Dialysis

What is Dialysis?
a type of renal replacement therapy which
is used to provide an artificial replacement
for lost kidney function due to renal failure.
It is a life support treatment and does not
treat any kidney diseases.

History
Life, death and a washing machine
Although experiments with dialysis are said to
have occurred thousands of years ago, dialysis
as we know it has its roots in the 20th century.
Dr. Willem Kolff- Dutch physician who is
considered as the father of dialysis. He was the
first to construct the dialyzer (artificial kidney) in
1943.
Dr.Belding Scribner- came up with the idea of
connecting the patient to the dialyzer using
plastic tubes, one inserted into an artery and
one into a vein.

Principle
Dialysis works on the principle of the diffusion of solutes
across a semipermeable membrane. Blood flows by one
side of a semipermeable membrane, and a dialysis
solution or fluid flows by the opposite side.
The dialysis solution has levels of minerals like sodium
and chloride that are similar to their natural concentration
in healthy blood.
For another solute, bicarbonate, dialysis solution level is
set at a slightly higher level than in normal blood, to
encourage diffusion of bicarbonate into the blood, to
neutralise the acidosis that is often present in these
patients.
Types
Hemodialysis
Hemodialysis
In hemodialysis, the patient's blood is pumped through
the blood compartment of a dialyzer.
Dialysis solution is pumped through the dialysate
compartment of the dialyzer, which is configured so that
the blood and dialysis solutions flow on opposite sides of
the semipermeable membrane.
The cleansed blood is then returned via the circuit back
to the body.
Ultrafiltration occurs by increasing the hydrostatic
pressure across the dialyzer membrane. This usually is
done by applying a negative pressure to the dialysate
compartment of the dialyzer.
Hemodialysis

The connection between an artery and a vein can be made using
blood vessels (an arteriovenous fistula, or AVF) or a synthetic bridge
(arteriovenous graft, or AVG).
AVF is more desirable, because rates of infection are very low and it
is quite durable. It may take many months for the AVF to mature, so
careful planning is required.
The AVG can be accessed a few weeks after creation. It provides
good flows but has a high complication rate. It should be attempted
only if the AVF is not feasible.
These are typically given three times per week, but more
frequent sessions, which are usually 2-3 hours in
duration given 5-6 times per week can be sometimes
prescribed.
Can be given either in outpatient dialysis centers or can
be done by a patient at home, providing they have
suitable help and accommodation.


How to prepare for the test
Just before your health care provider begins the
hemodialysis procedure, the following assessments will
be made:

Blood pressure
Temperature
Heart rate
Breathing rate
Weight
Chest assessment
Examination of venous access
What risks are?
The immediate risks include:
Hypotension (low blood pressure)
Infection
Electrolyte imbalance
Bleeding from the access site
Nausea and vomiting
Cramps
Dialyzer reaction
Air embolism
Cardiac ischemia or arrhythmia (irregular heart beats)

What are the risks?
Long-term risks include:
Dialysis-associated amyloidosis
Dialysis dementia (uncommon now that aluminium levels
are closely monitored)
Cardiovascular disease
Autonomic Neuropathy
Blood loss leading to iron deficiency (requiring regular
iron replacement)

Peritoneal Dialysis
a sterile solution containing minerals and glucose is run
through a tube into the peritoneal cavity, the abdominal
body cavity around the intestine, where the peritoneal
membrane acts as a semipermeable membrane.
The dialysate is left there for a period of time to absorb
waste products, and then it is drained out through the
tube and discarded.
This cycle or "exchange" is normally repeated 4-5 times
during the day, (sometimes more often overnight with an
automated system).

Peritoneal Dialysis
Peritoneal dialysis is less efficient than hemodialysis, but
because it is carried out for a longer period of time the
net effect in terms of removal of waste products and of
salt and water are similar to hemodialysis.
It does free patients from the routine of having to go to a
dialysis clinic on a fixed schedule multiple times per
week, and it can be done while traveling with a minimum
of specialized equipment.
Hemofiltration