Renal Replacement Therapy

HD, PD, Renal Transplantation

Hemodialysis
 Complications
First use syndrome;
Hypersensitivity to ethylene oxide (ETO) gas, sterilant
used in most dialysers & bloodlines
Complement activation by cellulosic dialysis
membrane
Anaphylactoid reactions in patients receiving ACE-I
and dialyzed with high flux membrane
Hypotension
Autonomic neuropathy
Osmotic disequilibrium between EC & IC
compartments
Cardiomyopathy
Air embolus
 Assessment peritoneal membrane
function
Peritoneal solute clearance =
[CDxVD] / [Cpxt]
PET ,peritoneal equilibrium test, transport
characteristics
2L of 2.5% dialysate is placed in the peritoneal cavity
for 4 hours
Periodically dialysate and blood are sampled for
urea/creatinine & glucose
At the end of the exchange, the drained volume is
measured
D/P [Cr] and ratios sampled dialysate glucose to initial
dialysate glucose are calculated and plotted on a
nomogram
 It is just the dialysate over plasma ratio of various
solutes versus the dwell time of four hours in this
situation. It is an important one because it shows you
that transport will have its highest rate here in the
beginning and the rate will decrease the longer the dwell
time.

That means a few things. When you want to use these

kinds of graphs to characterize the peritoneal
membrane, you should either calculate the dialysate
over plasma ratio, over here, or mass transfer area
coefficients (MTACs), which are the maximum
clearances that you can obtain at time zero, because in
between the clearance changes.

Once equilibrium between blood and dialysate has been

reached, urea transport is determined by the drain
volume, so ultrafiltration is very important over here.
PERITONEAL DIALYSIS
Number of transplants, by donor type
Figure 7.1

Transplant counts as
known to the USRDS
(reconciled from various
sources).
 Median waiting times, by age, gender & race
Figure 7.8

Patients receiving deceased donor, kidney-only first transplants; unadjusted. Year is the year of transplant, not the year
the patient was first listed.
 Survival: Deceased donor transplants
Figure 7.14

Cumulative incidences obtained from Cox proportional hazards models, adjusted for year, age, gender, race, & primary
diagnosis. Half-life estimates are conditional on first-year graft survival.
 Survival: Living donor transplants
Figure 7.15

Cumulative incidences obtained from Cox proportional hazards models, adjusted for year, age, gender, race, & primary
diagnosis. Half-life estimates are conditional on first-year graft survival.
 Absolute
Bloodgroup compatible
PRA, the lower the better
B & T cell Crossmatch