Types of dialysis

This is due to the weakness in the diaphragm at the region of oesophageal opening coupled with sudden increase in the intra abdominal pressure resulting in the herniation of the part of the stomach into the chest cavity

• Hemodialysis – this is by far the most common and widely used type

• Peritoneal dialysis- in this the abdominal cavity is made used for the dialysis

• Hemofiltration- this is similar to Hemodialysis

• Intestinal dialysis- in this the intestine is used for dialysis

 Indications for dialysis

Acute renal disease with failure like

• Severe dehydration following vomiting and diarrheal illness

• Drug overdose injury to kidney

• Following snake and other reptilian bite liver failure

• In acute infections of kidney with acute renal failure

Chronic renal disease with

• Fluid over lode not responding to medications

• Hypertension not responding to anti hypertensive medications

• Cardiac embracement in the form of pericardial effusion

• Uremic encephalopathy

• Hyperkalemia – a condition where the potassium levels in the blood is very high causing cardiac instability

 Procedure 

• Hemodialysis – in this the blood from the arteries is pumped into a dialyzing compartment of the dialysis machine where the blood and the dialysate fluid is separated by a semi-permeable membrane. The excess water and impurities are removed and then the blood is returned back into the patient’s body via the circuit into a vein. This is a constant procedure where the blood is drawn from the artery into the dialyzing machine and pumped back into the vein. A typical may last for 3 to 5 hours.

• Peritoneal dialysis – Here a tube is inserted into the abdominal cavity where a solution of glucose and minerals is left in the peritoneal cavity for 4 to 5 hours and then pumped out of the peritoneal cavity. The peritoneal membrane acts as semipermeable membrane.

• Intestinal dialysis- in this the patient is supplemented with a fiber which is digested to nitrogenous product which is eliminated in the form of feces. Or a solution of mannitol every 4 hourly. This is not as effective as other methods.

• Hemofilteration- this is the same procedure as of the Hemodialysis but the dialysate is not used instead which a negative pressure is applied across the semi permeable membrane to remove the waste and excess water.

During the process of dialysis the blood is prevented by clotting with the use of anti coagulants like heparin.

For those who require repeated dialysis surgical A-V fistula is created for the ease of the dialysis

In case of emergency dialysis the central arterial line is used for dialysis .

Complications

• Hypotension

• Catheter exit site infection

• Peritonitis – in peritoneal dialysis

• Bacteremia and meningitis

• Amyloidosis

• Hypothermia and hypernatremia

• Catheter block with clots and thrombo embolism