Dialysis

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Aim is to replace excreatory functions of the kidney; maintain normal electrolyte concentrations and fluid balance

Temporary for AKI or permanent for CKD

Options:

1. Haemodialysis --> diffusion of solte from dlood to dialysate across a semi-permeable membrane down a concentration gradient

Need arterovenous fistula or central venous catheter or arteriovenous shunt

2. Haemofiltration --> water and solutes are filtered by pressure gradient. replacement fluid put back into patient

3. Haemodiofiltration

4. Periotoneal dialysis --> fluid into cavity via catheter --> solutes diffuse from blood across peritoneal membrane to PD fluid down a concentration gradient and water diffuses through osmosis

5. Renal transplant --> blood supply is anastomised via internal iliac vessels and ureter to bladder.

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Haemodialysis

Efficient; 4 hours 3 x a week

2-3 days between tx

Visits to hospital

Venous access for vascular access

Compliance with diet and fluid restrictions are needed

Can result in haemodynamic instability

Infections

Dependent on others

Periotoneal dialysis

Less efficient; 4 exchanges a day (30-60 mins)

Few hours between tx

Performed at home

Requires intact peritoneal cavity

Diet and fluid less restricted

Slow continous removal --> therefore less instability

Peritonitis

Patients more autonmous