DIALYSIS

Dr Frank Edwin

CAUSES OF RENAL FAILURE

1048707 Diabetes1048707 Untreated high blood pressure1048707 Inflammation1048707 Heredity1048707 Chronic infection1048707 Obstruction1048707 Accidents

1Renal Failure DiagnosisSymptoms Anorexia Nausea Vomiting Oliguria

bull Precipitating factors

Signs Anaemia Hypertension Fluid Overload etcBiochemistry

ndash Bloodbull Urea gt7mmollbull Creatinine gt120umollbull Electrolytes Rising K+

ndash Creatinine Clearance (GFR ltlt120mll)ndash Urine Proteinuria

May be Acute or ChronicAcute ndash Reversible or Irreversible

2 Treatment Options

No TreatmentMonitoring amp Predialysis

ndash Control symptomsndash Preserve Residual Renal Function

bull Control rising BP (Antihypertensives)

bull Control Renal Bone Disease (Ca2+ Vit D)

bull PreventTreat Anaemias (Erythropoietin Blood)

DialysisRenal Transplantation

Dialysis

DefinitionArtificial process that partially replaces renal

functionRemoves waste products from blood by

diffusion (toxin clearance)Removes excess water by ultrafiltration

(maintenance of fluid balance)Wastes and water pass into a special liquid ndash

dialysis fluid or dialysate

Types

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 membraneFrom region of high concentration to one of

low concentration

Ultrafiltration

Made possible by osmosisMovement of waterAcross semipermeable membraneFrom low osmolality to high osmolalityOsmolality ndash number of osmotically active

particles in a unit (litre) of solvent

The process of diffusion

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

CAUSES OF RENAL FAILURE

1048707 Diabetes1048707 Untreated high blood pressure1048707 Inflammation1048707 Heredity1048707 Chronic infection1048707 Obstruction1048707 Accidents

1Renal Failure DiagnosisSymptoms Anorexia Nausea Vomiting Oliguria

bull Precipitating factors

Signs Anaemia Hypertension Fluid Overload etcBiochemistry

ndash Bloodbull Urea gt7mmollbull Creatinine gt120umollbull Electrolytes Rising K+

ndash Creatinine Clearance (GFR ltlt120mll)ndash Urine Proteinuria

May be Acute or ChronicAcute ndash Reversible or Irreversible

2 Treatment Options

No TreatmentMonitoring amp Predialysis

ndash Control symptomsndash Preserve Residual Renal Function

bull Control rising BP (Antihypertensives)

bull Control Renal Bone Disease (Ca2+ Vit D)

bull PreventTreat Anaemias (Erythropoietin Blood)

DialysisRenal Transplantation

Dialysis

DefinitionArtificial process that partially replaces renal

functionRemoves waste products from blood by

diffusion (toxin clearance)Removes excess water by ultrafiltration

(maintenance of fluid balance)Wastes and water pass into a special liquid ndash

dialysis fluid or dialysate

Types

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 membraneFrom region of high concentration to one of

low concentration

Ultrafiltration

Made possible by osmosisMovement of waterAcross semipermeable membraneFrom low osmolality to high osmolalityOsmolality ndash number of osmotically active

particles in a unit (litre) of solvent

The process of diffusion

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

1Renal Failure DiagnosisSymptoms Anorexia Nausea Vomiting Oliguria

bull Precipitating factors

Signs Anaemia Hypertension Fluid Overload etcBiochemistry

ndash Bloodbull Urea gt7mmollbull Creatinine gt120umollbull Electrolytes Rising K+

ndash Creatinine Clearance (GFR ltlt120mll)ndash Urine Proteinuria

May be Acute or ChronicAcute ndash Reversible or Irreversible

2 Treatment Options

No TreatmentMonitoring amp Predialysis

ndash Control symptomsndash Preserve Residual Renal Function

bull Control rising BP (Antihypertensives)

bull Control Renal Bone Disease (Ca2+ Vit D)

bull PreventTreat Anaemias (Erythropoietin Blood)

DialysisRenal Transplantation

Dialysis

DefinitionArtificial process that partially replaces renal

functionRemoves waste products from blood by

diffusion (toxin clearance)Removes excess water by ultrafiltration

(maintenance of fluid balance)Wastes and water pass into a special liquid ndash

dialysis fluid or dialysate

Types

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 membraneFrom region of high concentration to one of

low concentration

Ultrafiltration

Made possible by osmosisMovement of waterAcross semipermeable membraneFrom low osmolality to high osmolalityOsmolality ndash number of osmotically active

particles in a unit (litre) of solvent

The process of diffusion

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

2 Treatment Options

No TreatmentMonitoring amp Predialysis

ndash Control symptomsndash Preserve Residual Renal Function

bull Control rising BP (Antihypertensives)

bull Control Renal Bone Disease (Ca2+ Vit D)

bull PreventTreat Anaemias (Erythropoietin Blood)

DialysisRenal Transplantation

Dialysis

DefinitionArtificial process that partially replaces renal

functionRemoves waste products from blood by

diffusion (toxin clearance)Removes excess water by ultrafiltration

(maintenance of fluid balance)Wastes and water pass into a special liquid ndash

dialysis fluid or dialysate

Types

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 membraneFrom region of high concentration to one of

low concentration

Ultrafiltration

Made possible by osmosisMovement of waterAcross semipermeable membraneFrom low osmolality to high osmolalityOsmolality ndash number of osmotically active

particles in a unit (litre) of solvent

The process of diffusion

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

Dialysis

DefinitionArtificial process that partially replaces renal

functionRemoves waste products from blood by

diffusion (toxin clearance)Removes excess water by ultrafiltration

(maintenance of fluid balance)Wastes and water pass into a special liquid ndash

dialysis fluid or dialysate

Types

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 membraneFrom region of high concentration to one of

low concentration

Ultrafiltration

Made possible by osmosisMovement of waterAcross semipermeable membraneFrom low osmolality to high osmolalityOsmolality ndash number of osmotically active

particles in a unit (litre) of solvent

The process of diffusion

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

Types

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 membraneFrom region of high concentration to one of

low concentration

Ultrafiltration

Made possible by osmosisMovement of waterAcross semipermeable membraneFrom low osmolality to high osmolalityOsmolality ndash number of osmotically active

particles in a unit (litre) of solvent

The process of diffusion

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

Diffusion

Movement of solute Across semipermeable membraneFrom region of high concentration to one of

low concentration

Ultrafiltration

Made possible by osmosisMovement of waterAcross semipermeable membraneFrom low osmolality to high osmolalityOsmolality ndash number of osmotically active

particles in a unit (litre) of solvent

The process of diffusion

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

Ultrafiltration

Made possible by osmosisMovement of waterAcross semipermeable membraneFrom low osmolality to high osmolalityOsmolality ndash number of osmotically active

particles in a unit (litre) of solvent

The process of diffusion

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 diffusion

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

22

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 fluid which need to be changed

Haemodialysis Dialysis process occurs outside the body in a

machineThe dialysis membrane is an artificial one

DialyserThe 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

AV Fistula

Vascular Access Catheter

PD Access

Done under LA or GA

Problems with HD Rapid changes in BP

ndash fainting vomiting cramps chest pain irritability fatigue temporary loss of vision

Fluid overload ndash esp in between sessions

Fluid restrictionsndash more stringent with HD than PD

Hyperkalaemia ndash esp in between sessions

Loss of independence Problems with access

ndash poor quality blockage etc Infection (vascular access catheters) Pain with needles Bleeding

ndash from the fistula during or after dialysis Infections

ndash during sessions exit site infections blood-borne viruses eg Hepatitis HIV

SODIUMRegulates blood volume and pressure

Avoid salt

Use Alternate food seasonings lemon and limes spices seafood seasoning Italian seasoning vinegars peppers

FLUIDS

Healthy kidneys remove fluids as urine

Check for fluid and sodium retention

Need to restrict fluid intake

LAB MONITORING

Haemoglobin Albumin Calcium Phosphorus GFR (24 hour urine)

Sodium Potassium Urea Creatinine

Haemodialysis Dialysis process occurs outside the body in a

machineThe dialysis membrane is an artificial one

DialyserThe 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

AV Fistula

Vascular Access Catheter

PD Access

Done under LA or GA

Problems with HD Rapid changes in BP

ndash fainting vomiting cramps chest pain irritability fatigue temporary loss of vision

Fluid overload ndash esp in between sessions

Fluid restrictionsndash more stringent with HD than PD

Hyperkalaemia ndash esp in between sessions

Loss of independence Problems with access

ndash poor quality blockage etc Infection (vascular access catheters) Pain with needles Bleeding

ndash from the fistula during or after dialysis Infections

ndash during sessions exit site infections blood-borne viruses eg Hepatitis HIV

SODIUMRegulates blood volume and pressure

Avoid salt

Use Alternate food seasonings lemon and limes spices seafood seasoning Italian seasoning vinegars peppers

FLUIDS

Healthy kidneys remove fluids as urine

Check for fluid and sodium retention

Need to restrict fluid intake

LAB MONITORING

Haemoglobin Albumin Calcium Phosphorus GFR (24 hour urine)

Sodium Potassium Urea Creatinine

AV Fistula

Vascular Access Catheter

PD Access

Done under LA or GA

Problems with HD Rapid changes in BP

ndash fainting vomiting cramps chest pain irritability fatigue temporary loss of vision

Fluid overload ndash esp in between sessions

Fluid restrictionsndash more stringent with HD than PD

Hyperkalaemia ndash esp in between sessions

Loss of independence Problems with access

ndash poor quality blockage etc Infection (vascular access catheters) Pain with needles Bleeding

ndash from the fistula during or after dialysis Infections

ndash during sessions exit site infections blood-borne viruses eg Hepatitis HIV

SODIUMRegulates blood volume and pressure

Avoid salt

Use Alternate food seasonings lemon and limes spices seafood seasoning Italian seasoning vinegars peppers

FLUIDS

Healthy kidneys remove fluids as urine

Check for fluid and sodium retention

Need to restrict fluid intake

LAB MONITORING

Haemoglobin Albumin Calcium Phosphorus GFR (24 hour urine)

Sodium Potassium Urea Creatinine

Vascular Access Catheter

PD Access

Done under LA or GA

Problems with HD Rapid changes in BP

ndash fainting vomiting cramps chest pain irritability fatigue temporary loss of vision

Fluid overload ndash esp in between sessions

Fluid restrictionsndash more stringent with HD than PD

Hyperkalaemia ndash esp in between sessions

Loss of independence Problems with access

ndash poor quality blockage etc Infection (vascular access catheters) Pain with needles Bleeding

ndash from the fistula during or after dialysis Infections

ndash during sessions exit site infections blood-borne viruses eg Hepatitis HIV

SODIUMRegulates blood volume and pressure

Avoid salt

Use Alternate food seasonings lemon and limes spices seafood seasoning Italian seasoning vinegars peppers

FLUIDS

Healthy kidneys remove fluids as urine

Check for fluid and sodium retention

Need to restrict fluid intake

LAB MONITORING

Haemoglobin Albumin Calcium Phosphorus GFR (24 hour urine)

Sodium Potassium Urea Creatinine

PD Access

Done under LA or GA

Problems with HD Rapid changes in BP

ndash fainting vomiting cramps chest pain irritability fatigue temporary loss of vision

Fluid overload ndash esp in between sessions

Fluid restrictionsndash more stringent with HD than PD

Hyperkalaemia ndash esp in between sessions

Loss of independence Problems with access

ndash poor quality blockage etc Infection (vascular access catheters) Pain with needles Bleeding

ndash from the fistula during or after dialysis Infections

ndash during sessions exit site infections blood-borne viruses eg Hepatitis HIV

SODIUMRegulates blood volume and pressure

Avoid salt

Use Alternate food seasonings lemon and limes spices seafood seasoning Italian seasoning vinegars peppers

FLUIDS

Healthy kidneys remove fluids as urine

Check for fluid and sodium retention

Need to restrict fluid intake

LAB MONITORING

Haemoglobin Albumin Calcium Phosphorus GFR (24 hour urine)

Sodium Potassium Urea Creatinine

Problems with HD Rapid changes in BP

ndash fainting vomiting cramps chest pain irritability fatigue temporary loss of vision

Fluid overload ndash esp in between sessions

Fluid restrictionsndash more stringent with HD than PD

Hyperkalaemia ndash esp in between sessions

Loss of independence Problems with access

ndash poor quality blockage etc Infection (vascular access catheters) Pain with needles Bleeding

ndash from the fistula during or after dialysis Infections

ndash during sessions exit site infections blood-borne viruses eg Hepatitis HIV

SODIUMRegulates blood volume and pressure

Avoid salt

Use Alternate food seasonings lemon and limes spices seafood seasoning Italian seasoning vinegars peppers

FLUIDS

Healthy kidneys remove fluids as urine

Check for fluid and sodium retention

Need to restrict fluid intake

LAB MONITORING

Haemoglobin Albumin Calcium Phosphorus GFR (24 hour urine)

Sodium Potassium Urea Creatinine

SODIUMRegulates blood volume and pressure

Avoid salt

Use Alternate food seasonings lemon and limes spices seafood seasoning Italian seasoning vinegars peppers

FLUIDS

Healthy kidneys remove fluids as urine

Check for fluid and sodium retention

Need to restrict fluid intake

LAB MONITORING

Haemoglobin Albumin Calcium Phosphorus GFR (24 hour urine)

Sodium Potassium Urea Creatinine

FLUIDS

Healthy kidneys remove fluids as urine

Check for fluid and sodium retention

Need to restrict fluid intake

LAB MONITORING

Haemoglobin Albumin Calcium Phosphorus GFR (24 hour urine)

Sodium Potassium Urea Creatinine

LAB MONITORING

Haemoglobin Albumin Calcium Phosphorus GFR (24 hour urine)

Sodium Potassium Urea Creatinine