1. DIALYSIS
Dr. Frank Edwin

2. CAUSES OF RENAL FAILURE
􀂃 Diabetes
􀂃 Untreated high blood pressure
􀂃 Inflammation
􀂃 Heredity
􀂃 Chronic infection
􀂃 Obstruction
􀂃 Accidents

3. 1.Renal Failure Diagnosis
Symptoms: Anorexia, Nausea, Vomiting, Oliguria
? Precipitating factors
Signs: Anaemia, Hypertension, Fluid Overload etc
Biochemistry:
Blood
Urea >7mmol/l
Creatinine >120umol/l
Electrolytes: Rising K+
Creatinine Clearance (GFR <<120ml/l)
Urine: Proteinuria
May be Acute or Chronic
Acute – Reversible or Irreversible

4. 2. Treatment Options No Treatment Monitoring & Predialysis Dialysis
Control symptoms
Preserve Residual Renal Function
Control rising BP (Antihypertensives)
Control Renal Bone Disease (Ca2+, Vit D)
Prevent/Treat Anaemias (Erythropoietin, Blood)
Dialysis
Renal Transplantation

5. Dialysis
Definition
Artificial process that partially replaces renal function
Removes waste products from blood by diffusion (toxin clearance)
Removes excess water by ultrafiltration (maintenance of fluid balance)
Wastes and water pass into a special liquid – dialysis fluid or dialysate

6. Types Haemodialysis (HD) Peritoneal Dialysis (PD)
They work on similar principles: Movement of solute or water across a semipermeable membrane (dialysis membrane)

7. Diffusion Movement of solute Across semipermeable membrane
From region of high concentration to one of low concentration

8. Ultrafiltration Made possible by osmosis Movement of water
Across semipermeable membrane
From low osmolality to high osmolality
Osmolality – number of osmotically active particles in a unit (litre) of solvent

9. The process of diffusion 1. 2
The process of diffusion                                                                                                Blood cells are too big to pass through the dialysis membrane,  but body wastes begin to diffuse (pass) into the dialysis solution                                                 Diffusion is complete. Body wastes have diffused through the membrane,  and now there are equal amounts of waste in both the blood and the  dialysis solution.

10. The process of ultrafiltration in PD 11. 2 2
The process of ultrafiltration in PD                                                                                                  Blood cells are too big to pass through the semi-permeable membrane,  but water in the blood is drawn into the dialysis fluid by the glucose                                                  Ultrafiltration is complete. Water has been drawn through the peritoneum by the glucose in the dialysis fluid  by the glucose in the dialysis fluid. There is now extra water in the dialysis  fluid which need to be changed.

11. Haemodialysis Dialysis process occurs outside the body in a machine
The dialysis membrane is an artificial one: Dialyser
The dialyser removes the excess fluid and wastes from the blood and returns the filtered blood to the body
Haemodialysis needs to be performed three times a week
Each session lasts 3-6 hrs

13. AV Fistula

14. Vascular Access Catheter

15. PD Access
Done under
LA or GA

16. Problems with HD Rapid changes in BP Fluid overload
fainting, vomiting, cramps, chest pain, irritability, fatigue, temporary loss of vision
Fluid overload
esp in between sessions
Fluid restrictions
more stringent with HD than PD
Hyperkalaemia
Loss of independence
Problems with access
poor quality, blockage etc. Infection (vascular access catheters)
Pain with needles
Bleeding
from the fistula during or after dialysis
Infections
during sessions; exit site infections; blood-borne viruses e.g. Hepatitis, HIV

17. SODIUM Regulates blood volume and pressure Avoid salt
Use Alternate food seasonings: lemon and limes, spices, seafood seasoning, Italian seasoning, vinegars, peppers

18. FLUIDS Healthy kidneys remove fluids as urine
Check for fluid and sodium retention
Need to restrict fluid intake

19. LAB MONITORING Haemoglobin Albumin Calcium Phosphorus GFR
(24 hour urine)
Sodium
Potassium
Urea
Creatinine