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RENAL REPLACEMENT

THERAPY

BY

PRAVEENAMSC NURSING


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MEANING OF RENAL REPLACEMENTTHERAPY

Renal replacement therapy is a term used toencompass life supporting treatments for renal

failure.

Procedures which temporarily or permanently

remedy insufficient cleansing of body fluids by the

kidneys.


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TYPES OF RENAL REPLACEMENT

THERAPY

It includes:

Hemodialysis

Peritoneal dialysis

Renal transplantation


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HISTORY OF DIALYSIS


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Dr Wilhem (Pim) Johan Kolff (19112009) and his rotating drum(1943) in 1999


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FUNCTIONS OF DIALYSIS

Dialysis replaces three main kidney functions:

1. Removing wastes from the blood,

2. Removing excess fluid from the blood,

3. Keeping electrolytes in balance.


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PRINCIPLES USED IN DIALYSIS

Scientific Principles of dialysis include the

following:

Solutions

Semi permeable membranes

Transport mechanisms


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Solutions and Membranes

Solutions:

Solvent is a fluid (water)

Solute is a substance that can be dissolved in

a solvent

Semi-Permeable membranes:

A thin layer of material with pores or openings

that allow some substances to pass throughfreely, while keeping other substances out.


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Transport Mechanisms

Necessary to move fluid and solutes through the

semi-permeable membrane

Mechanisms used in dialysis

Diffusion

Osmosis

Filtration

Ultra filtration


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Diffusion

Movement of dissolved particles (Solutes)

across a semipermeable membrane from an

area HIGHER solute concentration to an area

of LOWER solute concentration

Removes waste products from the blood

BUN and Creatinine


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Osmosis

Movement ofFLUID across a semipermeable

membrane from an area ofLOWER solute

concentration to an area ofHIGHER soluteconcentration.


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Filtration

Process of passing fluid through a filter or semi

permeable membrane.

Regulates fluid balance in the blood


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Ultrafiltration

Controlled fluid removal by manipulation ofhydrostatic pressure. Ultrafiltration uses both

positive and negative pressure:

Positive pressure = pressure exerted by the

blood flowing through the dialyzer

Results from blood being pushed by blood pump

Negative pressure = pressure applied to the

dialysateside by the machine

Pulls excess fluid from blood compartment to

dialysate compartment --- drain


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Indications for dialysis:The decision to initiate dialysis in patients with renal failure

depends on several factors. Acute indications:

Metabolic acidosis

Electrolyte abnormality

Fluid overload Complications ofuremia

Intoxication, that is, acute poisoning with a dialyzable

substance.

Chronic indications for dialysis: Symptomatic renal failure

Lowglomerular filtration rate (GFR)


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HEMODIALYSIS


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Principles of hemodialysis:osmosis and diffusion


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Prescription

A prescription for dialysis by a nephrologist will

specify various parameters for a dialysis

treatment.

Frequency

Length of each treatment

Blood and dialysis solution flow rates

Size of the dialyser


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Access

An intravenous catheter

An arteriovenous (AV) fistula

A synthetic graft.


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Catheter access::--

Catheter access, consists of a plastic catheter

with two lumens which is inserted into a large

vein to allow large flow of blood to be withdrawnfrom one lumen, to enter the dialysis circuit, and

to be returned via the other lumen.

Catheters are usually Non tunnelled and

Tunneled


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Tunneled catheter


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Advantages ofAV fistula

Lower infection rateHigher blood flow rate

Lower incidence of thrombosis

Complications ofAV fistula

Steal syndrome

Aneurysms


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AV graft

AV grafts are

much like fistulas

in most except

that an artificialvessel is used to

join the artery

and vein.


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Grafts are inserted when the patient's native

vasculature does not permit a fistula.

They mature faster than fistulas, and may beready for use several weeks after formation.

AV grafts are at high risk to develop

narrowing.


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Types of Hemodialysis

Conventional hemodialysis,

Daily hemodialysis, and

Nocturnal hemodialysis


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Conventional hemodialysis:

3 times a week

3-4 hours for each treatment


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Advantages and disadvantages of

hemodialysis

Advantages

Low mortality rate

Better control of bloodpressure and abdominalcramps

Less diet restriction

Better solute clearanceeffect for the daily

hemodialysis: bettertolerance and fewercomplications with morefrequent dialysis.

Disadvantages

Restricts independence.

Requires more supplies.

Requires reliable technologylike dialysis machines

The procedure iscomplicated and requiressound knowledge

Requires time to set up andclean dialysis machines, andexpense with machines andassociated staff.


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Complications ofHemodialysis

Technical complications

Fluctuations in blood pressure

Cardiac dysrthymias Air embolism

Hemorrhage

Restless legs syndrome Pyrogenic reactions.


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Nursing care for hemodialysis patient

Hemodialysis Vascular Access

Hemodialysis adequacy

Hemodialysis treatment and complications Medication management and infection

control practice


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PERITONEAL DIALYSIS


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Peritoneal dialysis involves repeated

cycles of instilling dialysate into the

peritoneal cavity, allowing time for

substance exchange, and then removing

the dialysate.


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Uses

Patients with cardio vascular diseases

patients with diabetes

Patients with bleeding disorders


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Contra indications

Hypercatabolism

Poor peritoneal membrane

Obesity History of ruptured diverticula

Abdominal diseases, respiratory diseases

Recurrent episodes of peritonitis Abdominal malignancies


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Types of peritoneal dialysis:

Continuous ambulatory peritoneal dialysis

Automated peritoneal dialysis

Continuous cyclic peritoneal dialysis Intermittent peritoneal dilaysis

Nightly intermittent peritoneal dialysis


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Advantages and Disadvantages:

simple to set up +

perform

easy to use

hemodynamic stability

no anti-coagulation

bedside peritoneal access

unreliable ultrafiltration

slow fluid + solute

removal

drainage failure, leakage

catheter obstruction

respiratory compromise

hyperglycemia

peritonitis

advantages disadvantages


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Complications of peritoneal dialysis:

Peritonitis

Catheter related complications-displacement

and obstruction Dialysis related complications-pain,

hypotension, weight gain.

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