Michaela Cartner on Dialysis

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  • Cole: there is a rise to 7 but compensated by reduction in CL and removal of unmeasured ionaions
  • Michaela Cartner on Dialysis

    1. 1. Compare and Contrast 3 Modalities of Renal Replacement Therapy CRRT/SLED/IHD
    2. 2. Explain the Acronym IHD – Intermittent Haemodialysis SLEDD – Slow Low Efficiency Daily Dialysis CRRT – Continuous Renal Replacement Therapy
    3. 3. Haemodialysis vs Haemofiltration
    4. 4. Dialysis Electrochemical gradient across the membrane DIFFUSION across the membrane Eg, IHD, CAPD Good for small molecules eg Urea
    5. 5. Filtration “Solvent drag” driven by transmembrane pressure (solute carried in solution) Solute and solvent move across porous membrane (CONVECTION) Good for fluid and middle sized molecules
    6. 6. Convection of a Solute Depends on – Hydraulic permeability coefficient (sieving Coefficient) – Membrane Surface area – Transmembrane pressure
    7. 7. Patient Type- IHD
    8. 8. Patient Type- CRRT
    9. 9. Outline the differences inmembranes between IHD and CRRT
    10. 10. IHD membranes  Low flux  Cellulose based (cuprophane)  Unable to remove middle molecules >500kD  Haemodynamic instability and SIRS response…  Need large SA if high volume…1.6-2m2
    11. 11. CRRT membranes High flux Synthetic Remove up to 20-30kD Convection superior to diffusion Membrane size not standard. 1.2m2 AN69, polyamide, polysulphone, cellulose triacetate
    12. 12. Time for some evidence: HEMO study: no impact on morbidity with high or low flux filters Eknoyan G et al, Effect of dialysis dose and membrane flux in maintenance hemodialysis NEJM, 2002 347:2010-9 Cochrane data base review: no benefit in terms of mortality or dialysis related adverse events MPO study: mortality benefit in Alb<40 or B2M. Locatelli F et al, Membrane permiability outcome group: Effect of membrane permiability on survival of haemodialysis patients. J Am Soc Nephrol 2009; 20: 645-654
    13. 13. Blood flow rate
    14. 14. 3 Modalities and Clotting
    15. 15. 3 Modalities and Access devices
    16. 16. Dialysis Rate
    17. 17. TYPES of Buffer• LACTATE-> bicarb  BICARB-> expensive, 1:1 by liver reserved for those unable process lactate or high lactate producing…..(7) short shelf life
    18. 18. Other Additives K+  No K added for use in hyperkalaemic states PO4 – Would precipitate out with Ca++ so is replaced systemically Water Soluble vitamins, replaced systemically Proteins esp glutamate
    19. 19. Dialysate fluids …the Evidence Cole et al The Impact of lactate buffered high volume hemofiltration on acid base balance Intensive Care Medicine 2003:29:1113-20 Barenbrock Effects of Bicarb and lactate buffered replacement fluids on CVS outcome in CVVH patients Kidney Int 2000;58(4) 1751-7
    20. 20. How long should a filter last?
    21. 21. ADVANTAGES &DISADVANTAGES
    22. 22. Thank you

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