Abstract

DIALYSIS FOR TREATING CHRONIC KIDNEY DISEASE

Nilanjan Pahari* and Anirban Roy

ABSTRACT

Dialysis is a prompt and effective treatment modality in symptomic patients with severe kidney failure. Dialysis cannot cure kidney failure, but helps patients to live comfortably in spite of kidney failure. Even after starting dialysis, dietary restriction must be continued. Dialysis is mainly two type: Hemodialysis (HD) and Peritoneal Dialysis (PD). Hemodialysis is a common method used to treat end stage kidney failure. It is a process of removing waste products and excess fluid from blood using an artificial kidney and a dialysis machine. Hemodialysis process based on Central Venous Catheter (CVC), AV Fistula, Graft. AV Fistula is the lifeline in patients of CKD (Chronic Kidney Disease), without which long term HD is not possible. To ensure adequate blood delivery and effective long term HD, special care of AV Fistula is most essential. HD machine, with the help of dialyzer, filters blood and maintains fluids, electrolytes and acid base balance. Dialysate corrects electrolyte imbalance and removes the waste products during the process of HD. Advantages of HD are safety, effectiveness and comfort. It’s success and safety 68 percentage. In patients with HD restriction of fluids and salt is essential to control weight gain between two dialysis. Peritoneal Dialysis (PD) is an effective method of treating end stage kidney disease (ESKD). In PD a soft tube called a catheter is inserted in the abdomen. Through the catheter, dialysis solution is infused into the abdominal cavity to remove waste products and excess fluid from the body, PD is done at home, usually without a machine. In a 2004 worldwide survey of patients in ESKD, approximately 11% were receiving PD, compared to the much more common HD. In Hong Kong and Mexico, PD is more common than the world average, with Mexico conducting most of its dialysis (75%) through PD, while Japan and Germany have rates lower than the world average. Types of PD: Intermittent PD (IPD), Continuous Ambulatory PD (CAPD), Continuous Cycling PD (CCPD). IPD is a valuable and effective dialysis option for short term dialysis in patients. It widely used in acute kidney Disease (AKD) in children and during emergency in ESKD. CAPD is a type of dialysis that can be carried out by patients at home with specialized fluid. CAPD must be carried out meticulously every day at a fixed time with no holidays. CCPD is carried out at home with an automated cycler machine. Precautions to avoid infections are of utmost importance in CAPD patients. Main benefits of CAPD are freedom in location, conveniences in timings and lesser dietary restrictions. Patients on CAPD must take high protein diet to avoid malnutrition and reduce risk of infection.

Keywords: CKD, AV Fistula, Dialyzer, ESKD, IPD.