PRESENTATION ON
DIALYSIS
.
 Patient with end stage of renal failure depend upon
maintenance dialysis in order to survive.
 DIALYSIS is the artificial process of getting rid of waste
(diffusion) & unwanted water (ultra filtration) from the blood.
Dialysis is an artificial way of doing the work of the kidneys, but it
cannot replace the natural efficiency of the kidneys. If you are
on dialysis you need to carefully regulate your diet.
INDICATIONS TO USE DIALYSIS





ACUTE INDICATIONS
Acidemia from metabolic acidosis
Electrolyte abnormality
Intoxication
Overload of fluid
Uremia complications
CHRONIC INDICATIONS
 Symptomatic renal failure
 Low glomerular filtration rate
 Difficulty in medically controlling fluid overload
DIALYSIS HELPS, BUT IS NOT
EFFICIENT AS THE KIDNEYS
 Patients on dialysis need to be careful, about what & how




much they eat & drink.
A significant no. of people on dialysis can work & lead
normal lives.
Women on dialysis will probably not be able to get
pregnant .
If a woman has a successful kidney transplant, her fertility
should return to normal.
Dialysis has some effect on male fertility, but much less
than on female fertility.
WHY IS DIALYSIS NECESSARY?
 Approximately 1.5 liters of blood are filtered by a healthy
person's kidneys each day.
 We could not live if waste products were not removed
from our kidneys.
 People whose kidneys either do not work properly or not
at all experience a buildup of waste in their blood.
 Without dialysis the amount of waste products in the
blood would increase and eventually reach levels that
would cause coma and death.
PRINCIPLE OF DIALYSIS
Dialysis works on the principles of the diffusion of
solutes and ultra filtration of fluid across a semipermeable membrane. Diffusion describes a property
of substances in water. Substances in water tend to
move from an area of high concentration to an area of
low concentration.
 works on the principles of the diffusion of solutes and
ultra filtration of fluid across a semi-permeable
membrane.
 Blood flows by one side of a semi-permeable membrane,
and a dialysate, or special dialysis fluid, flows by the
opposite side.
 A semi permeable membrane is a thin layer of material
that contains various sized holes, or pores.
 Plastic tubing attached to the needles connects the patient
to the artificial kidney.
 Artificial kidney contains, two compartments, one for the
patient’s blood and one for a cleaning solution calleddialysate. A thin porous membrane separates these
compartments.
 Blood cells, proteins and other important substances in
the blood remain in the compartment.
 Smaller waste products- urea, creatinine and excess water-
are washed away.
TYPES OF DALYSIS
CONTINUOUS
AMBULATORY P.D
PERITONEAL
DIALYSIS
CONTINUOUS
CYCLIC DIALYSIS
DIALYSIS
HEMODIALYSIS
HEMOFILTRATION
HEMODIALYSIS
 Removes waste & water by circulating blood outside the
body, through an external filter- dialyzer.
 Blood and dialysate are brought into the dialyser, which has
an artificial membrane made of cellulose and other meterial.
 The blood flows in one direction and the dialysate flows in
the opposite.
 In the latter type blood flows through microscopic
lumina in bundle of thousand of hollow fibred, while
dialysate circulate around the fibre.
 The flow of the blood needed for adequate dialysis is
high- usually 200-300 ml/ min and dialysate flows at
500 ml/min.





WORKING-:
Hemodialysis requires permanent access to the bloodstream
through a fistula created by surgery to connect an artery and
a vein.
Fistulas are often made near the wrist.
If the patient's blood vessels are fragile, an artificial vessel
called a graft may be surgically implanted.
The dialysis fluid electrolyte content is similar to that of
normal plasma.
Waste products and electrolites move by diffusion,
ultrafiltration , and osmosis from the blood into the dialysate
and are removed
 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.
 Hemodialysis Treatrnent is usually for 3 to 5 hours, three
times per week.
 Before the blood process into the dialyser, the
anticoagulant heparin is added to prevent cloating.
 Inter-dialytic parenteral nutrition is a means of
providing calories and protein
(Dietary protein needs are about 1.2 g/kg, to make up
for some losses through the dialysate)
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
partially permeable membrane.
WORKING-:
 Makes use of the semipermeable membrane of the




peritoneum.
A catheter is surgically implanted in the abdomen and
into the peritoneal cavity.
Dialysate containing a high-dextrose concentration
instilled into the peritoneum, where diffusion carries
waste products from the blood through the peritoneal
membrane and into the dialysate; water moves by
osmosis.
This fluid is then withdrawn and discarded, and new
solution is added. Several types of peritoneal dialysis
exist.
Each time the dialysate fills and empties from the
abdomen is called one exchange.
 Is less efficient method of removing waste product from
the blood.
 Treatment usually last longer than hemodialysis, about 1012 hrs/day, 3 times a week.
 Patients have higher needs of protein (about 1.2- 1.5g/kg
body weight).
CONTINUOUS AMBULATOR
PERITONEAL DIALYSIS
 Is similar to peritoneal dialysis, except that the dialysate is
left in the peritoneum and exchanged manually so that no
machine is required.
 Exchange of dialysate fluid are done 4-5 times daily
making it a 24 hour treatment.
 Protein losses are more than regular peritoneal dialysis.
 ADVANTAGES-:
 Avoidance of large fluctuation in blood chemical.
 Patient can achieve a normal life style.
• COMPLICATIONS-:
 Peritonitis
 Hypertension require additional fluid and sodium
replacement.
 Weight gain.
CONTINUOUS CYCLIC
PERITONEAL DIALYSIS
 A machine does the dialysis fluid exchanges.
 It is generally done during the night while the patient
sleeps. This needs to be done every night. Each session
lasts from ten to twelve hours.
 After spending the night attached to the machine, the
majority of people keep fluid inside their abdomen
during the day.
 A study found that a significant number of patients prefer
"dialysis while you sleep" treatment.
 Another study found that nocturnal dialysis improves
heart disease in patients with end-stage kidney failure.
 Patients who choose PD have higher protein needs
(about 1.2 to 1.5 g of protein per kilogram) because of
greater protein losses.
 Most people on PD do not have to limit potassium in
their diet. Many need to add high-potassium foods to
keep blood levels from getting too low; a typical intake
is 3 to 4 g/day.
 Advantages of this form of treatment are avoidance of
large fluctuations in blood chemistry, longer residual
renal function, and the ability of the patient to achieve a
more normal lifestyle.
HEMOFILTRATION
 The blood is pumped through a dialyzer or "hemofilter" as
in dialysis, but no dialysate is used.
 A pressure gradient is applied; as a result, water moves
across the very permeable membrane rapidly, "dragging"
along with it many dissolved substances, importantly ones
with large molecular weights, which are cleared less well by
hemodialysis.
 Salts and water lost from the blood during this process are
replaced with a "substitution fluid" that is infused into the
extracorporeal circuit during the treatment.
 Hemodiafiltration is a term used to describe several
methods of combining hemodialysis and hemofiltration in
one process.
HEMODIFILTRATION
 Hemodialfiltration is a combination of hemodialysis and
hemofiltration. In theory, this technique offers the
advantages of both hemodialysis and hemofiltration.
INTESTINAL DIALYSIS
 In intestinal dialysis, the diet is supplemented with
soluble fibres such as acacia fibre, which is digested by
bacteria in the colon.
 This bacterial growth increases the amount of nitrogen
that is eliminated in fecal waste.
 An alternative approach utilizes the ingestion of 1 to
1.5 liters of non-absorbable solutions of polyethylene
glycol or mannitol every fourth hour.
NUTRITION
MANAGEMENT
NUTRITIONAL REQUIREMENT
FOR ADULTS WITH RENAL
DISEASE BASED ON THERAPY
THERAPY
ENERGY
(kcal/kg
BWt)
PROTEIN FLUID
(g/kg
(ml/day)
BWt)
Na
(g/day)
K
(g/day)
P
(g/day)
HEMODILYSIS
35
1-1.2
1000+
urine
output
2-3
2-3
1-1.2
PERITON
EAL
DIALYSIS
30
1.2
1000+
urine
output
2-3
2-3
1-1.2
THERAPY
ENERGY
(kcal/kg
BWt)
PROTEIN
(g/kg
BWt)
FLUID
(ml/day)
Na
(g/day)
K
(g/day)
P
(g/day)
CAPD
25
1.2
2000+
urine
output
6-8
3-4
1.5-2
DIABITIC
ON
HEMODI
ALYSIS
35
1.5
1000+ urine 6-8
output.
Monitor
thirst,
blood sugar
& wt.
changes
3-4
1-1.2
Medical Nutrition Therapy
 To prevent deficiency and maintain good nutrition
status through adequate protein, energy, vitamin,
and mineral intake
 To control edema and electrolyte imbalance by
controlling sodium, potassium, and fluid intake
 To prevent or retard the development of renal
osteodystrophy by controlling calcium, phosphorus,
and vitamin D intake
 To enable the patient to eat a palatable, attractive diet
that fits his or her lifestyle as much as possible
DIETARY MANAGEMENT
 FLUID AND Na BALANCE-:
 Fluid should be continued at a normal level.
 Dialysis patient with hypertension and edema may need to
restrict intakes of Na and fluid.
 Some patients with fluid retention have to watch their
fluid intake carefully however. And if you are not
producing urine, you have to reduce your fluid intake.
 Haemodialysis patients often have greater restrictions on
fluid intake than peritoneal dialysis patients.
 If on hemodialysis your weight increases by around 0.5 kg
per day between treatments - if it increases by more than
this then you are suffering from fluid retention.
• POTASSIUM-:
 High intakes are not tolerated with less frequent dialysis.
 The daily intake of potassium is 75-100mEq (3-4g).
 This is usually reduced in ESRD to 40-65mEq (1.5-2.5g)/day
and is reduced for the anuric patient on dialysis to 51mEq
(2g/day).
• PROTEIN-:
 Dialysis is a drain on body protein, and the daily intake
should be increased to compensate for this.
 Protein losses of 20-30 g can occur during a 24 hr peritoneal
dialysis.
 A daily intake of 1.2-1.5 g/kg body weight is recommended.
• ENERGY-:
 Energy intake must be adequate to spare protein for -:
tissue protein synthesis
To prevent its metabolism for energy.
 Between 25-30 kcal/kg body weight should be provided.
• FLOURIDE-:
 High level of fluoride in the serum of uremic patient appear
to aggravate the existing bone diseases.
 It should be restricted.
PHOSPHATE AND CALCIUM
 Phosphate and calcium affect the health of the bones.
When a person has kidney failure, the calcium level in
their body tends to be too low and the phosphate level too
high.
 Treatment for kidney patients aims to raise blood calcium
levels and lower blood phosphate levels. These aims can be
achieved by moderating the phosphate content of your
diet, by adequate dialysis,
 IRON-:
 Several types of anemia occur with dialysis.
 It is caused due to-:
Inability of kidney to produce erythropoietin
Increased destruction of RBC’s.
 A synthetic form of EPO, recombinant human EPO (r Hu
EPO) is used to treat anemia of ESRD.
• VITAMINS-:
 Increased need for water-soluble vitamins because of losses
during dialysis.
 Fat-soluble vitamins A. D. and K are not supplemented.
 Vitamin E may be supplemented.
 Vitamin C
6o mg(not too exceed200 mg








1 mg
1.5 mg
1.7 mg
20 mg
10 mg
6 mcg
10 mg
0.3 mg
daily)
Folic acid
Thiamin
Riboflavin
Niacin
Vitamin B6
Vitamin B12
Pantothenic acid
Biotin
 CARBOHYDRATES-:
 Glucose intolerance with both hyperglycemia & hypoglycemia
is frequently observed in patients with ESRD.
 A delayed action of insulin occur.
 Control the intake of carbohydrate in the diet.
 If there are problems with hypoglycemia, the addition of
dextrose to the dialysate usually aviates the problem.
 No matter what your state of health, you can almost
always improve your condition by simple measures such
as not smoking, eating healthily, and exercising regularly.
 Weight loss is a problem that causes particular concern
in kidney failure. This is usually because patients are not
eating enough protein and energy-providing food.
Malnourished people lose weight and muscle mass.
Malnutrition can develop with patients on either
haemodialysis or peritoneal dialysis. Dietitians monitor
renal patients for any signs of malnutrition.
 Peritoneal dialysis is less likely to work for patients who
have a fat or distended tummy.
 Overweight patients should refer to a dietitian for advice.
KINETIC MODELING
A method for evaluating the efficacy of dialysis relies on
measuring the removal of urea from the patient's blood
over a given period of time.
This method, often called KT/V
(where K is the urea clearance of the dialyzer, T is the
length of time of dialysis, and V is the patient's total body
water volume),should ideally produce a result higher than
1.4 per dialysis, or 3.2 per week
Another method to determine effective dialysis
treatment is the urea reduction
ratio.
which looks at the reduction in urea before and after
dialysis.
RISKS & SIDE EFFECTS DURING
DIALYSIS
 Bleeding from the Access Point
 As dialysis is an invasive technique, the area surrounding the




access point can be damaged and bleeding can occur.
Hypotension
Dialysis patients are at risk of a sudden drop in blood pressure
(hypotension).However this can be controlled by medication.
Infections
Dialysis patients are generally more susceptible to infection. The
access point should be kept clean, and any sign of infection
(redness, itching, or other problems) watched for. Peritonitis with
its associated flu-like symptoms, is also a possibility. Hence the
importance of cleanliness and good general hygiene.
 Cramps, Nausea and Headaches
 Diseases
 There is a slight risk of contracting hepatitis B and
hepatitis C due to the the exposure of blood during the
treatment. Vacination against the B strain is generally
recommended.
 Electrolyte Imbalance
 This will almost certainly be detected via the normal blood
tests conducted on dialysis patients. There are a variety of
vital electrolytes (ionic species) in the blood that control a
number of bodily process and this is too general an area
for discussion here.
 Anemia
 The red blood cell volume in dialysis patients (especially
hemodialysis patients) is often lower then normal. This
is due to reduced levels of the hormone erythropoietin,
which is produced by the kidneys and regulates red
blood cell production.
REFERENCES