominal cavity through a permanently placed catheter. Through the processes of diffusion and osmosis, waste products such as urea, creatinine, and excess electrolytes and fluid pass from the blood vessels in the peritoneum into the dialysate. After a defined dwell time, the spent dialysate is drained and replaced with fresh solution. This cycle is repeated multiple times during each treatment session.

Differences from Other Forms of Peritoneal Dialysis

Peritoneal dialysis includes several modalities:

IPD (Intermittent Peritoneal Dialysis): Treatment takes place in individual sessions, typically 3–5 times per week over 8–12 hours each, often in a clinical setting.
CAPD (Continuous Ambulatory Peritoneal Dialysis): Continuous home-based treatment with several manual exchanges per day.
APD (Automated Peritoneal Dialysis): Machine-assisted treatment, usually performed overnight during sleep.

IPD is used less frequently today than in the past, as continuous modalities generally achieve more effective clearance of toxins.

Indications

Intermittent peritoneal dialysis may be used in the following situations:

Acute kidney injury, particularly when venous access for haemodialysis is not feasible
End-stage chronic kidney disease (terminal renal failure)
Patients for whom haemodialysis is contraindicated (e.g., cardiovascular disease or poor vascular access)
Certain poisonings or metabolic emergencies
Children and neonates with kidney failure, as the procedure is considered gentler

Procedure

Before starting IPD, a peritoneal catheter (usually a Tenckhoff catheter) is surgically placed into the abdominal cavity. During each treatment session, the following steps are repeated:

Fill: 1–3 litres of dialysis solution are infused into the abdominal cavity.
Dwell: The solution remains in the abdomen for a set period (shorter than in CAPD during IPD sessions).
Drain: The used dialysate is drained out of the abdomen.

Sessions may be carried out in a hospital, dialysis centre, or – with appropriate training – at home.

Advantages

No continuous venous access required
Gentler haemodynamic impact compared to haemodialysis
Suitable for patients with cardiovascular conditions
Potential for home-based dialysis
Residual kidney function is often preserved for longer

Possible Risks and Side Effects

Peritonitis: Inflammation of the peritoneum due to infection – the most common and serious complication
Catheter-site infections at the exit site
Mechanical issues such as catheter kinking or inadequate drainage
Hyperglycaemia (elevated blood sugar) caused by the glucose-containing dialysate
Protein loss through the dialysate
Hernia formation due to increased intra-abdominal pressure
Reduced dialysis efficiency if peritoneal membrane function is impaired

Contraindications

IPD is not suitable for patients with:

Extensive pre-existing abdominal adhesions
Active inflammatory bowel disease or diverticular perforation
Recent abdominal surgery (relative contraindication)
Severe respiratory compromise that could be worsened by increased abdominal pressure

References

Daugirdas, J. T., Blake, P. G., Ing, T. S. – Handbook of Dialysis. 5th edition. Wolters Kluwer, 2015.
Bargman, J. M. – Advances in peritoneal dialysis: a review. Seminars in Dialysis, 2012.
World Health Organization (WHO) – Chronic kidney disease and renal replacement therapy. Available at: https://www.who.int (accessed 2024).

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