Does everyone understand how important we are? Kidneys Urine
Types of Dialysis
Dialysis is a way to clean blood of wastes, fluids and salts that build up in the body when the kidneys fail. There are 2 kinds of Dialysis:
Uses the peritoneal membrane as the filter. The membrane covers the abdominal organs and lines the abdominal wall. This takes place inside the body and requires placement of a catheter in the peritoneal cavity to allow fluid to be instilled and drained out.
Uses a dialyzer or artificial kidney to filter the blood. This takes place outside the body and requires some form of access to the circulatory system. Accomplished with the use of a sophisticated computerized control unit (dialysis machine )
To be placed on a transplant list the patient must be on some form of renal replacement therapy, whether it is peritoneal dialysis or hemodialysis
Once a patient is accepted for transplant, the date of start of dialysis is the date they are active on the list
If the patient has a living donor who has been accepted as healthy donor, it is possible to have a pre-emptive transplant, bypassing dialysis.
No treatment or palliative care
Uses the peritoneal membrane as the filter. The membrane covers the abdominal organs and lines the abdominal wall. The membrane size is 1 – 2 m 2 and approximates the body surface area. Uses the following principles:
Diffusion : movement of solutes across the peritoneal membrane from an area of higher concentration to an area of lower concentration
Osmosis : movement of water across the peritoneal membrane from an area of lower solute concentration to an area of higher solute concentration.
Ultrafiltration: water removal related to an osmotic pressure gradient with the use of various concentrations of dialysate fluid
How does PD work?
Fluid called DIALYSATE is put into the abdomen through a PD catheter. This fluid is left to dwell in the peritoneum for several hours.
While in the abdomen, the fluid collects wastes that have been filtered through the peritoneal membrane. These wastes pass from the body when the fluid is drained.
Performed daily, by the patient at home, more physiological
Allows for independence, patients can work or travel
Fewer fluid and dietary restrictions
Often fewer medications or lower doses required
Residual renal function preserved
Ministry of Health funded home therapy
must have a clean room to perform exchanges and a large enough area to store all supplies
no pets allowed in the room
must learn to monitor their own weight and blood pressures
must be able to follow important instructions to prevent infection in the peritoneum
must also be able to determine the choice of dialysate fluid and when to use it
Peritoneal Dialysis Catheter
Types of Peritoneal Dialysis
CAPD ~ Continuous Ambulatory Peritoneal Dialysis
The blood is cleaned constantly by dialysate fluid while it is in the abdomen.
CAPD does not require the use of a machine, the exchanges are completed manually.
APD ~ Automated Peritoneal Dialysis
Requires the use of a machine called a CYCLER
The CYCLER is used during the night and is set to deliver the fluid in and out of the abdomen .
Blood is circulated through an artificial kidney which has two compartments: Blood & Dialysate, separated by a thin semi-permeable membrane
Waste and excess water pass from the blood side to the dialysate side and is discarded in the drain The cleaned blood is returned to the patient.
It is diffusion-based mass transfer (BUN, Creat, lytes) & Pressure-driven water removal (ultrafiltration)
usually done 3x /week ~ 4hrs M-W-F or T-Th-Sat
Hemodialysis treatments every other day are not as physiological as peritoneal dialysis
Requires a trip to the hospital up to 3 times weekly
Patients can travel to other units but must be pre-arranged and space is not always available
Patients are more restricted in dietary and fluid intake between treatments
Medication requirements different than for those on peritoneal dialysis e.g. require more antihypertensive meds, higher doses of Erythropoietin
Hemodialysis ~ The “Integra”
Requires access to the blood stream
Arterio – venous fistula
Arterio – venous graft
Long – term catheter
Hemodialysis ~ fistula
Hemodialysis ~ Graft
Temporary Hemodialysis Catheter Exit site at surface of the skin Tip located at junction of SVC and right Atrium Inserted in the jugular vein
Tunneled Hemodialysis Catheter Exit site Catheter tunnel Tip located at junction of SVC and right Atrium Inserted in the jugular vein Dacron cuff