Last week my wife had an appointment with her GP to discuss her hypertension. During the conversation, inter alia, she commented in passing to her GP that I was on peritoneal dialysis. His response was somewhat baffling to me: “You know dialysis does not replace many of the functions of the kidneys.” When my wife related this interface to me, I immediately thought, “What Functions?” In all my training with Fresenius, dialysis research, and discussions with dialysis experts this subject had never been even hinted at let alone broached!
With my research assistant in hand, I wrote the following Prompt with the following results. Please, those on PD or considering PD read on. The AI-provided response sheds light on why my Dialysis Team is so intent on many of the lab results and also on other aspects of PD. By the way, I canceled my subscription to ChatGPT from OpenAI because readily available AI sources are at the forefront. In this instance, I am using my “new” go-to AI assistant, Poe, from Poe.com. I am running the Android App version.
Prompt: A natural kidney performs many functions. Explore the functions that ARE NOT addressed by peritoneal dialysis.
Poe AI Assistant’s Response:
Peritoneal dialysis is a form of renal replacement therapy that helps remove waste products and excess fluid from the body in individuals with kidney failure. While peritoneal dialysis is effective in addressing some aspects of kidney function, there are several functions of the natural kidneys that it does not fully replicate. Here are some functions that are not addressed by peritoneal dialysis:
- Hormone Production: The kidneys play a crucial role in hormone production. They produce erythropoietin (EPO), which stimulates the production of red blood cells in the bone marrow. Peritoneal dialysis does not produce EPO, so patients may require additional medications or injections to maintain adequate red blood cell production.
- Vitamin D Activation: The kidneys convert inactive vitamin D into its active form (calcitriol). Active vitamin D is essential for the absorption of calcium and phosphorus from the intestines and the regulation of bone health. In peritoneal dialysis, the kidneys’ ability to activate vitamin D is impaired, leading to the potential for vitamin D deficiency and subsequent bone problems.
- Acid-Base Balance: The kidneys help regulate the body’s acid-base balance by excreting hydrogen ions and reabsorbing bicarbonate ions. When the kidneys are not functioning properly, acid-base imbalances can occur. Peritoneal dialysis primarily focuses on fluid and waste removal and may not adequately address acid-base imbalances, requiring additional interventions or medications.
- Electrolyte Regulation: The kidneys play a vital role in maintaining the balance of electrolytes such as sodium, potassium, calcium, and phosphate in the body. Peritoneal dialysis helps remove some electrolytes, but it may not provide the same degree of fine-tuned regulation as healthy kidneys. Frequent monitoring and adjustments in diet or medications may be necessary to maintain proper electrolyte balance.
- Blood Pressure Regulation: Healthy kidneys help regulate blood pressure by controlling the balance of water and sodium in the body. In peritoneal dialysis, blood pressure management may be more challenging, and patients may require additional medications to control hypertension.
- Toxin Clearance: While peritoneal dialysis effectively removes waste products from the blood, it may not be as efficient as healthy kidneys in clearing certain toxins. Some toxins, such as certain medications or substances with larger molecular sizes, may not be effectively cleared by peritoneal dialysis alone.
It’s important to note that peritoneal dialysis is a valuable treatment option, and its benefits often outweigh the limitations compared to natural kidney functions. However, patients undergoing peritoneal dialysis may require additional medical interventions and close monitoring to address the functions that are not fully replicated by the therapy.
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