Treatment options: Kidney Failure
Jomin Joykutty
Renal Nurse
MRHTullamore.
Treatment options for Renal failure
• Haemodialysis
Outside the body
• Haemodiafiltration
• Peritoneal dialysis
Inside the body
• Renal Transplantation
Best option
Function
Salt, water, and acid-base balance
Water balance
Sodium balance
Potassium balance
Bicarbonate balance
Magnesium balance
Phosphate balance
Excretion of nitrogenous end products
Urea
Creatinine
Uric acid
Endocrine-metabolic
Conversion of vitamin D to active
metabolite
Production of erythropoietin
Renin
Dysfunction
Fluid retention and hyponatremia
Edema, congestive heart failure, hypertension
Hyperkalemia
Metabolic acidosis
Hypermagnesemia
Hyperphosphatemia, osteodystrophy
?Anorexia, nausea, pruritus, pericarditis,
polyneuropathy,
encephalopathy
Osteomalacia, osteodystrophy
Anemia
Hypertension
• Two normally functioning kidneys filter about 180
litres of blood a day, extracting about two litres of
waste and extra water.
• Functional unit of kidney is the NEPHRON
• One healthy Kidney has approximately ONE MILLION
NEPHRONS.
• However dialysis is a process in which blood is filtered
to remove excess fluid, it uses a filter(membrane) and
special dialysate to remove the fluid and waste.
• Haemodialysis: synthetic/cellulose membrane
• Peritoneal dialysis: Peritoneal membrane
Dialysis CAN
• Remove waste products
(e.g. urea, creatinine,
phosphorus, etc.)
• Remove excess water
• Correct high or
imbalanced levels of
potassium, chloride,
sodium, etc.
Dialysis CANNOT
• Automatically regulate
blood pressure
• Produce hormones like
Erythropoetin (EPO)
• Regulate normal calcium
levels
Haemodialysis Extracorporeal circuit
Blood leak
detector
Photo of first Kolff rotating drum
dialyzer
Modified Kolff rotating drum dialyzer
Kill Flat Plate Dialyser
Artificial Kidney
Hollow fibre Dialyser
Blood inlet
Dialysate outlet
Blood outlet
Dialysate inlet
Closer look of hollow fibres
Access for Hameodialysis
Protect My access: This is my life line
∗ AVFistulas (preferred and best)
Pros
• Last Longer(decades).
• Less prone to infection.
• Less chance of clotting.
• Best dialysis performance.
Cons
• It takes time to mature.
• Needles to be inserted every
time.
• Bleeding after removing
needles.
• Visible under the skin.
• May require temporary access
while it develops.
• Steal syndrome.
• Aneurysms
Care of AVFistulas
No constrictive clothing.
Avoid cuts and abrations
No blood samples
No Blood pressure
No IV cannulas
Do not sleep with your access
arm under your head or body.
Avoid dehydration
∗ ArterioVenous Fistula needles
Tunnelled Dialysis catheter
Pros
• Perform dialysis immediately.
• Avoids needle insertion each
time.
Cons
• High infection rates.
• May cause stenosis/ narrow
central veins.
• Blood flow may not be
sufficient to perform
adequate dialysis.
• Difficult with shower or bath.
Principles of Haemodialysis
1.Diffusion
The movement of solutes from an area of high
concentration to an area of low concentration;
Clearance by diffusion targets small molecules.
Diffusion
The rate of movement of solutes is dependent upon blood and dialysate
flow rates, concentration gradient and the membrane characteristics.
Dialysate Out
Blood In
Clearance
Dialysate In
LOW CONC
Blood Out
HIGH CONC
2.Ultrafiltration
Ultrafiltration is achieved by
the creation of pressure within
the dialyser, forcing fluid from
the blood to the dialysate.
This is created by applying
positive pressure in the blood
compartment and negative
pressure in the dialysate
compartment.
Filtered water is measured
constantly.
NEGATIVE PRESS
Blood In
Fluid Volume
Reduction
Blood Out
POSITIVE PRESS
3.Convection
Solutes are dragged across a membrane with ultrafiltered fluid; the rate of transfer
is dependent on the ultrafiltrate volume. Clearance by convection targets middle
molecular weight uremic toxins.
Blood In
Clearance
Blood Out
LOW PRESS
HIGH PRESS
Quality of life
• Mortality rates are high with HD.
• Treatments are scheduled by the center and are
relatively fixed. (12 hours weekly)
• Travel to the center for treatment.
• This treatment has the strictest diet and fluid limits of
all.
• Longer treatment times is more beneficial, however
not liked by clients.
• Other endocrine functions: Anaemia management,
Calcium phosphate management, BP management
etc…
Renal Transplantation
Best treatment option
Two types
∗ Cadaveric : From people that have died suddenly.
∗ Living donors: Living person usually a relative.
Average waiting time is more than 3years.
More than 500 people waiting for transplant.
Demand is more supply is less.
ANY
QUESTIONS?