Problems of Hemodialysis

It also in hospital it has to visit in hospital twice or thrice in a week.

That is why in some areas still hemodialysis facility is not available. So, it is not practical for patients living in remote areas to get dialysis done. It is a painful procedure because for hemodialysis needless are pricked.

Chances of blood related infections like hepatitis b, hepatitis c etc.

Need, a vascular access because in some patients a vascular access is a problem.

Advantages of Hemodialysis

Rapid correction and rapid fluid removal which is not possible with peritoneal dialysis

Disadvantages of Hemodialysis

Use of heparin (I.e. anticoagulant) which prevents clothing of blood and increases the risk of bleeding

Peritoneal Dialysis

it is a form of dialysis in which a special fluid (peritoneal dialysis and fluid) is inserted into abdomen through a peritoneal dialysis catheter and then this fluid is kept in the abdomen for 6-12 hours (somewhere it is a time for which the fluid is kept in the abdomen i.e. in between inflow and outflow time) dual time .Then this fluid, will remove toxin, extra fluid and control electrolytes. This cycle of inserting and removing fluid is a continuous process for whole day or for 24 hours.

P.D.

• CAPD – continuous ambulatory peritoneal dialysis
• APD – automated peritoneal dialysis

Automated Peritoneal Dialysis

In this the inflow and outflow of the fluid is controlled through automated machine and which is usually done during night time and it exchanges are of shorter period of time could be combined 1 or 2 manual exchanges with fluid. During day time the benefit of CAPD is slow ongoing dialysis which is more physiological, no vascular access is required.

It is painless procedure need not to require to go to hospital can be performed at home.

Problems of peritoneal dialysis

• Chances of abdomen infection is very high
• High sugar
• Protein loss
• It needs to take very high protein intake
• Abdomen fullness every time
• Peritoneal dialysis catheter is to be placed
• Can perform on his own need not to take his help from anybody

Peritoneal dialysis

It is the treatment for kidney failure. A special kind of fluid which is sterile in nature, introduced into the abdomen through a permanent tube. This is placed in the peritoneal cavity. Fluid circulates through abdomen to drain out impurities from blood vessels in the peritoneum; it is than drained from the body.

PD can be done at home, work, or even on trips. But it requires special kind of supervision. PD patient also requires regular working with dialysis technician, nephrologist, dialysis nurse, and dietician.

Two types of peritoneal dialysis

• CAPD – Continuous Ambulatory Peritoneal Dialysis
• APD – Automated Peritoneal Dialysis

Special Instructions for Dialysis Patient:

Regular maintenance hemodialysis thrice weekly.
If patient has good urine output, stable renal functions, minimal symptoms, potassium and phosphorus are controlled and inter-dialytic weight gain is not much than patient can come twice weekly.

• Good high protein low potassium diet
• Good physical activity.
• Regular investigation as per protocol.
• Vaccination as per protocol.
• Control of inter-dialytic weight gain.
• Care of Vascular access
• Care of dialysis catheter (avoid water soakage or soiling of catheter dressing).
• Fistula (no blood pressure measurements and intravenous pricks on fistula arm)

Differences between CAPD and APD

CAPD	APD
Performed for 24 hours	Mainly during sleeping time
Less costly	Very costly
Chances of technique failure is more (ultrafiltration)	Chances of techniques (ultrafiltration) failure is less
Can more around with dialysis going on	The patient is continuously connecting with machine, so can’t move around.
Chances of infection is high	Chances of infection is less

Differences between Hemodialysis and Peritoneal Dialysis:

Hemodialysis	Peritoneal dialysis
Blood related therapy	Water based therapy
Usually done is hospital settings	Done at home
More dietary restrictions	Less dietary restrictions needed
No protein loss	High protein loss leads to malnourishment
Painful	Not painful
Needs vascular access	Needs peritoneal dialysis catheter
Cost varies but less costly than peritoneal dialysis	More costly
Chances of blood related infections	More chances of peritonitis
Chances of low BP and cardiac arrythmia	Less risk of hemodynamic instability and increased sugar levels
Less preferred modality for pediatric cases.	Preferred modality in pediatric cases.

DIALYSIS IN CRITICAL ILL PATIENT

• The options for dialysis in critical ill patient are slow low efficiency dialysis (SLED).
• Continuous renal displacement therapy CRRT.
• Continuous veno venous hemodialysis CVVHD
• Continuous veno venous hemodialysis CVVHDF
• Continuous veno venous hemofiltration CVVHF
• Slow continuous ultra filtration SCUF
• Acute peritoneal dialysis – it is now mostly useful where hemodialysis machine is not available and the patient the critically ill and needs dialysis, also, it is useful in pediatric cases.

SLED	CRRT
Done with conventional hemodialysis machine	Done with special machine
Needs less man power	Needs more man power and expertise
Less costly	More costly
It is intermittent form of dialysis	It is a continuous form of dialysis.Lasting for 2-4 days
More chances of hypotension	Less chances of lower blood pressure