Differences between haemodialysis and peritoneal dialysis

1. RENAL DIALYSIS
Dr. V.S.Swathi
Assistant Professor

2. Definition
It is the process which substitutes many of
the normal functions of the kidney and
needed when kidneys no longer do its
normal function.

3. Indications of Renal dialysis
◦ Hyperkalemia
◦ Metabolic acidosis
◦ Fluid overload
◦ Uremic Pericarditis
◦ Other non specific symptoms like
◦ Anorexia
◦ Nausea
◦ Impaired nutritional status
◦ Increased sleepiness
◦ Decreased energy level
◦ Attentiveness
◦ Cognitive tasking

4. Indications of Renal dialysis
◦It is done until to get a kidney donor in case of
ESRD.
◦Temporary dialysis is done in case of:
Acute renal failure
Poisoning cases
Trauma to kidney
Chronic heart disease

5. Functions of Renal dialysis
◦It removes excess of wastes, salts and water from
the body
◦It maintains electrolyte balance
◦It helps in controlling blood pressure

7. Factors affecting Renal dialysis
◦ Stage of kidney injury
◦ Age and race of patient
◦ Co morbid conditions
◦ Quality of pre dialysis treatment
◦ Financial status of patient
◦ Fluid and diet control
◦ Control on taking potassium rich food and protein rich food
◦ Overall compliance of the patient

8. Types of Renal dialysis
◦ Haemodialysis
◦ Peritoneal dialysis

9. Haemodialysis
An artificial kidney is used to remove wastes, extra chemicals and fluid from the blood
Access for haemodialysis
◦ Minor surgery to arm or leg is needed
Fistula
◦ Joining of artery and vein under skin to make bigger blood vessel for collection of blood to
haemodialysis
Graft
◦ Artery and vein are joined with the help of plastic tube
Catheter
◦ Access made by means of narrow plastic tube which is inserted in to large vein in the neck

11. Working of Haemodialysis
◦ It works by principle of diffusion
◦ Dialysis has two parts; one for blood and other is for dialysate (washing
fluid) and thin membrane separates two parts.
◦ Blood is collected in to the artificial kidney from artery
◦ Essential components of blood like proteins and blood cells are not
crosses membrane due to its bigger size where as waste products like
creatinine, urea and other substances(extra fluid) crosses membrane
due to its small size and washed away from the body by artificial kidney
◦ Purified blood again goes in to the vein from dialyser

13. More points about Haemodialysis
◦ Haemodialysis is mostly done in dialysis center
◦ Patients who requires dialysis should visit centre thrice in a week
◦ Its duration is 3 to 4 hours
◦ It is done for acute kidney injury on temporary basis and for
chronic kidney disease for long time
◦ Dialysis efficiency is calculated by urea reduction ratio and Kt/V
◦ Urea reduction ration should be at least 65%
◦ Kt/v value should be at least 1.2

14. Advantages of Haemodialysis
◦ Minimal participation of patients
◦ Effective removal of waste products
◦ Care is given by trained professionals
◦ Rapid correction of electrolyte imbalance
◦ Treatment usually occurs 3 times per week
◦ No need of keeping and maintain of equipment at home

15. Disadvantages of Haemodialysis
◦ Minor surgery is required for vascular access
◦ Inflexible schedule
◦ Cramps and risk of bacteremia may occur

16. Composition of Haemodialysis fluid
◦ Sodium
◦ Chlorides
◦ Potassium
◦ Calcium
◦ Magnesium
◦ Acetate
◦ Bicarbonate
◦ Glucose

17. Peritoneal dialysis
◦ In this process blood is purified inside the body
◦ Requires small surgery for insertion of catheter in to
peritoneal cavity for vascular access

18. Working of Peritoneal dialysis
◦ Involves principle of diffusion, convection and ultrafilteration
◦ During treatment, catheter is inserted in to peritoneal cavity and it
is slowly filled with dialysate.
◦ Blood is collected from lining of peritoneal cavity in to the
catheter.
◦ Dialysate will washes the extra fluid and waste products from the
body and purified blood again go back to veins which surrounds
the peritoneal cavity

20. Types of Peritoneal dialysis
Continuous ambulatory peritoneal dialysis (CAPD)
◦ It is done without machine
◦ Done by patient him/ herself at home or at work
◦ Here bag of dialysate is connected to peritoneal cavity through catheter and waste products are
collected in other bag from the catheter.
◦ Requires 4 to 5 hours time
Automated peritoneal dialysis (APD)
◦ It can be done at home using special machine called cycler.
◦ Procedure is same like CAPD but manual changing of bags are not required
◦ Each cycle occurs for 90 minutes and can be done at during sleep

21. Advantages of Peritoneal dialysis
◦ Schedule flexibility
◦ Care can be taken by patient itself and patient care
takers
◦ Limited clinical visits
◦ No need of use of needles every time

22. Disadvantages of Peritoneal dialysis
◦ Body image is affected
◦ Every day treatment is required
◦ Less care by trained professionals and doctors
◦ Weight gain and peritonitis can occur
◦ Equipment maintenance is required at home

23. Composition of dialysate
◦ Sodium
◦ Chlorides
◦ Potassium
◦ Calcium
◦ Magnesium
◦ Lactate

24. Problems in Renal dialysis
◦ Hypotension
◦ Muscle cramps
◦ Nausea
◦ Vomiting
◦ Head ache
◦ Chest pain
◦ Back pain
◦ Itchiness
◦ Fever and chills
◦ Infection at access site
◦ Depression

25. Resources
◦ https://link.springer.com/article/10.1186/s12882-016-0292-9
◦ https://pdfs.semanticscholar.org/fc07/ba7e064fbc322a19f123d4d9a
faa5a4acfeb.pdf
◦ https://europepmc.org/backend/ptpmcrender.fcgi?accid=PMC5708
539&blobtype=pdf
◦ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6882607/pdf/medi-
98-e17923.pdf
◦ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6739024/pdf/medi-
98-e16812.pdf