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DIALYSIS Physiological Basis

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by

Brinda Srinivasagopalane

on 26 November 2014

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Transcript of DIALYSIS Physiological Basis

DIALYSIS Physiological Basis
CHRONIC RENAL FAILURE
Causes:
Irreversible damage to large number of nephrons
Diabetes mellitus, Hypertension
Chronic golmerulonephritis, pyelonephritis
Vascular diseases, chronic obstructive renal diseases

Principles of Dialysis

The Kidneys
Definitions
Dialysis is the process of removing waste products and excess fluids from the body

Causes for Renal Diseases Examples
The Physiological Basis
RENAL FAILURE
ACUTE RENAL FAILURE:

Dr.Brinda
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

Causes:
Acute decrease in RBF
Acute infection or inflammation of renal tubules
Acute obstruction of urinary tract

Effects:
Water and salt retention
Hyperkalaemia
Metabolic acidosis
Oliguria
Uraemia

Effects:
Generalized edema
Acidosis, Uremia
Hyperkalemia
Oliguria
Anemia, osteomalacia
Principles of Dialysis Therapy

Diffusion
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.

Ultrafiltration
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.

Hemodialysis Apparatus

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

Willem Kolff

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

Mechanism
Membrane is permeable to all substances except colloids
Amount of substance transferred depends on:
Difference in concentration gradient
Molecular size
Duration of time
Artificial kidney clears off 100-200ml of plasma/min
Types: Hemodialysis, Peritoneal Dialysis

Hemodialysis Access

Acute dialysis catheter (vascular catheter, i.e. Quentin catheter)
Cuffed, tunneled dialysis catheter (Permcath)
Arteriovenous graft
Arteriovenous fistula

Radiocephalic AVF

Flow Scheme Hemodialysis
Hemodialysis
Haemodialysis
HEMODIALYSIS
ADVANTAGES
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.

DISADVANTAGES
Use of needles.
Dietary restrictions.
Minor surgery required to create access site.
Less schedule flexibility.
Travel to dialysis center for treatments.

Acute Complications of Dialysis

Hypotension (25-55%)
Cramps (5-20%)
Nausea and vomiting (5-15%)
Headache (5%)
Chest pain (2-5%)
Back pain (2-5%)
Itching (5%)
Fever and chills (<1%)

Peritoneal
Dialysis

Indications

1. Renal Failure
2. No vascular access
3. CVS unstable
4. Children
5. Old adults
6. Pts unwilling to accept hemodialysis
7. Severe anaemia
8. Severe HD related symptoms e.g. disequilibrium

Contraindications

1. Peritoneal adhesion
2. Severe lung disease
3. Abdominal sepsis

Peritoneal Dialysis
How is Peritoneal Dialysis Done?
Peritoneal Dialysis Solution
Which Mode of Renal Replacement Therapy?
Peritoneal Dialysis

Kidney Transplantation

Hemodialysis

Each mode has its advantages and disadvantages.
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