This document discusses kidney failure treatment options including hemodialysis, peritoneal dialysis, and transplantation. Hemodialysis and peritoneal dialysis are dialysis techniques that use filters or the peritoneal membrane to remove waste and excess fluid from the blood. Kidney transplantation is usually the best long-term treatment but demand for donors exceeds supply.

1. HEMODIALYSIS,
PERITONEAL DIALYSIS
AND TRANSPLANTATION

2. • Failing kidneys may reach a point when they no
longer excrete water and ions at rates that
maintain body balances of these substances,
nor can they excrete waste products as fast as
they are produced.
• An elevation of waste products, as measured in
the blood, is called "azotemia." When waste
products accumulate they, cause a sick feeling
throughout the body called “uremia”.

3. • The clinical techniques used to perform the
kidney’s excretory functions are hemodialysis
and peritoneal dialysis.
• Dialysis simply means to separate substances
using a permeable membrane.
• The two major blood chemical levels that are
measured are the "creatinine level" and the
"blood urea nitrogen" (BUN) level. As these two
levels rise, they are indicators of the decreasing
ability of the kidneys to cleanse the body of waste
products.

4. • Usually, when the creatinine clearance falls to
10-12 cc/minute, the patient needs dialysis.
• Hemodialysis uses a special type of filter to
remove excess waste products and water from
the body.
• Peritoneal dialysis uses a fluid that is placed
into the patient's stomach cavity through a
special plastic tube to remove excess waste
products and fluid from the body.

5. • Hemodialysis

6. • In hemodialysis, the patient's blood is pumped
through the blood compartment of a dialyzer,
exposing it to a partially permeable membrane.
The dialyzer is composed of thousands of tiny
synthetic hollow fibers. The fiber wall acts as
the semipermeable membrane.
• Blood flows through the fibers, dialysis solution
flows around the outside of the fibers, and
water and wastes move between these two
solutions. The cleansed blood is then returned
via the circuit back to the body.

7. • Ultrafiltration occurs by increasing the
hydrostatic pressure across the dialyzer
membrane. This usually is done by applying a
negative pressure to the dialysate
compartment of the dialyzer.
• This pressure gradient causes water and
dissolved solutes to move from blood to
dialysate, and allows the removal of several
litres of excess fluid during a typical 3 to 5
hour treatment.

8. For example, if the plasma potassium
concentration of the patient is above normal,
potassuim diffuses out of the blood across the
tubing and into the dialysis fluid. Similarly,
waste products and excesses of other
substances also diffuse into the dialysis fluid.
• This type of hemodialysis is usually called
"nocturnal daily hemodialysis", which has
shown a significant improvement in both small
and large molecular weight clearance and
decrease the requirement of taking phosphate
binders.

9. Peritoneal dialysis

10. • In peritoneal dialysis, a sterile solution
containing glucose is run through a tube into
the peritoneal cavity, the abdominal body cavity
around the intestine, where the peritoneal
membrane acts as a semi permeable
membrane.
• The peritoneal membrane or peritoneum is a
layer of tissue containing blood vessels that
lines and surrounds the peritoneal, or
abdominal, cavity and the internal abdominal
organs (stomach, spleen, liver, and intestines)..

11. The dialysate is left there for a period of time to
absorb waste products, and then it is drained
out through the tube and discarded.
This cycle or "exchange" is normally repeated
4-5 times during the day, (sometimes more
often overnight with an automated system).
Each time the dialysate fills and empties from
the abdomen is called one exchange. A dwell
time means that the time of dialysate stay in
patient's abdominal cavity—wastes,
chemicals and extra fluid move from patient's
blood to the dialysate across the peritoneum.

12. • A drain process is the process after the dwell time, the
dialysate full with waste products and extra fluid is
drained out of patient's blood.
• Ultrafiltration occurs via osmosis; the dialysis solution
used contains a high concentration of glucose, and the
resulting osmotic pressure causes fluid to move from
the blood into the dialysate.
• As a result, more fluid is drained than was instilled.
Peritoneal dialysis is less efficient than hemodialysis,
but because it is carried out for a longer period of time
the net effect in terms of removal of waste products
and of salt and water are similar to hemodialysis.

13. • For many patients, the major advantage of
hemodialysis is minimal participation in the
treatment. However, patients are required to
adhere to a specific schedule and travel to the
dialysis unit. Hemodialysis also requires stricter
diet control and fluid control than peritoneal
dialysis.
• The major problem with peritoneal dialysis is
infection. The patient has a plastic tube that goes
from the peritoneal cavity to the outside of the
body and this is a potential site for the entry of
bacteria into the body. Great emphasis is placed
on cleanliness and technique during the training
sessions.

14. TRANSPLANTATION
• The long term treatment of choice for most
patients with renal failure is kidney
transplantation.
• Many people who might benefit from a
transplant, however, do not receive one.
• It is more effective than dialysis and works ten
times better. Kidneys can be donated from living
persons or the deceased.

15. Kidney to be transplanted

16. • Patients with kidney transplants are required to take
medicines for life or for as long as the transplant is in
the body. This medicine keeps the body from rejecting
the transplant.
• Before a kidney transplant can be done, the patient has
to undergo several tests to determine the chances of
your body accepting the available kidney.
• The transplant kidney is inserted into the lower
abdomen and connected to an artery and a vein. As
soon as blood begins to flow through the new kidney,
will be able to perform the regular functions of a
kidney.