What do you know about dialysis?

Dr P Mayurathan
Consultant Physician (Act)
 What Is Renal Replacement Therapy (RRT)?
• RRT is a therapy that replaces the normal blood-filtering function of
the kidneys.

• It is used when the kidneys are not working well, which is

called renal failure and includes acute kidney injury and
chronic kidney disease.

• 2 types:
– Dialysis

– Kidney Transplantation (KT)

 What do you mean by the term of dialysis?
• Is a process for removing waste and excess water from the blood
and is used primarily as an artificial replacement for lost kidney
function in people with kidney failure.

• Dialysis works on the principles of the diffusion of solutes

and ultrafiltration of fluid across a semi-permeable membrane. 
 How many types of dialysis are available?

1. Haemodialysis (HD)

2. Peritoneal Dialysis (PD)

3. Haemofiltration
 Haemodialysis (HD)
• Hemodialysis removes wastes and water by circulating blood
outside the body through an external filter, called a dialyzer, that
contains a semipermeable membrane.

• the patient's blood is pumped through the blood compartment of a

dialyzer, exposing it to a partially permeable membrane.
 Haemodialysis may be:

• Continuous

• Intermittent
Haemodialysis
 Problems with HD
• Disequilibration syndrome

• Arrhythmias
• Time consuming
• Access:
– Fistula (Thrombosis, stenosis, aneurysm, steal syndrome,
ischaemia
– Temporary line (Infection, blockage)
• Difficult in a patient with low blood pressure
 Peritoneal Dialysis (PD)
A sterile solution containing glucose (called dialysate) is run
through a tube into the peritoneal cavity, the abdominal body
cavity around the intestine, where the peritoneal membrane acts as
a partially permeable membrane.
 Peritoneal Dialysis may be:

• Continuous

• Intermittent
Email
 Contraindications of PD
Absolute
• Recent abdominal surgery
• Known faecal or fungal peritonitis
• Pleuro - peritoneal fistula

Relative
• Abdominal wall cellulites
• Paralytic ileus
• New aortic prosthesis
• Abdominal adhesion or fibrosis
 Advantages of PD
• Technically simple

• Do not require highly trained persons

• Can be instituted quickly
• Usually performed manually
• Avoids the potential potential problem related to the vascular
access
• Gradual removal of fluid and solutes with less haemodynaemic
Instability
 Disadvantages of PD
• Less effective than HD in treating acute problems like

Pulmonary oedema
Drug over dose

Hyperkalaemia
• Not suitable for extremely catabolic patients
• Protein loss can be substantial
• Expensive compare to HD
 Haemofiltration
• Hemofiltration is similar to haemodialysis, but no dialysis solution is used.

• Instead the blood is passed to a semipermeable membrane where a

positive hydrostatic pressure pushes water across.

• As the water passes through the membrane large and small waste solutes
are also drawn through.

• Haemofiltration, unlike haemodialysis, provides solute clearance solely

by convection and not diffusion, as solutes are dragged down a pressure
gradient with water. 

• Replacement fluid must be extremely pure as fluid is administered directly

into the patient
 Haemofiltration

• Relatively safe in patients with low blood pressure.

• May be;
– Continuous

– intermittent
 Haemodiafiltration

• Haemodiafiltration is a combination of haemodialysis and

haemofiltration.
• Continuous Renal Replacement Therapy (CRRT)
– continuous hemodialysis (CHD)
• continuous arteriovenous hemodialysis (CAVHD)
• continuous venovenous hemodialysis (CVVHD)
– continuous hemofiltration (CHF)
• continuous arteriovenous hemofiltration (CAVH or CAVHF)
• continuous venovenous hemofiltration (CVVH or CVVHF)
– continuous hemodiafiltration (CHDF)
• continuous arteriovenous hemodiafiltration (CAVHDF)
• continuous venovenous hemodiafiltration (CVVHDF)
– continuous peritoneal dialysis (CPD)

• Intermittent Renal Replacement Therapy (IRRT)

– intermittent hemodialysis (IHD)
• intermittent venovenous hemodialysis (IVVHD)
– intermittent hemofiltration (IHF)
• intermittent venovenous hemofiltration (IVVH or IVVHF)
– intermittent hemodiafiltration (IHDF)
• intermittent venovenous hemodiafiltration (IVVHDF)
– intermittent peritoneal dialysis (IPD)
Arterio-Venous Fistula (AVF) Creation
 Arterio-Venous Fistula (AVF) Creation
• Adequate dialysis requires a blood flow of at least 200ml/min

• HD fistulas are surgically created communications between the

native artery and vein in an extremity. 

• Creating artificial arterial structure in a peripheral vein –

“arterialization of the vein”

• Need 6 – 8 weeks to mature for HD

• Used for the long-term purpose of dialysis access.