Renal Replacement Therapy PDF

RENAL REPLACEMENT THERAPY Dr Naresh Midha Associate Professor General Medicine WHAT IS DIALYSIS  Dialysis is a procedure to remove waste products, toxins and excess fluid from the blood Acid Base Problems...

RENAL REPLACEMENT THERAPY Dr Naresh Midha Associate Professor General Medicine WHAT IS DIALYSIS  Dialysis is a procedure to remove waste products, toxins and excess fluid from the blood Acid Base Problems Serum Electrolytes abnormalities Intoxication Uremic symptoms (AKI/CKD) Fluid Overload TYPES OF DIALYSIS INDICATIONS FOR RENAL REPLACEMENT THERAPY IN CKD  Uremic Pericarditis (urgent indication).  Progressive uremic encephalopathy - confusion, asterixis, myoclonus or seizures (urgent indication).  Fluid overload refractory to diuretics.  Hypertension poorly responsive to antihypertensive medications.  Persistent metabolic disturbances that are refractory to medical therapy - hyperkalemia, hyponatremia, metabolic acidosis, hypercalcemia, hypocalcemia, and hyperphosphatemia.  Persistent nausea and vomiting. TYPES OF FILTRATIONS FORMS OF EXTRACORPOREAL RENAL REPLACEMENT THERAPY FORMS OF EXTRACORPOREAL RENAL REPLACEMENT THERAPY MECHANISM OF HEMODIALYSIS MACHINE & DIALYZER HEMODIALYSIS VASCULAR ACCESS  HEMODIALYSIS VASCULAR ACCESS AV Fistula AV Graft o Tube made of biocompatible material o High-pressure flow dilates and (gortex) attached end-to-side to thickens vein artery and vein o Best alternative: o required in patients with vascular Lowest infectious risk disease (occluded distal veins) Longest lasting with less o Advantages chances of thrombosis Ready to use when swelling o Drawbacks resolves (~2 weeks) Takes 2-4 months to mature o Disadvantages Only about 50% ever mature High stenosis/thrombosis rate Moderate infectious risk  HEMODIALYSIS VASCULAR ACCESS Catheter (IJ most common) o Tunnelled under skin to reduce communication from skin flora with blood o Advantages Ready for use immediately o Disadvantages High infectious risk High thrombosis risk A/W increased mortality Can be a sign of poor pre-dialysis care or extensive vascular disease SAVE THE NON-DOMINANT ARM FOR VASCULAR ACCESS When GFR < 30 mL/min o No BP measurement o No IV o No Blood Draws MODALITIES OF RRT INTERMITTENT AND CONTINUOUS FORMS OF RENAL REPLACEMENT THERAPY MODES OF RRT COMPLICATIONS OF HEMODIALYSIS Fever Bacteraemia, water-borne pyrogens, overheated dialysate Hypotension Excessive ultrafiltration, cardiac arrhythmia or due to anaphylaxis Hemolysis Inadequate removal of chloramine from dialysate Dementia Cerebral Edema, Electrolyte imbalance, Raised ICP Seizures Bleeding Excessive heparin or other anticoagulant Muscle cramps Excessive ultrafiltration, Electrolyte wash-out PERITONEAL DIALYSIS (PD) PERITONEAL DIALYSIS (PD)  Abdominal cavity is lined by a vascular peritoneal membrane which acts as a semi-permeable membrane  Diffusion of solutes (urea, creatinine) from blood into the dialysate contained in the abdominal cavity  Removal of excess water (ultrafiltration) due to osmotic gradient generated by glucose in dialysate TYPES OF PERITONEAL DIALYSIS CONTINUOUS PD REGIMENS CAPD: Continuous Ambulatory PD (Does not require a machine) CCPD: Continuous Cyclic PD (By automated machine) CONTINUOUS AMBULATORY PD PERITONEAL ACCESS  A Single-lumen, silicone rubber catheter traversing the anterior Dacron cuff abdominal wall IDEAL PERITONEAL DIALYSIS SOLUTION  consist of water, osmotic agents, electrolytes, and minerals and are sometimes fortified with different substances. Ideal PD fluid should -  Have a sustained and predictable solute clearance with minimal absorption of the osmotic agents  Provide deficient electrolytes and nutrients if required  Correct acid-base problems without interacting with other solutes in the peritoneal dialysis fluid  Be free of and inhibit the growth of pyrogens and micro-organisms  Be free of toxic metals  Be inert to the peritoneum COMPLICATIONS OF PERITONEAL DIALYSIS THANK S QUESTION