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Dr. Leonid Feldman Nephrology and Hypertension Division Assaf Harofeh Medical Center November, 2007 Peritoneal Dialysis.

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Presentation on theme: "Dr. Leonid Feldman Nephrology and Hypertension Division Assaf Harofeh Medical Center November, 2007 Peritoneal Dialysis."— Presentation transcript:

1 Dr. Leonid Feldman Nephrology and Hypertension Division Assaf Harofeh Medical Center November, 2007 Peritoneal Dialysis

2 AJKD 2002:39:S32 3.3

3 Three options for renal replacement therapy

4 Criteria for initiation of chronic dialysis Uremic syndrome Hyperkalemia Volume expansion Metabolic acidosis Bleeding diathesis CrCl ≤ 10 ml/min resistant to conservative therapy

5 KidneyDialyzer

6 Peritoneal Membrane

7 What is peritoneal dialysis?  PD involves the transport of solutes and water across a “membrane” that separates two fluid- containing compartments: 1.blood in the peritoneal capillaries 2.dialysis solution in the peritoneal cavity

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12 Peritoneal Transport  Tree Distinct Processes: Diffusion Ultrafiltration ( Convection ) Fluid Absorption

13 Peritoneal Transport  Two Clinical Endpoints: Clearance Fluid Removal

14 Peritoneal Membrane

15 Manual CAPD: Continuous Ambulotary Peritoneal Dialysis

16 Cycler: performs four or five exchanges overnight, while patient sleep

17 Two double-cuff Tenckhoff peritoneal catheters: standard (A), curled (B).

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20 Paradox of UF with glucose-based solutions: small pore radius A, glucose molecule 2-3A How does glucose exerts it’s osmotic gradient?

21 Peritoneal Membrane

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24 Directed primarily at small solutes clearance Use of 2.5% dextrose – osmotic drive not optimal Normal ranges for UF volume for each transport category - not fully defined Standard PET Peritoneal Equilibration Test

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29 Prognosis and transport type What happens with our high transporters?

30 The high transporters in the beginning have reduced patient survival Wang, NDT 1998

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32 Adequate dose of peritoneal dialysis Weekly Kt/V ≥ Creatinine clearence ≥ L/week K – urea clearence, L of blood/hour t – time, hours V – volume of Urea distribution

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34 Complications of peritoneal dialysis  Peritonitis and Exit site infections  Catheter problems (malfunction, leak)  Fluid overload  Hyperglycemia  Hyper- and hyponatremia  Hypoalbuminemia  Hernias

35 Exit site infection

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38 Sclerosing encapsulating peritonitis. Abdominal CT scan of a patient with sclerosing encapsulating peritonitis. The thickened peritoneum is clearly visible

39 Patients on dialysis in Israel Total dialysis HD PD 497 pts.–26% 545 pts.–23% 376 pts. – 8%

40 Percent distribution of prevalent dialysis patients, by modality, USRDS 2006

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42 Thank you

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44 Composition of Peritoneal Dialysis Solution 4.25%2.5%1.5% * * * Sodium(mEq/L) Potassium (mEq/L) Chloride (mEq/L) Calcium (mEq/L) Magnesium(mEq/L) Lactate (mEq/L) Glucose (mg/dL) pH Osmolality (mosm/kg) *Low Ca has 2.5 mEq/L

45 Blood vessels in the parietal peritoneum. Transverse sections of peritoneal arterioles (a) normal, (b) vasculopathy in a patient on PD; the vascular lumen is occluded by connective tissue containing fine calcific stippling (toluidine blue)

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55 Peritonitis  Empiric Treatment IP Cefazoline (15 mg/kg/d) + Ceftazidime (1g/d) Once culture results and sensitivities are known, antibiotic therapy should be adjusted as appropriate

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