RENAL DIALYSIS

Hemodialysis
- Most common method of dialysis
- Used in patient with:
- Acutely ill
- Short – term (days → weeks)
- ESRD (End Stage Renal Disease)

- Dialyzer (Artificial Kidney)

- Synthetic semipermeable membrane replacing the renal gromeruli and
tubule as the filter for the impaired kidneys
- Treatment usually occur 3x a week for 3 – 4 hours
- Objectives:
- Extract toxic nitrogenous substances in the blood
- Remove excess water

- Princples of Hemodialysis
Diffusion
- > Concentration → < Concentration
- Toxins and waste are removed in the blood
Osmosis
- > Solute concentration (Blood) → < Solute concentration (dialysate
bathe)
- Removed excess water
Ultrafiltration
-  pressure → pressure
- More efficient to remove water
- Accomplished by applying negative pressure on the dialysis
membrane
- Because patient with renal disease usually cannot excrete water
- Dialysate
- Solution made up of all important electrolytes in their ideal
extracellular concentration
- Bicorbonate (HCO3) – buffer system
- Acetate – metabolized to form HCO3
 - Vascular Access
- 300 – 550 mL / min
- Types:
Vascular Access Devices
- Double – lumen with large bore catheter into:
o Subclavian vein
o Internal jugular vein (long term access)
o Femoral vein
- Risk Factors
- Hematoma
- Pneumothorax
- Infection
- Thrombosis in subclavian vein
- Can be used < 3 weeks

Arteriovenous Fistula
- Preferred method of permanent access
- Created through surgery by anastamosis of artery and vein
- Side – to – side (cephalic vein and redial artery)
- Side – to – end
- At least 14 days for maturation of the fistula
- Uses large bore needles (14, 15, 16 gauge)

Arteriovenous Graft
- Created by subcutaneous interposing a biologic, semibiologic, synthetic
graft material between an artery and vein

- Used if fistula cannot be created due to compromised vascular system

- √ arm , thigh and chest
- Common complication
- Infection
- Thrombosis
 - Complications
- Atherosclerotic Cardiovascular Disease
- Due to disturbance of lipid metabolism accentuated by hemodialysis
- Erythropoietin (Epogen) given before dialysis starts
- Improves hematocrit count

- Disturbed Calcium metabolism → OSTEODYSTROPHY

- Causes bone pain and fracture
- Hypotension (N/V, diaphoresis, tachycardia & dizziness are sign of hypotension)
- Because of fluid is remove
- Painful muscle cramping
- Fluid and electrolytes rapidly leaves the extracellular space
- Exsanguination
- If blood lines separate or dialysis needles become dislodged
- Dysrhythmias
- Result from electrolyte and pH changes
- Removal of anti – arrhythmia drugs

- Dialysis Disequilibrium (headache, n/v, restlessness,  consciousness & seizure)

- More likely occur in ARF or very high level of BUN (> 150 mg/dL)
- It is result from cerebral fluid shifts

- 3 Types of Peritoneal Dialysis

Continuous Ambulatory Peritoneal Dialysis (CAPD)
Continuous Cyclic Peritoneal Dialysis (CCPD)
Intermittent Peritoneal Dialysis (IPD)