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DIALYSIS
DIALYSIS
Haemodialysis (HD)
Peritoneal Dialysis (PD)
They work on similar principles: Movement
of solute or water across a semipermeable
membrane (dialysis membrane)
Diffusion
Movement of solute
Across semipermeable membrane
From region of high concentration to one of
low concentration
Ultrafiltration
Clinical condition
Lifestyle
Patient competence/hygiene (PD - high risk
of infection)
Affordability / Availability
1.
2.
Blood cells are too big to pass through the dialysis membrane,
but body wastes begin to diffuse (pass) into the dialysis solution.
3.
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.
The process of ultrafiltration in PD
11.
2
2.
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.
3.
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
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
Requirements for HD
Done under
LA or GA
DIET
Why is diet important?
Potassium
Sodium
Phosphorous
Fluid
PROTEINS
Animal protein
Dairy (milk, cheese)
Meat (steak, pork)
Poultry (chicken, turkey)
Eggs
Plant protein
Vegetables
Breads
Cereals
MAJOR SOURCES
OF POTASSIUM
Milk Legumes
Potatoes Nuts
Bananas Salt substitute
Oranges Chocolate
Dried Fruit
SODIUM
Regulates blood volume and pressure
Avoid salt
Iron supplements
Blood pressure
Blood samples
LAB MONITORING
Haemoglobin Sodium
Albumin Potassium
Calcium Urea
Phosphorus Creatinine
GFR
(24 hour urine)
Lifestyle Changes with PD
Flexibility
– Can be performed almost anywhere
– Least impact on work / school life (esp APD)
Travel
– Dialysis supplies can be delivered to most parts of the
world; travel more flexible. APD machines are portable;
will fit into a car boot, can be carried by train/air
Responsibility
– Requires more responsibility from patient but more
independence
Lifestyle Changes with PD
Sports/Exercise
– Most are possible
– Advice on swimming, lifting, contact sports
Sexual Activity
– May affect relations based on patient anxiety
Delivery & Storage of Supplies
– Home delivery and storage
– A month’s supplies – 40 boxes; space to store
– Specially recruited and trained delivery staff
Problems with Treatment
Monotomy of treatment
– The treatment never goes away against days off with HD
Body Image Problems
– Esp with a permanent catheter
– Abdominal stretching
Fluid Overload
– Much less a problem than with HD
Dehydration
– Less common than fluid overload
Abdominal Discomfort
– Bloated feeling
Problems with Treatment
Poor drainage
– Common problem esp with new patients
– Fibrin plug
– Catheter displacement
Leakage
– Fluid may leak around catheter exit site. (May leak
into scrotum)
– Stop PD temporarily
– Resite catheter (use new one)
Infections
– Exit site infections
– Tunnel infection
– peritonitis
Problems with Treatment
Hernia
– Aggravation of pre-existing herniae (repair)
– Evolution of new herniae
Declining effectiveness of the peritoneum
– e.g. repeated infection
– Effect of glucose in the dialysis fluid
Comparison of Dialysis Treatment Options
PD Unit HD Home HD
Home Dialysis √ × √
Convenient Sessions √ × √
Socializn with other CRF pats × √ ×
Home Equipment/Supplies √ × √
Special diet/fluid allowance √ √ √
Sports/exercises participation Most Most Most
Full day activity -work/school √ Not alwys √
Direct assist–partner/family × × √
Travel √ Delivery of √ Prior × Prior
supplies to most arrangements arrangements must
destins easy. must be made be made well in
Some notice req well in advance advance