Page 21 - GHES-3-2

Global Health Economics and
Sustainability
Retrospective analysis of dialysis and kidney transplant

Figure 1. Components of a hemodialysis system

flexibility, enabling home-based treatment and reducing PD include infections (peritonitis), catheter problems, and
the need for hospital visits, making it an attractive option issues related to fluid balance (Alscher, 2005).
(Amerling et al., 2003).
2.2.5. Factors affecting efficiency and physiological
2.2.4. Principles of PD aspects of PD
The mechanism of PD is similar to that of HD, but PD The permeability of the peritoneal membrane is
uses the peritoneum as the membrane for solute exchange. influenced by its surface area and the size of the pores in
This process relies on the peritoneum’s natural ability to the mesothelial cells. Permeability variations affect how
filter blood and remove waste products (Mehrotra et al., effectively solutes and fluids are exchanged (Stachowska-
2016). The efficiency of PD depends on the transport Pietka et al., 2015). Nonetheless, chronic exposure to
characteristics of the peritoneal membrane, including dialysis solutions, especially those with high-glucose
surface area, permeability, and thickness (Mehrotra etal., concentrations, can lead to inflammation and fibrosis,
2016). Ultrafiltration is the removal of fluid driven by subsequently reducing membrane permeability over
osmotic pressure created by the dialysate. The volume of fluid time (Stachowska-Pietka et al., 2015). Besides that,
removed can be adjusted by changing the concentration of the efficiency of PD is influenced by the dialysate
osmotic agents in the dialysate. Conversely, the clearance composition, including its osmotic agents. High-glucose
of solutes (e.g., urea and creatinine) is influenced by the concentrations can increase ultrafiltration but may also
dialysis solution composition and dwell time (Mehrotra lead to adverse effects on the peritoneal membrane over
time (Stachowska-Pietka et al., 2015).
et al., 2016).
However, not all patients are suitable for PD. Factors, 2.3. Comparison between HD and PD
such as peritoneal membrane function, patient compliance, Among ESRD patients, PD and HD remain the two major
and anatomical considerations, determine patient dialysis modes, with their respective indications and
suitability (Alscher, 2005). The common complications of contraindications, depending on the patient’s medical

Volume 3 Issue 2 (2025) 13 https://doi.org/10.36922/ghes.4639