Professional Documents
Culture Documents
Hemodialysis (HD)
Peritoneal dialysis (PD)
Absolute Indications for
Dialysis
Presence of uremic syndrome
(intractable fatigue, anorexia,
nausea, vomiting, pruritus).
Presence of hyperkalemia
unresponsive to conservative
measures
Extracellular volume expansion
refractory to diuretic agents.
Bleeding diatheses.
Creatinineclearance of 10
ml/minute per 1.73 m2.
Encephalopathy
Factors to be considered in
choosing HD or PD
Patient’ age.
Ability to perform the procedure.
Patient’s own perception about
the therapy.
Dialyzer
Composition and delivery of
dialysate
Blood delivery system
1. Dialyzer
0 to 4 mmol/L - K+ concentration
of the dialysate (depending on the
predialysis plasma K+
concentration)
Extracorporealcircuit in the
dialysis machine.
Dialysis access.
Components of the Dialysis
Machine
1. Blood pump
temperature
conductivity
flow of dialysate
3. Safety monitors
Anticoagulation
1. Heparin
2. Arteriovenous fistula: a
surgically constructed connection
b/w an artery and a vein in the
arm.
3. Arteriovenous graft: a
surgically implanted Gore-Tex
tube that connects an artery and
a vein.
HD Angioaccess
Requires direct access to the
circulation, either via:
c. Large-bore intravenous
catheter.
Other Dialysis Access
Arm (brachial artery to basilia
vein)
Overly
ambitious rate for fluid
removal.
Administration of salt-poor
albumin.
Prevention of Hypotension
Withholdingof antihypertensive
medications on the day prior to
and on the day of dialysis.
Hematocritmaintained at a
reasonable level.
Asymptom complex of
nonspecific chest and back pain
which appears to result from
complement activation and
cytokine release.
Occur most frequently with the
bioincompatible cellulosic-
containing membranes.
Intermediate hypersensitivity
reaction (anaphylactic) due to an
IgE – mediated reaction to
ethylene oxide used in the
sterilization of new dialyzer.
4. Cardiovascular disease
Inadequate treatment of
hypertension.
Presence
of hyperlipidemia,
homocystinemia and anemia
Calcification
of coronary arteries
(due to elevated calcium-
phosphorus product)
Alterations
in cardiovascular
dynamics during the dialysis
treatment.
5. Dialysis Dysequilibrium
Syndrome
is
a syndrome that typically
develops during or shortly after
hemodialysis, especially during
the first few dialysis sessions.
is
the result of cerebral edema;
the exact pathogenesis remains in
dispute.
causesnausea, vomiting, and
headaches, w/c may occasionally
progress to seizures and coma.
is
usually self-limiting and only
requires measures for symptom
control.
Patients at risk of dialysis
disequilibrium syndrome:
is
associated with the use of
acetate dialysate.
also
called dialysis
encephalopathy.
is
a progressive, frequently fatal
neurologic disease.
in
adults, the disease is seen
almost exclusively in patients
being treated with chronic
hemodialysis.
Etiology:
Increase
in brain aluminum content
has been strongly implicated in
some cases of dialysis dementia
Peritonitis.
Hyperglycemia.
Hypertriglyceridemia.
Obesity.
Hypoproteinemia.
Uremia secondary to loss of
residual renal function.
Malnutrition.
Forms of Peritoneal Dialysis