Dialysis PPT PDF

DIALYSIS  Introduction of dialysis Types Dialysis process Types of peritoneal dialysis Indications Complications TYPES 1. HEMODIALYSIS 2.PERITONEAL DIALYSIS RENAL DIALYSIS Dialysis is a life-saving treatment used for patients with chronic kidney disease (CKD) or acute kidney inj...

DIALYSIS  Introduction of dialysis Types Dialysis process Types of peritoneal dialysis Indications Complications TYPES 1. HEMODIALYSIS 2.PERITONEAL DIALYSIS RENAL DIALYSIS Dialysis is a life-saving treatment used for patients with chronic kidney disease (CKD) or acute kidney injury (AKI) when the kidneys can no longer maintain normal fluid, electrolyte, and waste balance. It helps manage symptoms of kidney failure, including uremia, fluid overload, and electrolyte imbalances. Dialysis may be temporary (for AKI) or a long-term solution (for End-Stage Kidney Disease, ESKD) HEMODIALYSIS (HD) Hemodialysis is the most common form of dialysis used in patients with ESKD. It involves passing blood through a filter called a dialyzer, where wastes and excess fluids are removed before the blood is returned to the body COMPONENTS Dialyzer Dialysate Blood delivery system DIALYZER Dialyzer are hollow-fiber artificial kidneys that contain thousands of tiny tubules that act as semipermeable membranes. The blood flows through the tubules, while a solution (the dialysate) circulates around the tubules. The exchange of wastes from the blood to the dialysate occurs through the semipermeable membrane of the tubules Direction of blood and dialysate flow in artificial kidney The blood flows in one direction and the dialysate flows in the opposite DIALYSATE Customizable fluid that helps pull out waste products. It contains water and electrolytes, and its composition can be adjusted depending on the patient’s needs (e.g., sodium, potassium, calcium levels). Potassium concentrations typically range from 0–4 mmol/L. Blood Delivery System Blood is pumped from the patient, through the dialyzer, and back to the patient. Blood flow rates are typically between 250–450 mL/min. The system includes monitors for blood pressure, air bubbles, and flow rates. Vascular Access of Hemodialysis Access to the patient's vascular system must be established to allow blood to be removed, cleansed, and returned to the patient's vascular system Several types of access are available. Arteriovenous (AV) Fistula Arteriovenous (AV) Graft Catheters Fistula A more permanent access. created surgically (usually in the forearm) by joining an artery to a vein, either side to side or end to side. The arterial segment the fistula is used for arterial flow and the venous segment for reinfusion of the dialyzed blood The fistula takes 4 to 6 weeks to mature before it is ready for use. This gives time for healing and for the venous segment of the fistula to dilate GRAFT An arterio venous graft can be created by subcutaneously inserting a biologic, semi biologic, or synthetic graft material between an artery and vein Indications: When the patient's vessels are not suitable for a fistula. Grafts are usually placed in the forearm, upper arm, or upper thigh Complications of Hemodialysis: Hypotension: The most common complication, especially in diabetic patients. This occurs due to rapid fluid removal, inadequate vascular refilling, or overuse of antihypertensive medications. Muscle Cramps: Often related to excessive fluid removal or low blood pressure. Infections: Particularly in catheter-related access, infections are a major cause of morbidity. AV fistulas have the lowest infection rate, while catheters are associated with the highest infection risk. Vascular Access Problems: Thrombosis and stenosis are common issues with grafts and catheters. Peritoneal Dialysis (PD) Peritoneal dialysis is less commonly used in developed countries but is a preferred option in areas with limited healthcare resources. It involves the infusion of a dialysate solution into the peritoneal cavity, where the peritoneal membrane acts as a natural filter. MECHANISM Dialysate: A dextrose-based solution is instilled into the abdomen and left for a dwell time of 2–4 hours. Wastes pass from the blood vessels into the dialysate, and then the fluid is drained out. Ultrafiltration: Fluid removal occurs through osmotic gradients created by the dextrose in the dialysate. Forms of PD: Continuous Ambulatory Peritoneal Dialysis (CAPD): The patient performs manual exchanges 3–5 times a day. Continuous Cyclic Peritoneal Dialysis (CCPD): Exchanges are done automatically by a machine (cycler), typically overnight. Hybrid Approach: Some patients may combine both methods to optimize solute clearance. Complications of Peritoneal Dialysis: Peritonitis: The most serious complication, characterized by abdominal pain, fever, and cloudy dialysate. This is often caused by contamination during exchanges. Catheter-Related Infections: Nonperitonitis infections can occur at the catheter insertion site. Metabolic Complications: Due to dextrose absorption, patients may experience hyperglycemia and weight gain. Albumin and protein losses are also common, necessitating higher dietary protein intake. Residual Uremia: PD may be less efficient in clearing waste compared to HD, particularly in patients with little or no residual kidney function. Indications for Starting Dialysis Dialysis initiation depends on symptoms rather than a specific creatinine or urea level. Common indications include: Severe uremic symptoms: Fatigue, anorexia, nausea, vomiting, and pruritus. Refractory hyperkalemia: High potassium levels not responsive to conservative treatments. Fluid overload: Especially if resistant to diuretics, causing symptoms such as difficulty breathing. Metabolic acidosis: Uncontrolled by medical therapies. Pericarditis or encephalopathy: Late complications that are now rare due to earlier dialysis initiation. Global Perspective on Dialysis The availability and utilization of dialysis vary worldwide: In wealthier nations, hemodialysis is more commonly used, while in low-resource settings, peritoneal dialysis is often preferred due to lower costs. Kidney transplantation offers the best outcome for ESKD, but the availability of organs is limited in many regions.