22. RENAL DIALYSIS

Renal dialysis is a life-supporting treatment used when the kidneys can no longer filter waste products and excess fluid from the blood. Dialysis acts as an artificial replacement for kidney function, helping to restore chemical balance and remove toxins in patients with severe Chronic Kidney Disease (CKD) or Acute Kidney Injury (AKI).

Purpose of Dialysis

Dialysis helps to:

  • Remove waste products such as urea and creatinine
  • Eliminate excess water and toxins
  • Maintain electrolyte balance
  • Regulate acid–base levels

Types of Renal Dialysis

1. Hemodialysis

In hemodialysis, the patient’s blood is filtered through a machine called a dialyzer.

Procedure

  • Blood flows from the body to the dialyzer
  • Dialyzer removes waste and extra fluid
  • Clean blood returns to the body

Access Types

  • Arteriovenous (AV) fistula – preferred access
  • AV graft
  • Central venous catheter (temporary)

Frequency

  • Usually 3 times per week, 3–5 hours per session

2. Peritoneal Dialysis

The peritoneal membrane in the abdomen acts as a natural filter.

Procedure

  • Dialysis fluid is infused into the abdominal cavity
  • Waste products diffuse into the fluid
  • Fluid is drained and replaced regularly

Types

  • Continuous Ambulatory Peritoneal Dialysis (CAPD) – manual exchanges
  • Automated Peritoneal Dialysis (APD) – machine-assisted exchanges at night

Indications for Dialysis

  • End-stage renal disease (GFR < 15)
  • Severe fluid overload
  • Uncontrolled high potassium
  • Metabolic acidosis
  • Symptoms of uremia (itching, confusion, seizures)
  • Toxin removal (certain drug overdoses)

Complications of Dialysis

Hemodialysis

  • Low blood pressure (hypotension)
  • Muscle cramps
  • Infection at access site
  • Bleeding
  • Fatigue after sessions

Peritoneal Dialysis

  • Peritonitis (infection of abdominal cavity)
  • Catheter site infection
  • Weight gain (due to glucose in dialysis fluid)
  • Hernias

Advantages of Dialysis Types

Hemodialysis

  • Efficient waste removal
  • Performed under medical supervision

Peritoneal Dialysis

  • Can be done at home
  • Flexible schedule
  • Better for children and elderly patients

Patient Counseling

  • Follow dialysis schedule strictly
  • Maintain proper hygiene to avoid infection
  • Limit salt, potassium, and fluid intake as advised
  • Report swelling, fever, or pain immediately
  • Avoid heavy lifting (peritoneal dialysis patients)
  • Take medications such as phosphate binders and vitamins regularly

Detailed Notes:

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