Renal dialysis

Differences between haemodialysis and peritoneal dialysis

1. ReNAL DIALYSIS Dr. V.S.Swathi Assistant Professor

2. Definition It is the process which substitutes many of the normal functions of the kidney and needed when kidneys no longer do its normal function.

3. Indications of Renal dialysis Hyperkalemia Metabolic acidosis Fluid overload Uremic Pericarditis Other non specific symptoms like Anorexia Nausea Impaired nutritional status Increased sleepiness Decreased energy level Attentiveness Cognitive tasking

4. Indications of Renal dialysis It is done until to get a kidney donor in case of ESRD. Temporary dialysis is done in case of: Acute renal failure Poisoning cases Trauma to kidney Chronic heart disease

5. Functions of Renal dialysis It removes excess of wastes, salts and water from the body It maintains electrolyte balance It helps in controlling blood pressure

6. Factors affecting Renal dialysis Stage of kidney injury Age and race of patient Co morbid conditions Quality of pre dialysis treatment Financial status of patient Fluid and diet control Control on taking potassium rich food and protein rich food Overall compliance of the patient

7. Types of Renal dialysis Haemodialysis Peritoneal dialysis

8. Haemodialysis An artificial kidney is used to remove wastes, extra chemicals and fluid from the blood Access for haemodialysis Minor surgery to arm or leg is needed Fistula Joining of artery and vein under skin to make bigger blood vessel for collection of blood to haemodialysis Graft Artery and vein are joined with the help of plastic tube Catheter Access made by means of narrow plastic tube which is inserted in to large vein in the neck

9. Working of Haemodialysis It works by principle of diffusion Dialysis has two parts; one for blood and other is for dialysate (washing fluid) and thin membrane separates two parts. Blood is collected in to the artificial kidney from artery Essential components of blood like proteins and blood cells are not crosses membrane due to its bigger size where as waste products like creatinine, urea and other substances(extra fluid) crosses membrane due to its small size and washed away from the body by artificial kidney Purified blood again goes in to the vein from dialyser

10. More points about Haemodialysis Haemodialysis is mostly done in dialysis center Patients who requires dialysis should visit centre thrice in a week Its duration is 3 to 4 hours It is done for acute kidney injury on temporary basis and for chronic kidney disease for long time Dialysis efficiency is calculated by urea reduction ratio and Kt/V Urea reduction ration should be at least 65% Kt/v value should be at least 1.2

11. Advantages of Haemodialysis Minimal participation of patients Effective removal of waste products Care is given by trained professionals Rapid correction of electrolyte imbalance Treatment usually occurs 3 times per week No need of keeping and maintain of equipment at home

12. Disadvantages of Haemodialysis Minor surgery is required for vascular access Inflexible schedule Cramps and risk of bacteremia may occur

13. Composition of Haemodialysis fluid Sodium Chlorides Potassium Calcium Magnesium Acetate Bicarbonate Glucose

14. Peritoneal dialysis In this process blood is purified inside the body Requires small surgery for insertion of catheter in to peritoneal cavity for vascular access

15. Working of Peritoneal dialysis Involves principle of diffusion, convection and ultrafilteration During treatment, catheter is inserted in to peritoneal cavity and it is slowly filled with dialysate. Blood is collected from lining of peritoneal cavity in to the catheter. Dialysate will washes the extra fluid and waste products from the body and purified blood again go back to veins which surrounds the peritoneal cavity

16. Types of Peritoneal dialysis Continuous ambulatory peritoneal dialysis (CAPD) It is done without machine Done by patient him/ herself at home or at work Here bag of dialysate is connected to peritoneal cavity through catheter and waste products are collected in other bag from the catheter. Requires 4 to 5 hours time Automated peritoneal dialysis (APD) It can be done at home using special machine called cycler. Procedure is same like CAPD but manual changing of bags are not required Each cycle occurs for 90 minutes and can be done at during sleep

17. Advantages of Peritoneal dialysis Schedule flexibility Care can be taken by patient itself and patient care takers Limited clinical visits No need of use of needles every time

18. Disadvantages of Peritoneal dialysis Body image is affected Every day treatment is required Less care by trained professionals and doctors Weight gain and peritonitis can occur Equipment maintenance is required at home

19. Composition of dialysate Sodium Chlorides Potassium Calcium Magnesium Lactate

20. Problems in Renal dialysis Hypotension Muscle cramps Nausea Vomiting Head ache Chest pain Back pain Itchiness Fever and chills Infection at access site Depression

21. Resources https://link.springer.com/article/10.1186/s12882-016-0292-9 https://pdfs.semanticscholar.org/fc07/ba7e064fbc322a19f123d4d9afaa5a4acfeb.pdf https://europepmc.org/backend/ptpmcrender.fcgi?accid=PMC5708539&blobtype=pdf https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6882607/pdf/medi-98-e17923.pdf https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6739024/pdf/medi-98-e16812.pdf