Kidney Failure

Treatment of Kidney Failure
When a patient has a mild to moderate kidney failure where the serum creatinine is less than 400 µmol/L, he does not require renal replacement therapy such as dialysis or renal transplant. This is due to the fact that he still has enough residual renal function to sustain life. However he requires certain medications and dietary restriction to delay damage to the kidney.
When his serum creatinine increase to 900 µmol/L, he requires dialysis or a kidney transplant.
Dialysis in General
Dialysis is a process which allows diffusion of solutes dissolved in blood across a semi- permeable membrane into another solution and vice versa. This means that it removes waste products through this special membrane and bicarbonate can diffuse across to the blood to neutralise acid. In this way the imbalance in the body can be corrected.

Peritoneal Dialysis

What is Peritoneal Dialysis?

Peritoneal dialysis is a form of dialysis that occurs inside the body.
Dialysis solution will flow into the peritoneal (abdominal) cavity through a silastic catheter. The peritoneal membrane (petrionuem) acts as a filter. Waste products and excess water pass from the body through the membrane into the dialysis solution. When the filtering process is completed, the waste filled solution is to be drained from the peritoneal cavity into a bag and is then discarded.
Fresh dialysis solution is drained into the abdominal cavity through the catheter again. Each exchange takes about 45 minutes.
There are two forms of peritoneal dialysis :
• CAPD or Continuous Ambulatory Peritoneal Dialysis - The patient will perform four exchanges during the day
• APD or Automated Peritoneal Dialysis - The exchanges are performed by the machine during the night while the patient is asleep.
The advantages and disadvantages of peritoneal dialysis
Advantages
Disadvantages
Patient's involvement in self-care Four exchanges per day
Control over schedule Permanent external catheter
Less diet & fluid restriction Change of body image
More steady physical condition as it provides slow, continuous therapy Potential weight gain
Most similar to original kidneys Some risks of infection
Can be done in the night as in automated peritoneal dialysis If on automated peritoneal dialysis, one will be tie onto a machine in the night
Provide less severe cardiovascular instabilities in patients with underlying heart disease Storage space is needed for supplies


Haemodialysis



What is Haemodialysis?
Haemodialysis is a process by which excess waste products and water are removed from the blood. This process requires an access to the patient's blood stream and the use of a haemodialysis machine. An access is a specially created vein in the arm known as arterio-venous (AV) fistula.
In haemodialysis, the blood channels through plastic tubings (blood lines) to the dialyzer which is a bundle of hollow fibres made up from semi-permeable membrane. Here the exchange (diffusion) takes place from blood to the dialysis solution (dialysate) and vice versa. The dialysate has a salt composition similar to blood but without any waste products.
Usually one dialysis session takes about 4 hours to complete and patient requires dialysis 3 times a week.
The advantages and disadvantages of haemodialysis
Advantages
Disadvantages
Staff performs treatment in the dialysis centre Requires travel to a dialysis centre
Three treatments per week in the dialysis centre Fixed treatment schedule
Permanent internal access required Two needle sticks for each treatment; tie onto a machine and cannot move about during treatment
Regular contact with people in the centre Diet and fluid intake restriction