Dr Shubham Upadhyay
© Medi - Lectures Dr Shubham Upadhyay
INTRODUCTION
• Acute Kidney Injury (AKI) or Chronic Kidney Disease (CKD)
© Medi - Lectures Dr Shubham Upadhyay
INTRODUCTION
• Acute Kidney Injury (AKI) or Chronic Kidney Disease (CKD)
• ESRD Etiology
© Medi - Lectures Dr Shubham Upadhyay
INTRODUCTION
• Acute Kidney Injury (AKI) or Chronic Kidney Disease (CKD)
• ESRD Etiology
• Treatment options for ERSD
Hemodialysis
Peritoneal Dialysis
Renal Transplantation
© Medi - Lectures Dr Shubham Upadhyay
INDICATIONS
• Uremic Symptoms
• Hyperkalemia unresponsive to conservative measures
• Persistent extravascular volume expansion despite diuretic therapy
• Acidosis refractory to medical therapy
• Bleeding diasthesis
• Creatinine Clearance or eGFR <10 ml/min per 1.72 m2
© Medi - Lectures Dr Shubham Upadhyay
SYMPTOMS OF UREMIA
• Nausea
• Vomiting
• Anorexia
• Dysgeusia (abnormal taste)
• Pruritus
• Alterations is sleep (insomnia and
daytime hypersomnolence)
• Sensation of being cold
• Cognitive changes
© Medi - Lectures Dr Shubham Upadhyay
SYMPTOMS OF UREMIA SIGNS OF UREMIA
• Nausea • Sallow discoloration of the skin
• Vomiting • Ammonia odor to the breath
• Anorexia • Pericardial friction rub/pericardial
• Dysgeusia (abnormal taste) effusion
• Pruritus • Myoclonus/seizure
• Alterations is sleep (insomnia and • Foot or wrist drop/uremic motor
daytime hypersomnolence) neuropathy
• Sensation of being cold • Prolonged bleeding time/platelet
• Cognitive changes dysfunction
© Medi - Lectures Dr Shubham Upadhyay
HEMODIALYSIS
© Medi - Lectures Dr Shubham Upadhyay
HEMODIALYSIS
• Mechanism of Solute Transport
Diffusion
Solvent Drag(Convection)
• Mechanism of Volume Removal
Ultrafiltration (Negative hydrostatic pressure)
© Medi - Lectures Dr Shubham Upadhyay
HEMODIALYSIS
DIALYZER DIALYSATE BLOOD DELIVERY SYSTEM
© Medi - Lectures Dr Shubham Upadhyay
HEMODIALYSIS
DIALYZER DIALYSATE BLOOD DELIVERY SYSTEM
• Plastic Chamber • K+ conc : 0 -4 meq/l • Extracorporeal Circuit
• Perfuse blood and dialysate • Ca+2 conc : 2.5 meq/l • Dialysis Access
simultaneously
• Polysulfonale membrane • Na+ conc : 136 - 140 meq/l
© Medi - Lectures Dr Shubham Upadhyay
HEMODIALYSIS
DIALYZER DIALYSATE BLOOD DELIVERY SYSTEM
• Plastic Chamber • K+ conc : 0 -4 meq/l • Extracorporeal Circuit
• Perfuse blood and dialysate • Ca+2 conc : 2.5 meq/l • Dialysis Access
simultaneously
• Polysulfonale membrane • Na+ conc : 136 - 140 meq/l
DIALYSIS MACHINE
• Blood Pump
• Dialysis solution delivery system
• safety Monitors
© Medi - Lectures Dr Shubham Upadhyay
© Medi - Lectures Dr Shubham Upadhyay
HEMODIALYSIS VASULAR ACCESS
• Arteriovenous Fistula
• Arteriovenous Graft
• Vascular Catheter
© Medi - Lectures Dr Shubham Upadhyay
HEMODIALYSIS VASULAR ACCESS
• Arteriovenous Fistula
• Arteriovenous Graft
• Vascular Catheter
© Medi - Lectures Dr Shubham Upadhyay
HEMODIALYSIS VASULAR ACCESS
• Arteriovenous Fistula
• Arteriovenous Graft
• Vascular Catheter
© Medi - Lectures Dr Shubham Upadhyay
• Flow rate of heparinized blood = 250 - 450 ml/min
• Flow rate of dialysate in counter-current direction = 500 - 800 ml/min
• Efficency of Dialysis
• Dose of Dialysis
In - Center Dialysis Home based Dialysis
• Thrice weekly, 4 h • Short daily, 6x/week, 2-3 h
• Nocturnal, thrice weekly, 6-8 h • Nocturnal, 3-6x/week, 6-8 h
• Conventional, thrice weekly, 4 h
© Medi - Lectures Dr Shubham Upadhyay
COMPLICATIONS DURING HEMODIALYSIS
ACUTE
• Hypotension
• Infection
• Muscle Cramps
• Anaphylactoid Reaactions
• Dialysis Dysequilibrium Syndrome
© Medi - Lectures Dr Shubham Upadhyay
COMPLICATIONS DURING HEMODIALYSIS
ACUTE CHRONIC
• Hypotension • Anemia
• Infection • Adynamic Bone Disease
• Muscle Cramps • Aluminium Induced dementia
• Anaphylactoid Reaactions • Amyloidoses
• Dialysis Dysequilibrium Syndrome
© Medi - Lectures Dr Shubham Upadhyay
PERITONEAL DIALYSIS
• Peritoneum acts as Semipermeable membrane
• Dextrose containing solution
• Mechanism of Solute Transport
Diffusion
Convection (Solvent Drag)
• Mechanism of Volume Removal
Ultrafiltration (Osmotic; due
© Medi toDr Shubham
- Lectures highUpadhyay
dextrose concentration)
PERITONEAL DIALYSIS
CAPD CCPD
Continuous Ambulatory Peritoneal Dialysis Continuous Cyclic Peritoneal Dialysis
© Medi - Lectures Dr Shubham Upadhyay
PERITONEAL DIALYSIS
CAPD CCPD
Continuous Ambulatory Peritoneal Dialysis Continuous Cyclic Peritoneal Dialysis
DIALYSATE
• 1.5 TO 3 Litres
• Hypertonic
• Dextrose or Icodextrin
• Additional drugs- Heparin, Antibiotics, Insulin
• Larger the volume-> More is the Solute Clearance
© Medi - Lectures Dr Shubham Upadhyay
PERITONEAL CAVITY ACCESS
• Peritoneal catheter
Flexible
Silicone Rubber
Numerous side holes at distal end
Two Dacron cuffs
• Peritoneal Equilibrium test
• Low Transporters
• Low-Average
• High-Average
• High
© Medi - Lectures Dr Shubham Upadhyay
COMPLICATIONS DURING PERITONEAL DIALYSIS
• Peritonitis
• Catheter associated non peritonitis infections
• Weight Gain
• Hyperglycemia
• Metabolic Disturbances
• Hernia © Medi - Lectures Dr Shubham Upadhyay
PROGNOSIS
• Major Cause of death in ESRD- Cardiovascular disease
• Adequacy of solute removal • Anemia management
• Adequacy of blood pressure • Protein nutrition
control
• Control of hyperkalemia
• Volume control
• Management of renal bone
disease
© Medi - Lectures Dr Shubham Upadhyay
DIALYSIS IN AKI
• Indications
• Hemodialysis can itself lead to hypotension & ppt AKI
• CRRT(Continuous Renal Replacement Therapy)
• CVVH
• CVVHD
• Slow Low Efficiency Dialysis (SLED)
• Extended Daily Dialysis (EDD)
© Medi - Lectures Dr Shubham Upadhyay
© Medi - Lectures Dr Shubham Upadhyay
