Dialysis

Question 1

Types of Dialysis

Answer 1

There are two main types of dialysis used to treat end-stage renal disease (ESRD): hemodialysis (HD) and peritoneal dialysis (PD). Both types of dialysis have different medical indications, applications, and potential complications.

Question 2

Indications and applications for Dialysis

Answer 2

1)Hemodialysis (HD):
A)Medical Indications:
End-stage renal disease (ESRD): HD is the most common form of dialysis used for individuals with advanced kidney failure.

Acute kidney injury: HD can be used temporarily for individuals with acute kidney injury until kidney function recovers.

B)Applications:
HD involves the use of a dialysis machine that filters the blood outside the body. The patient’s blood is pumped through a dialyzer, where waste products and excess fluids are removed, and the cleaned blood is returned to the body.
Typically, HD is performed in a dialysis center or hospital setting, typically three times a week for a few hours per session.
HD requires vascular access, which is usually established through an arteriovenous fistula (AVF) or graft, or a central venous catheter.

2) Peritonean Dialysis :
A)Medical Indications:
End-stage renal disease (ESRD): PD is an alternative to HD and can be suitable for certain individuals with ESRD.
PD may be considered when HD is not feasible or preferred by the patient.

B)Applications:
PD involves the use of the peritoneal membrane in the abdomen as a natural filter. Dialysis solution is introduced into the peritoneal cavity through a catheter, and waste products and excess fluids pass through the peritoneum into the solution.
PD can be performed at home, allowing for more independence and flexibility. It can be done manually (continuous ambulatory peritoneal dialysis, CAPD) or with the help of a machine (automated peritoneal dialysis, APD).
PD requires the insertion of a peritoneal catheter into the abdomen.1

Question 3

Complications of Dialysis

Answer 3

Complications:

1) Hemodialysis :
Hypotension (low blood pressure): Rapid removal of fluids during HD can lead to low blood pressure.

Muscle cramps: Fluid and electrolyte shifts during HD can cause muscle cramps.
Infection: There is a risk of infection at the vascular access site, such as catheter-related infections or access-related infections in AVF or graft.

Clotting and blockages: The dialysis access site may develop blood clots or blockages, requiring interventions or revisions.

Inflammation and immune system changes: Chronic inflammation and immune system alterations can occur over time with HD, leading to various complications such as cardiovascular disease, anemia, and bone disorders.

2) Peritoneal Dialysis:
Peritonitis: Infection of the peritoneal cavity is the most common and serious complication of PD. It requires prompt treatment with antibiotics.

Exit site and tunnel infections: Infections can occur at the site where the peritoneal catheter exits the body.

Hernias: The increased intra-abdominal pressure from the dialysis solution can contribute to the development of hernias.

Fluid and electrolyte imbalances: Imbalances can occur if there are issues with fluid removal or absorption during PD.

Encapsulation and sclerosis of the peritoneal membrane: Over time, the peritoneal membrane may undergo changes that can affect its effectiveness as a dialysis filter.