Preface

The peritoneal dialysis (PD) is a kidney replacement therapy technique that has been growing in the last years. One reason for this growth is the freedom that the PD technique provides pa‐ tients allowing them a better social development. However, parallel to the increase in frequen‐ cy, it also increased its complications.

Cardiovascular and infectious diseases, malnutrition and peritoneal damage arising from inher‐ ent to PD process itself are still the leading causes of morbidity and mortality. Recently, there have been many advances in the understanding of the complications associated with PD and uremic state that suggests that the peritoneal cavity is a victim of the attacks produced by bioincompatible liquids, plastics, hemoperitoneum and infections and see victimizer because acti‐ vation of this cavity acts as a true organ releasing substances with systemic effects. These substances could induce systemic effects as inflammation, dyslipidemia, diabetes, hyperten‐ sion, accelerated atherosclerosis and malnutrition. Effectively, the hyperproduction and renal retention of pro-inflammatory cytokines is key for the initiation and maintenance of accelerated atherosclerosis, loss of renal function, bone renal diseases, protein malnutrition and other ure‐ mic complications. Furthermore, local effects of PD liquids that activate the immune system, the abdominal fat tissue, which is bathed by these PD liquids, the mesothelial cells and the oth‐ er components of the abdominal cavity, induce deterioration of the peritoneal membrane reach‐ ing anatomical and functional failure. Although considerable efforts to improve the biocompatibility of PD fluid has been made in the last years. It should be noted also that the changes undergone in the peritoneal and mesothelial-to-mesenchymal transition (MMT) offer new and novel therapeutic opportunities. MMT is regularly triggered by the action of glucose degradation products, low pH of the PD fluids, and other advance glycation end-products for‐ mation. These transdifferentiated mesothelial cells acquire migratory capacity, invade the sub‐ mesotelio where they produce high quantity of extracellular matrix components and high number of sanguineous and lymphatic vessels (angiogenesis and lymphangiogenesis).

This book provides an update on the emerging concepts in relation to new substances and mechanisms implicated in PD complications and attempts to organize the puzzle of these po‐ tentially active molecules. The authors have made a significant effort to update and summarize the relevance of each topic and especially to sort, in a logical and understandable way, the in‐ formation provided here. New therapeutic strategies are proposed.

> **Dr. Abelardo Aguilera Peralta (MD, Ph.D),** specialty in Nephrology, senior researcher (Miguel Servet Program) at Instituto de Investigación Sanitaria del Hospital Universitaria de la Princesa, Madrid, Spain

**Section 1**

**The Peritoneal Catheter in Peritoneal Dialysis**

**The Peritoneal Catheter in Peritoneal Dialysis**

**Chapter 1**

**Peritoneal Dialysis Catheter Placement and**

Peritoneal dialysis (PD) is an alternative to hemodialysis in patients with end-stage renal disease (ESRD). The main function of a peritoneal dialysis catheter is to permit consistent bidirectional flow of dialysate into intraabdominal peritoneal cavity without obstruction or undue discomfort [1]. Most catheters are flexible tubes with multiple ports in the intraabdo‐ minal segment which is ideally positioned freely in the intraabdominal pelvic area. The catheter's function depends upon its design, implantation site, and the configuration of the system used to perform dialysis exchanges, and also be directly related to skill of catheter placement doctors, catheter-related problems and infections are responsible for approximately 20% of implantation technique failure [2]. 12 contents of this chapter are types of catheters, considerations in catheter placement, exit site location, exit site size, antibiotic prophylaxis, implantation technique, postoperative catheter care, exit site care, complication, repositioning migrated peritoneal dialysis catheters, brief information for patients, recommendations.

Many types of catheters are currently available for chronic peritoneal dialysis (Figure 1).

Peritoneal catheters have intraperitoneal and extraperitoneal segments. The extraperitoneal segment passes through a tunnel within the abdominal wall, exits through the skin, and has an external segment. Most catheters are flexible tubes with multiple ports in the distal intraperitoneal segment. The intraperitoneal portion of the catheter should be ideally placed between the visceral and parietal peritoneum near the pouch of Douglas. The catheter's midportion is normally implanted within the wall of the abdomen by one to two Dacron velour cuffs. With double-cuffed catheters, the inner cuff should be imbedded in the abdominal rectus muscle to prevent leaks; the superficial cuff in both double cuff and single cuff catheters should

> © 2013 Su; licensee InTech. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use,

© 2013 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution,

distribution, and reproduction in any medium, provided the original work is properly cited.

and reproduction in any medium, provided the original work is properly cited.

Additional information is available at the end of the chapter

**Management**

http://dx.doi.org/10.5772/56596

**1. Introduction**

**1.1. Types of catheters**

Zhen Su
