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DIALYSIS Physiological Basis
Transcript of DIALYSIS Physiological Basis
CHRONIC RENAL FAILURE
Irreversible damage to large number of nephrons
Diabetes mellitus, Hypertension
Chronic golmerulonephritis, pyelonephritis
Vascular diseases, chronic obstructive renal diseases
Principles of Dialysis
Dialysis is the process of removing waste products and excess fluids from the body
Causes for Renal Diseases Examples
The Physiological Basis
ACUTE RENAL FAILURE:
Dialysis is on of the primary modalities for pts with RF
Dialysis can do two of the principal functions of the kidney; 1. removal of endogenous waste products 2. maintenance of water balance
Acute decrease in RBF
Acute infection or inflammation of renal tubules
Acute obstruction of urinary tract
Water and salt retention
Principles of Dialysis Therapy
A compound will spread as evenly as possible in a defined space.
The movement of solutes from a higher to a lower solute concentration area.
Physical Basis of Dialysis Ultrafiltration
Exertion of pressure on one side of the membrane produces filtration of water with solutes, as long as they can pass the membrane.
The movement of a fluid through a membrane caused by a pressure gradient.
The pressure gradient can be:
a positive pressure ("push") a negative pressure ("suck") an osmotic pressure.
Dialyzer (cellulose, substituted cellulose, synthetic noncellulose membranes)
Dialysis solution (dialysate – water must remain free of Al, Cu, chloramine, bacteria, and endotoxin)
Tubing for transport of blood and dialysis solution
Machine to power and mechanically monitor the procedure (includes air monitor, proportioning system, temperature sensor, urea sensor to calculate clearance)
The Beginning of Modern Hemodialysis
Kolff´s first rotating artificial kidney used for dialysis on humans in Kampen (NL) in 1943
The Breakthrough: Hollow Fiber Dialyzers
Blood inlet header of a hollow fiber dialyzer
Product range of Dialyzers
Membrane is permeable to all substances except colloids
Amount of substance transferred depends on:
Difference in concentration gradient
Duration of time
Artificial kidney clears off 100-200ml of plasma/min
Types: Hemodialysis, Peritoneal Dialysis
Acute dialysis catheter (vascular catheter, i.e. Quentin catheter)
Cuffed, tunneled dialysis catheter (Permcath)
Flow Scheme Hemodialysis
Effective removal of waste products.
Care given by trained professionals.
Regular contact with other patients.
Treatment is three times per week.
No equipment at home.
Use of needles.
Minor surgery required to create access site.
Less schedule flexibility.
Travel to dialysis center for treatments.
Acute Complications of Dialysis
Nausea and vomiting (5-15%)
Chest pain (2-5%)
Back pain (2-5%)
Fever and chills (<1%)
1. Renal Failure
2. No vascular access
3. CVS unstable
5. Old adults
6. Pts unwilling to accept hemodialysis
7. Severe anaemia
8. Severe HD related symptoms e.g. disequilibrium
1. Peritoneal adhesion
2. Severe lung disease
3. Abdominal sepsis
How is Peritoneal Dialysis Done?
Peritoneal Dialysis Solution
Which Mode of Renal Replacement Therapy?
Each mode has its advantages and disadvantages.