Dialysis is a process that removes waste and excess fluid from the body when the kidneys are not functioning properly. It usually requires a team including a doctor, nurse, and the patient. There are different types of dialysis including peritoneal dialysis which uses the peritoneum and exchanges fluid through a catheter, and hemodialysis which pumps blood out of the body to a machine that filters it before returning it. Hemodialysis is often needed when kidney function drops below 10-15% and usually occurs 3 times a week for 3-4 hours each time. Complications can include low blood pressure, infection, bleeding, and heart problems.

1. Dialysis
By,Kriti Chakrabarty

2.  Dialysis is an artificial process for removing
waste products and excess fluids from the
body, a process that is needed when the
kidneys are not functioning properly.
 Dialysis usually requires the effort of a team
of people. A doctor completes a dialysis
prescription, manages complications, and
monitors the medical care. A nurse monitors
the person's general well-being and mental
health and educates the person about
dialysis and what needs to be done to
maintain the best possible health.
Dialysis

3.  Chronic indications for dialysis:
 Symptomatic renal failure
 Low glomerular filtration rate (GFR) (RRT
often recommended to commence at a
GFR of less than 10-15 mls/min/1.73m2).
In diabetics, dialysis is started earlier.
 Difficulty in medically controlling fluid
overload, serum potassium, and/or serum
phosphorus when the GFR is very low
Chronic Indications

4.  Acidemia from metabolic acidosis in situations
in which correction with sodium bicarbonate is
impractical or may result in fluid overload
 Electrolyte abnormality, such as severe
hyperkalemia, especially when combined with
AKI
 Intoxication, that is, acute poisoning with a
dialyzable substance. These substances can be
represented by the mnemonic SLIME: salicylic
acid, lithium, isopropanol, Magnesium-
containing laxatives, and ethylene glycol
 Overload of fluid not expected to respond to
treatment with diuretics
 Uremia complications, such as
pericarditis, encephalopathy, or gastrointestinal
bleeding.
Indications for dialysis in the
patient with acute kidney injury

5.  Peritoneal dialysis
 Intermittent hemodialysis
 Hemofiltration
 Continuous renal replacement therapy
 Hemodiafiltration
• Decision of modality determined by catabolic
rate, hemodynamic stability, and whether
primary goal is fluid or solute removal
Types

6.  In peritoneal dialysis, the peritoneum acts as
semi permeable membrane as it has a large
surface area and a rich network of blood
vessels.
 A fluid (dialysate) is infused through a
catheter inserted through the abdominal wall
into the peritoneal space within the
abdomen.
 The dialysate must be left in the abdomen
for a sufficient time to allow waste products
from the bloodstream to pass slowly into it.
Then the dialysate is drained out, discarded
PD

7. Pic.

8.  Manual intermittent peritoneal
dialysis is the simplest technique. In
manual intermittent peritoneal
dialysis, bags containing dialysate are
warmed to body temperature and infused
into the peritoneal (abdominal) cavity,
 60 to 90 minutes and then is drained out
in about 10 to 20 minutes. This process is
then repeated. The entire treatment can
take 12 to 24 hours.
Various techniques are used for
peritoneal dialysis

9.  Automated cycler intermittent peritoneal
dialysis -This technique uses a machine
(cycler) to do automated exchanges of
dialysate
 continuous ambulatory peritoneal
dialysis, the dialysate is kept in the
abdomen for much longer intervals
 Continuous cycler-assisted peritoneal
dialysis uses an automated cycler to
perform short exchanges at night during
sleep, whereas longer exchanges are
performed manually

10. Bleeding Unintentional perforation of an
internal organ during
placement of the catheter
Removal of the catheter from
the body
Infection Unsterile techniques during dialysis
Low level of albumin (a protein) in Loss of protein in fluid removed
the blood during dialysis
Constipation Intake of inadequate fiber or use
of calcium salts to treat high
phosphate levels in the blood,
causing the intestine to widen,
which possibly interferes with
dialysate flow in and out of the
abdomen
Possible Complications of
Peritoneal Dialysis

11. Hemodia. v/s PD

12.  Hemodialysis is the most common method
used to treat advanced and permanent
kidney failure. Since the 1960s, when
hemodialysis first became a practical
treatment for kidney failure,
 In recent years, more compact and
simpler dialysis machines have made
home dialysis increasingly attractive.
Introduction to hemodialysis

13. Hemodialysis is usually needed when you
have only 10 to 15 percent of your kidney
function left.
 Hemodialysis can help take over your
kidneys' job by controlling your blood
pressure and maintaining the proper
balance of fluid and various chemicals —
such as potassium and sodium — in the
body
Intro cont.

14.  In hemodialysis, blood is removed from
the body and pumped by a machine
outside the body into a dialyzer (artificial
kidney).
 The dialyzer filters metabolic waste
products from the blood and then returns
the purified blood to the person.
 The total amount of fluid returned can be
adjusted. Hemodialysis requires repeated
access to the bloodstream.
Procedure

15. Pic.

16.  Doctors can achieve temporary access by
inserting a large intravenous catheter in a big
vein, usually one near the neck.
 An artificial connection between an artery and a
vein (an arteriovenous fistula) is surgically
created to make long-term access easier
 In this procedure, typically the radial artery in
the forearm is joined with the cephalic vein.
 When a fistula cannot be created, an artery and
a vein may be surgically connected to each other
using a synthetic connector (graft)
AV Fistulas/Graft

17. Pic.

18.  Heparin, a drug that prevents clotting, is
given during hemodialysis to prevent blood
from clotting in the dialyzer.
 Inside the dialyzer, a porous artificial
membrane separates the blood from a fluid
(the dialysate).
 Fluid, waste products, and electrolytes in the
blood filter through the membrane into the
dialysate. Blood cells and large proteins are
unable to filter through the small pores of the
membrane and so remain in the blood
Cont…

19.  Dialyzers have different
sizes and degrees of
efficiency.
 Dialysis treatment time
is usually about 3 to 4
hours.
 Most people who have
chronic kidney failure
need hemodialysis 3
times a week.
Dialysis

20. Fever Bacteria or fever-causing
substances (pyrogens) in the
bloodstream
Overheated dialysate
Life-threatening allergic reaction Allergy to a substance in the
(anaphylaxis) dialyzer or blood tubing
Low blood pressure Removal of too much fluid or
excessive fluid gain between
dialysis
Air embolus Air entering blood in the machine
Possible Complications of
Hemodialysis

21. Abnormal heart rhythms Abnormal levels of potassium
and other substances in the
blood
Low blood pressure
Bleeding in the intestine, brain, Use of heparin to prevent clotting
eyes, or abdomen in the machine
Infection Bacteria entering the bloodstream
through a dialysis catheter or
through a needle inserted into
veins
Complication

22.  Diet:For those undergoing hemodialysis, daily
consumption of sodium and potassium is
even more restricted.
 Foods high in phosphorus also may have to
be limited.
 Daily fluid intake is limited for people who
have very little urine output or a persistently
low or decreasing sodium concentration in
the blood. Daily weighing is important to
monitor weight gain.
 Multivitamins required.
Special Considerations

23. Medical considerations:
 Erytheopoeitin-Rbc Production
 Phosphate binders-to remove excess dietary
phosphates
 Vitamin D/Calcitrol-to maintain excess PTH
 Psychosocial Considerations: People
undergoing dialysis may experience losses in
every aspect of their life and become
depressed and anxious.
 Dialysis sessions may interfere with work,
school, or leisure activities.

24.  Hemofiltration is a similar treatment to
hemodialysis, but it makes use of a different
principle.
 The blood is pumped through a dialyzer or
"hemofilter" as in dialysis, but no dialysate is used.
 A pressure gradient is applied; as a result, water
moves across the very permeable membrane
rapidly, "dragging" along with it many dissolved
substances, including ones with large molecular
weights, which are not cleared as well by
hemodialysis.
 Salts and water lost from the blood during this
process are replaced with a "substitution fluid" that is
infused into the extracorporeal circuit during the
treatment. Hemodiafiltration is the combining of
hemodialysis and hemofiltration in one process.
Hemofiltration

25. Hemodialysis v/s hemofiltration

26.  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%)
 Arrhythmias
Acute Complications of Dialysis

27. Thank you