11. Hemodialysis:
Solute passively moves down a concentration
gradient between the dialysate and the
capillaries.
Hemofiltration
Plasma water and solute move down a
concentration gradient by ultrafiltration and
convection induced by hydrostatic pressure,
15. Hollow fiber dialyser, most commonly used.
Contains bundles of capillary tubes through
which blood flows, while the dialysate
circulates outside it.
16.
17. Dialysate flows countercurrent to the blood,
Urea, Creatinine and Potassium flow from
Blood to Dialysate.
Calcium and Bicarbonate flow from Dialysate
to Blood.
18.
19. Easy access to blood
Prevention of stenosis and thrombosis
Low risk of infection
Sites:
Internal Jugular vein
Subclavian vein
Femoral vein
20. • Vein cross cut and
attached end to side
with artery.
• Takes 2-4 months to
mature.
• Low infectious risk,
durable.
21. Biocompatible tube
attached from end to
side on artery and vein.
Requires 2 weeks till
swelling resolves.
Higher risk of
stenosis/thrombosis,
high infection risk.
22. Tunelled under skin to
reduce contamination.
Can be used
immediately.
High risk of
thrombosis, infection.
23. • Arm veins suitable for access should be
preserved.
• Wear Medic bracelet.
• Save the non-dominant arm
No B.P measurement
No I/V cannula
No blood draws
• Place vascular access within ayear of
hemodialysis anticipation.
24. To maintain patency of vascular access.
Unfractionated/LMW Heparin may be used
@40-70U/Kg bolus dose follwed by 0.5-
1.0U/kg/hour in infusion.
C/I to anticoagulation in dialysis?
25.
26. • Line sepis
• Air emboli
• Blood loss
• Platelet consumption
• Hemodynamic instability
• Electrolyte imbalance
• Hypothermia
• Heparin induced thrombocytopenia
27.
28. Dialysate infused into peritoneal cavity,
followed by slow diffusion of solutes e.g
urea, creatinine.
The vascular peritoneal membrane acts as a
semi-permeable membrane.
Ultrafiltration due to osmotic gradient
generated by glucose in dialysate.
29.
30.
31. Peritonitis
Catheter associated infections
Protein loss
Residual uremia
Interference with diaphragm function
33. During or immediately after dialysis.
Caused by acute rapid increase in water
content in the brain cells and change in pH of
CSF.
Anorexia, vomiting, headache, hypotension,
blurred vision, cramps, tremors.
May cause psychosis, confusion, seizures
34. Stop dialysis
Protect airway
Correct hypoglycemia
Inj Valium/Phenytoin for seizures
May be avoided by short dialysis session, low
sodium dialysate.
35.
36.
37. GFR < 20ml/kg/min
GFR 15-19ml/kg/min: live donor with 6
antigen matches
GFR <15ml/kg/min: any donor
38. Active malignancy
Advanced lung disease
Liver Cirrhosis
Ongoing infection
Life expectancy <2 years
Ischemic cardiac disease
Severe peripheral vascular disease
BMI >40
39.
40. Acute transplant rejection
Graft vs host disease
Post transplant malignancy
Diabetes
Recurrent infections
43. Caused due to decreased erythropoietin
production.
Erythropoietin stimulating agents e.g Epoietin
alfa or Darbepoietin alfa may be used if Hb
<10g/dL.
44. Calcium salts e.g Calcium acetate, Calcium
carbonate may be given with or without
Calcitriol.
Vitamin D analogues e.g Calcitriol (1,25
dihydroxycholecalciferol) or Doxercalciferol
(1-alphahydroxyergocalciferol) may be given
in case of elevated or rising PTH levls.
45. Calcium salts
Calcimimetics e.g
Cinacalcet by increasing sensitivity of calcium
receptors on parathyroid gland to
extracellular calcium
Etelcalcitide by enhancing calcium receptor
activation by extracellular calcium.
