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Renal replacement therapy

life saving therapy for the people with deranged renal funtion

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Renal replacement therapy

  1. 1. Renalreplacementtherapy DrBhupendraShah(AP) B.P.koirala institute of healthsciences
  2. 2. Modesof Renalreplacementtherapy  Hemodialysis  Peritoneal dialysis  Renal transplantation
  3. 3. Hemodialysis  Done in Acute kidney injury as well as Chronic kidney disease  Renal impairment interferes with the excretion of water, electrolytes, and organic solutes
  4. 4. Hemodialysis inAKI Metabolic acidosis ( pH<7.10 ) BUN>100 mg/dl Anuria Hyperkalemia (≥6.5meq/l) Uremic symptoms Rapid rise in urea/creatinine Certain alcohol and drug intoxications
  5. 5. Dialysis in AKI  Late initiation of dialysis:  Risk of avoidable volume, electrolyte, and metabolic complications  Initiating dialysis too early:  Unnecessarily exposure to intravenous lines and invasive procedures  Risks of infection, bleeding, and procedural complications  BUT DO NOT WAIT FOR A LIFE THREATENING COMPLICATION
  6. 6. Hemodialysis  The most common form of renal replacement therapy for AKI  Vascular access via the femoral, internal jugular, or subclavian veins  Removes solutes through diffusive and convective clearance  Typically performed 3–4 h per day, three to four times per week  Peritoneal dialysis often better tolerated than intermittent procedures like hemodialysis in hypotensive patients
  7. 7. How is hemodialysis done?
  8. 8. Dialyser Small solutes are removed across a semipermeable membrane
  9. 9. Complications duringHD  Hypotension — 25 to 55 percent  Cramps — 5 to 20 percent  Nausea and vomiting — 5 to 15 percent  Headache — 5 percent  Chest pain — 2 to 5 percent  Back pain — 2 to 5 percent  Itching — 5 percent  Fever and chills — Less than 1 percent
  10. 10. Peritonealdialysis  Performed through a temporary intraperitoneal catheter  Enjoyed widespread use internationally, particularly when hemodialysis technology is not available  Dialysate solution is instilled into and removed from the peritoneal cavity at regular intervals in order to achieve diffusive and convective clearance of solutes across the peritoneal membrane
  11. 11. Peritonealdialysis  Osmotic gradient across the peritoneal membrane achieved by high concentrations of dextrose in the dialysate solution  Often better tolerated than intermittent procedures like hemodialysis in hypotensive patients  Main problem is inadequate solute clearance
  12. 12. Peritonealdialysis: Youcando it at home
  13. 13. Hemodialysis inCKD Uremic encephalopathy (confusion, asterixis, myoclonus, wrist drop) Uremic gastritis Uremic pericarditis Uremic neuropathy Persistent hyperkalemia Persistent volume overload Bleeding diasthesis attributable to uremia Hypertension refractory to antihypertensives
  14. 14. VascularaccessforHD in CKDpatients  A-V fistula  Central catheters  Femoral catheter
  15. 15. Initiation of HDin CKD  CKD: No difference in survival between early or late initiation of dialysis  Dialysis initiation should be based upon clinical factors rather than the estimated GFR alone  Advantages of early dialysis: control of hypertension and increased dietary intake  Delaying initiation of diaysis: maturation of vascular access and chances of renal transplantation
  16. 16. How frequently?  For the majority of patients with ESRD, between 9 and 12 h of dialysis are required each week, usually divided into three equal sessions
  17. 17. Peritonealdialysis inCKD  Can be done at home  Not as efficient as hemodialysis  Has complications of its own
  18. 18. Donethrougha peritonealcatheter
  19. 19.  1.5–3 L of a dextrose-containing solution is infused into the peritoneal cavity and allowed to dwell for a set period of time, usually 2–4 h  Toxic materials are removed through a combination of convective clearance generated through ultrafiltration and diffusive clearance
  20. 20. Choiceis yours
  21. 21. Renaltransplantation
  22. 22. Renaltransplantation  Survival benefits of renal transplantation over dialysis therapy are well established for patients with end-stage renal disease  Post transplant outcomes are better these days  Living-donor grafts have a 96% 1-year survival
  23. 23. Problemswithtransplantation  Paucity of donors  Rejection  Technically difficult  Use of drugs post-transplant including immunosuppresive agents
  24. 24. Thank you