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