DIALYSIS

Dr Frank Edwin

CAUSES OF RENAL FAILURE

1048707 Diabetes1048707 Untreated high blood pressure1048707 Inflammation1048707 Heredity1048707 Chronic infection1048707 Obstruction1048707 Accidents

1Renal Failure DiagnosisSymptoms Anorexia Nausea Vomiting Oliguria

bull Precipitating factors Signs Anaemia Hypertension Fluid Overload etcBiochemistry

ndash Bloodbull Urea gt7mmollbull Creatinine gt120umollbull Electrolytes Rising K+

ndash Creatinine Clearance (GFR ltlt120mll)ndash Urine Proteinuria

May be Acute or ChronicAcute ndash Reversible or Irreversible

2 Treatment OptionsNo TreatmentMonitoring amp Predialysis

ndash Control symptomsndash Preserve Residual Renal Function

bull Control rising BP (Antihypertensives)bull Control Renal Bone Disease (Ca2+ Vit D)bull PreventTreat Anaemias (Erythropoietin Blood)

DialysisRenal Transplantation

Dialysis

DefinitionArtificial process that partially replaces renal

functionRemoves waste products from blood by

diffusion (toxin clearance)Removes excess water by ultrafiltration

(maintenance of fluid balance)Wastes and water pass into a special liquid ndash

dialysis fluid or dialysate

Types

Haemodialysis (HD)Peritoneal Dialysis (PD)They work on similar principles Movement

of solute or water across a semipermeable membrane (dialysis membrane)

Diffusion

Movement of solute Across semipermeable membraneFrom region of high concentration to one of

low concentration

Ultrafiltration

Made possible by osmosisMovement of waterAcross semipermeable membraneFrom low osmolality to high osmolalityOsmolality ndash number of osmotically active

particles in a unit (litre) of solvent

Selection for HDPD

Clinical conditionLifestylePatient competencehygiene (PD - high risk

of infection) Affordability Availability

The process of diffusion

1

2

Blood cells are too big to pass through the dialysis membrane but body wastes begin to diffuse (pass) into the dialysis solution

3

Diffusion is complete Body wastes have diffused through the membrane and now there are equal amounts of waste in both the blood and the dialysis solution

CAUSES OF RENAL FAILURE

1048707 Diabetes1048707 Untreated high blood pressure1048707 Inflammation1048707 Heredity1048707 Chronic infection1048707 Obstruction1048707 Accidents

1Renal Failure DiagnosisSymptoms Anorexia Nausea Vomiting Oliguria

bull Precipitating factors Signs Anaemia Hypertension Fluid Overload etcBiochemistry

ndash Bloodbull Urea gt7mmollbull Creatinine gt120umollbull Electrolytes Rising K+

ndash Creatinine Clearance (GFR ltlt120mll)ndash Urine Proteinuria

May be Acute or ChronicAcute ndash Reversible or Irreversible

2 Treatment OptionsNo TreatmentMonitoring amp Predialysis

ndash Control symptomsndash Preserve Residual Renal Function

bull Control rising BP (Antihypertensives)bull Control Renal Bone Disease (Ca2+ Vit D)bull PreventTreat Anaemias (Erythropoietin Blood)

DialysisRenal Transplantation

Dialysis

DefinitionArtificial process that partially replaces renal

functionRemoves waste products from blood by

diffusion (toxin clearance)Removes excess water by ultrafiltration

(maintenance of fluid balance)Wastes and water pass into a special liquid ndash

dialysis fluid or dialysate

Types

Haemodialysis (HD)Peritoneal Dialysis (PD)They work on similar principles Movement

of solute or water across a semipermeable membrane (dialysis membrane)

Diffusion

Movement of solute Across semipermeable membraneFrom region of high concentration to one of

low concentration

Ultrafiltration

Made possible by osmosisMovement of waterAcross semipermeable membraneFrom low osmolality to high osmolalityOsmolality ndash number of osmotically active

particles in a unit (litre) of solvent

Selection for HDPD

Clinical conditionLifestylePatient competencehygiene (PD - high risk

of infection) Affordability Availability

The process of diffusion

1

2

Blood cells are too big to pass through the dialysis membrane but body wastes begin to diffuse (pass) into the dialysis solution

3

Diffusion is complete Body wastes have diffused through the membrane and now there are equal amounts of waste in both the blood and the dialysis solution

1Renal Failure DiagnosisSymptoms Anorexia Nausea Vomiting Oliguria

bull Precipitating factors Signs Anaemia Hypertension Fluid Overload etcBiochemistry

ndash Bloodbull Urea gt7mmollbull Creatinine gt120umollbull Electrolytes Rising K+

ndash Creatinine Clearance (GFR ltlt120mll)ndash Urine Proteinuria

May be Acute or ChronicAcute ndash Reversible or Irreversible

2 Treatment OptionsNo TreatmentMonitoring amp Predialysis

ndash Control symptomsndash Preserve Residual Renal Function

bull Control rising BP (Antihypertensives)bull Control Renal Bone Disease (Ca2+ Vit D)bull PreventTreat Anaemias (Erythropoietin Blood)

DialysisRenal Transplantation

Dialysis

DefinitionArtificial process that partially replaces renal

functionRemoves waste products from blood by

diffusion (toxin clearance)Removes excess water by ultrafiltration

(maintenance of fluid balance)Wastes and water pass into a special liquid ndash

dialysis fluid or dialysate

Types

Haemodialysis (HD)Peritoneal Dialysis (PD)They work on similar principles Movement

of solute or water across a semipermeable membrane (dialysis membrane)

Diffusion

Movement of solute Across semipermeable membraneFrom region of high concentration to one of

low concentration

Ultrafiltration

Made possible by osmosisMovement of waterAcross semipermeable membraneFrom low osmolality to high osmolalityOsmolality ndash number of osmotically active

particles in a unit (litre) of solvent

Selection for HDPD

Clinical conditionLifestylePatient competencehygiene (PD - high risk

of infection) Affordability Availability

The process of diffusion

1

2

Blood cells are too big to pass through the dialysis membrane but body wastes begin to diffuse (pass) into the dialysis solution

3

Diffusion is complete Body wastes have diffused through the membrane and now there are equal amounts of waste in both the blood and the dialysis solution

2 Treatment OptionsNo TreatmentMonitoring amp Predialysis

ndash Control symptomsndash Preserve Residual Renal Function

bull Control rising BP (Antihypertensives)bull Control Renal Bone Disease (Ca2+ Vit D)bull PreventTreat Anaemias (Erythropoietin Blood)

DialysisRenal Transplantation

Dialysis

DefinitionArtificial process that partially replaces renal

functionRemoves waste products from blood by

diffusion (toxin clearance)Removes excess water by ultrafiltration

(maintenance of fluid balance)Wastes and water pass into a special liquid ndash

dialysis fluid or dialysate

Types

Haemodialysis (HD)Peritoneal Dialysis (PD)They work on similar principles Movement

of solute or water across a semipermeable membrane (dialysis membrane)

Diffusion

Movement of solute Across semipermeable membraneFrom region of high concentration to one of

low concentration

Ultrafiltration

Made possible by osmosisMovement of waterAcross semipermeable membraneFrom low osmolality to high osmolalityOsmolality ndash number of osmotically active

particles in a unit (litre) of solvent

Selection for HDPD

Clinical conditionLifestylePatient competencehygiene (PD - high risk

of infection) Affordability Availability

The process of diffusion

1

2

Blood cells are too big to pass through the dialysis membrane but body wastes begin to diffuse (pass) into the dialysis solution

3

Diffusion is complete Body wastes have diffused through the membrane and now there are equal amounts of waste in both the blood and the dialysis solution

Dialysis

DefinitionArtificial process that partially replaces renal

functionRemoves waste products from blood by

diffusion (toxin clearance)Removes excess water by ultrafiltration

(maintenance of fluid balance)Wastes and water pass into a special liquid ndash

dialysis fluid or dialysate

Types

Haemodialysis (HD)Peritoneal Dialysis (PD)They work on similar principles Movement

of solute or water across a semipermeable membrane (dialysis membrane)

Diffusion

Movement of solute Across semipermeable membraneFrom region of high concentration to one of

low concentration

Ultrafiltration

Made possible by osmosisMovement of waterAcross semipermeable membraneFrom low osmolality to high osmolalityOsmolality ndash number of osmotically active

particles in a unit (litre) of solvent

Selection for HDPD

Clinical conditionLifestylePatient competencehygiene (PD - high risk

of infection) Affordability Availability

The process of diffusion

1

2

Blood cells are too big to pass through the dialysis membrane but body wastes begin to diffuse (pass) into the dialysis solution

3

Diffusion is complete Body wastes have diffused through the membrane and now there are equal amounts of waste in both the blood and the dialysis solution

Types

Haemodialysis (HD)Peritoneal Dialysis (PD)They work on similar principles Movement

of solute or water across a semipermeable membrane (dialysis membrane)

Diffusion

Movement of solute Across semipermeable membraneFrom region of high concentration to one of

low concentration

Ultrafiltration

Made possible by osmosisMovement of waterAcross semipermeable membraneFrom low osmolality to high osmolalityOsmolality ndash number of osmotically active

particles in a unit (litre) of solvent

Selection for HDPD

Clinical conditionLifestylePatient competencehygiene (PD - high risk

of infection) Affordability Availability

The process of diffusion

1

2

Blood cells are too big to pass through the dialysis membrane but body wastes begin to diffuse (pass) into the dialysis solution

3

Diffusion is complete Body wastes have diffused through the membrane and now there are equal amounts of waste in both the blood and the dialysis solution

Diffusion

Movement of solute Across semipermeable membraneFrom region of high concentration to one of

low concentration

Ultrafiltration

Made possible by osmosisMovement of waterAcross semipermeable membraneFrom low osmolality to high osmolalityOsmolality ndash number of osmotically active

particles in a unit (litre) of solvent

Selection for HDPD

Clinical conditionLifestylePatient competencehygiene (PD - high risk

of infection) Affordability Availability

The process of diffusion

1

2

Blood cells are too big to pass through the dialysis membrane but body wastes begin to diffuse (pass) into the dialysis solution

3

Diffusion is complete Body wastes have diffused through the membrane and now there are equal amounts of waste in both the blood and the dialysis solution

Ultrafiltration

Made possible by osmosisMovement of waterAcross semipermeable membraneFrom low osmolality to high osmolalityOsmolality ndash number of osmotically active

particles in a unit (litre) of solvent

Selection for HDPD

Clinical conditionLifestylePatient competencehygiene (PD - high risk

of infection) Affordability Availability

The process of diffusion

1

2

Blood cells are too big to pass through the dialysis membrane but body wastes begin to diffuse (pass) into the dialysis solution

3

Diffusion is complete Body wastes have diffused through the membrane and now there are equal amounts of waste in both the blood and the dialysis solution

Selection for HDPD

Clinical conditionLifestylePatient competencehygiene (PD - high risk

of infection) Affordability Availability

The process of diffusion

1

2

Blood cells are too big to pass through the dialysis membrane but body wastes begin to diffuse (pass) into the dialysis solution

3

Diffusion is complete Body wastes have diffused through the membrane and now there are equal amounts of waste in both the blood and the dialysis solution

The process of diffusion

1

2

Blood cells are too big to pass through the dialysis membrane but body wastes begin to diffuse (pass) into the dialysis solution

3

Diffusion is complete Body wastes have diffused through the membrane and now there are equal amounts of waste in both the blood and the dialysis solution

The process of ultrafiltration in PD 11

22

Blood cells are too big to pass through the semi-permeable membrane but water in the blood is drawn into the dialysis fluid by the glucose

3

Ultrafiltration is complete Water has been drawn through the peritoneum by the glucose in the dialysis fluid by the glucose in the dialysis fluid There is now extra water in the dialysis fluid which need to be changed

Haemodialysis Dialysis process occurs outside the body in a

machineThe dialysis membrane is an artificial one

DialyserThe dialyser removes the excess fluid and

wastes from the blood and returns the filtered blood to the body

Haemodialysis needs to be performed three times a week

Each session lasts 3-6 hrs

Requirements for HD

Good access to patients circulationGood cardiovascular status (dramatic

changes in BP may occur)

Performing HD

HD may be carried out In a HD UnitAt a Minimal Care Self-Care CentreAt Home

HD Unit

Specially designed Renal Unit within a hospitalPatients must travel to the Unit 3x a weekPatients are unable to move around while on

dialysis may chat read watch TV or eatNursing staff prepare equipment insert the

needles and supervise the sessions

Minimal Self-Care Dialysis

Patients take a more active rolePatients prepare the dialysis machine insert

the needles adjust pump speeds and machine settings and chart their progress under the supervision of dialysis staff

Patients must travel to the unit 3x weekPatients need to be on a fixed schedule

Home HaemodialysisUse of machines set up at homeMachines have many safety devices inbuiltThorough patient trainingRequires the help of a partner at home every timeSuitability is assessed by the haemodialysis team Ideal for patients who value their independence

and need to fit in their treatment around a busy schedule

HD Access

2 types of access for HD ndash Must provide good flowndash Reliable access

A fistula arterio-venous (AV)Vascular Access Catheter

AV Fistula

AV Fistula

Vascular Access Catheter

AV Fistula AccessMatures in about 6 weeksEnsure good working order

ndash Avoid tight clothing or wrist watch on fistula armndash Assess fistula daily notify immediately if not workingndash Avoid BP cuff on fistula armndash Avoid blood sampling on fistula arm (except daily

HD Rx)ndash Avoid sleeping on fistula armndash Grafts (synthetic) may be used to create an AV fistula

Vascular Access CatheterDouble lumen plastic tubeMay be placed in Jugular Subclavian or Femoral

veinMay be temporary or permanentTemporary ndash awaiting fistula or maturationPermanent ndash poor vessels for fistula creation eg

children and diabeticsCatheters must be kept clean dry and dressed to

prevent infection

Effects of HD on Lifestyle Flexibility

ndash Difficult to fit in with school work esp if unit is far from home Home HD offers more flexibility

Travel ndash Necessity to book in advance with HD unit of places of travel

Responsibility amp Independencendash Home HD allows the greatest degree of independence

Sexual Activityndash Anxiety of living with renal failure affects relationship with

partner Sport amp Exercise

ndash Can exercise and participate in most sports Body Image

ndash Esp with fistula patient can be very self conscious about it

Problems with HD Rapid changes in BP

ndash fainting vomiting cramps chest pain irritability fatigue temporary loss of vision

Fluid overload ndash esp in between sessions

Fluid restrictionsndash more stringent with HD than PD

Hyperkalaemia ndash esp in between sessions

Loss of independence Problems with access

ndash poor quality blockage etc Infection (vascular access catheters) Pain with needles Bleeding

ndash from the fistula during or after dialysis Infections

ndash during sessions exit site infections blood-borne viruses eg Hepatitis HIV

Peritoneal Dialysis (PD)Uses natural membrane (peritoneum) for dialysisAccess is by PD catheter a soft plastic tube Catheter and dialysis fluid may be hidden under

clothingSuitability

ndash Excludes patients with prior peritoneal scarring eg peritonitis laparotomy

ndash Excludes patients unable to care for self

Addendum to Principles (PD)Fluid across the membrane faster than solutes

therefore longer dwell times are needed for solute transfer

Protein loss in PD fluid is significant ~ 8-9gdayProtein loss uarrs during peritonitisPD patients require adequate daily protein

averaging 12 ndash 15gkgdayOther substances lost in the dialysate

ndash Amino acids water soluble vitamins some medications and hormones

Calcium and dextrose are absorbed from the dialysate fluid into the circulation

Addendum to Principles (PD)Standard dialysis solution contains

bull Na+ ndash 132 mEqlbull Cl- ndash 96 -102 mEqlbull Ca2+ ndash 25 ndash 35 mEqlbull Mg2+ ndash 05 -15 mEql

Dialysis solution bufferndash Sodium lactatendash Pure HCo3

-

ndash HCo3- Lactate combinations

Lactate is absorbed and converted to HCo3- by

the liverDextrose solution strengths 15 25 425

Types

Continuous Ambulatory Peritoneal Dialysis (CAPD)

Automated peritoneal Dialysis (APD)

CAPDDialysis takes place 24hrs a day 7 days a weekPatient is not attached to a machine for treatmentExchanges are usually carried out by patient after

training by a CAPD nurseMost patients need 3-5 exchanges a day ie

ndash 4-6 hour intervals (Dwell time) 30 mins per exchangeMay use 2-3 litres of fluid in abdomenNo needles are usedLess dietary and fluid restriction

CAPD Exchange

APD

Uses a home based machine to perform exchangesOvernight treatment whilst patient sleepsThe APD machine controls the timing of

exchanges drains the used solution and fills the peritoneal cavity with new solution

Simple procedure for the patient to performRequires about 8-10 hrsMachines are portable with in-built safety features

and requires electricity to operate

PD Access

Done under LA or GA

DIETWhy is diet important

ndash Managing the diet can slow renal disease

ndash The need for dialysis can be delayed

ndash The diet affects how patients feel

CONTROLLING YOUR DIET

Foods to control are those containing Protein

Potassium

Sodium

Phosphorous

Fluid

PROTEINS

Animal protein Dairy (milk cheese)

Meat (steak pork) Poultry (chicken turkey) Eggs

Plant protein Vegetables Breads Cereals

MAJOR SOURCES OF POTASSIUM

MilkPotatoesBananasOrangesDried Fruit

LegumesNutsSalt substituteChocolate

SODIUMRegulates blood volume and pressure

Avoid salt

Use Alternate food seasonings lemon and limes spices seafood seasoning Italian seasoning vinegars peppers

FLUIDS

Healthy kidneys remove fluids as urine

Check for fluid and sodium retention

Need to restrict fluid intake

PHOSPHOROUS

Phosphorus is a mineral which combines with calcium to keep bones and teeth strong

Too little calcium and too much phosphorus

Need to control the phosphorus in the diet

Need to take a phosphate binder or a calcium supplement

VITAMINS

Folic acid

Iron supplements

Do not take OTCrsquos without consulting the doctor

MANAGING YOUR DIET

INDICATORS OF GOOD CONTROL

Weight loss or gain

Blood pressure

Swelling of hands and feet

Blood samples

LAB MONITORING

Haemoglobin Albumin Calcium Phosphorus GFR (24 hour urine)

Sodium Potassium Urea Creatinine

Lifestyle Changes with PD

Flexibilityndash Can be performed almost anywherendash Least impact on work school life (esp APD)

Travelndash Dialysis supplies can be delivered to most parts of the

world travel more flexible APD machines are portable will fit into a car boot can be carried by trainair

Responsibilityndash Requires more responsibility from patient but more

independence

Lifestyle Changes with PDSportsExercise

ndash Most are possiblendash Advice on swimming lifting contact sports

Sexual Activityndash May affect relations based on patient anxiety

Delivery amp Storage of Suppliesndash Home delivery and storagendash A monthrsquos supplies ndash 40 boxes space to storendash Specially recruited and trained delivery staff

Problems with TreatmentMonotomy of treatment

ndash The treatment never goes away against days off with HDBody Image Problems

ndash Esp with a permanent catheterndash Abdominal stretching

Fluid Overloadndash Much less a problem than with HD

Dehydrationndash Less common than fluid overload

Abdominal Discomfortndash Bloated feeling

Problems with TreatmentPoor drainage

ndash Common problem esp with new patientsndash Fibrin plugndash Catheter displacement

Leakagendash Fluid may leak around catheter exit site (May leak

into scrotum)ndash Stop PD temporarilyndash Resite catheter (use new one)

Infectionsndash Exit site infectionsndash Tunnel infectionndash peritonitis

Problems with Treatment

Herniandash Aggravation of pre-existing herniae (repair)ndash Evolution of new herniae

Declining effectiveness of the peritoneumndash eg repeated infectionndash Effect of glucose in the dialysis fluid

Comparison of Dialysis Treatment OptionsPD Unit HD Home HD

Home Dialysis radic times radicConvenient Sessions radic times radicSocializn with other CRF pats times radic timesHome EquipmentSupplies radic times radicSpecial dietfluid allowance radic radic radicSportsexercises participation Most Most Most

Full day activity -workschool radic Not alwys radicDirect assistndashpartnerfamily times times radicTravel radic Delivery of

supplies to most destins easy Some notice req

radic Prior arrangements must be made well in advance

times Prior arrangements must be made well in advance

• DIALYSIS
• CAUSES OF RENAL FAILURE
• 1Renal Failure Diagnosis
• 2 Treatment Options
• Dialysis
• Types
• Diffusion
• Ultrafiltration
• Selection for HDPD
• Slide 10
• Slide 11
• Haemodialysis
• Slide 13
• Requirements for HD
• Performing HD
• HD Unit
• Minimal Self-Care Dialysis
• Home Haemodialysis
• HD Access
• AV Fistula
• Slide 21
• Vascular Access Catheter
• AV Fistula Access
• Slide 24
• Effects of HD on Lifestyle
• Problems with HD
• Peritoneal Dialysis (PD)
• Addendum to Principles (PD)
• Slide 29
• Slide 30
• CAPD
• CAPD Exchange
• APD
• PD Access
• DIET
• CONTROLLING YOUR DIET
• PROTEINS
• MAJOR SOURCES OF POTASSIUM
• SODIUM
• FLUIDS
• PHOSPHOROUS
• VITAMINS
• MANAGING YOUR DIET
• LAB MONITORING
• Lifestyle Changes with PD
• Slide 46
• Problems with Treatment
• Slide 48
• Slide 49
• Comparison of Dialysis Treatment Options

Haemodialysis Dialysis process occurs outside the body in a

machineThe dialysis membrane is an artificial one

DialyserThe dialyser removes the excess fluid and

wastes from the blood and returns the filtered blood to the body

Haemodialysis needs to be performed three times a week

Each session lasts 3-6 hrs

Requirements for HD

Good access to patients circulationGood cardiovascular status (dramatic

changes in BP may occur)

Performing HD

HD may be carried out In a HD UnitAt a Minimal Care Self-Care CentreAt Home

HD Unit

Specially designed Renal Unit within a hospitalPatients must travel to the Unit 3x a weekPatients are unable to move around while on

dialysis may chat read watch TV or eatNursing staff prepare equipment insert the

needles and supervise the sessions

Minimal Self-Care Dialysis

Patients take a more active rolePatients prepare the dialysis machine insert

the needles adjust pump speeds and machine settings and chart their progress under the supervision of dialysis staff

Patients must travel to the unit 3x weekPatients need to be on a fixed schedule

Home HaemodialysisUse of machines set up at homeMachines have many safety devices inbuiltThorough patient trainingRequires the help of a partner at home every timeSuitability is assessed by the haemodialysis team Ideal for patients who value their independence

and need to fit in their treatment around a busy schedule

HD Access

2 types of access for HD ndash Must provide good flowndash Reliable access

A fistula arterio-venous (AV)Vascular Access Catheter

AV Fistula

AV Fistula

Vascular Access Catheter

AV Fistula AccessMatures in about 6 weeksEnsure good working order

ndash Avoid tight clothing or wrist watch on fistula armndash Assess fistula daily notify immediately if not workingndash Avoid BP cuff on fistula armndash Avoid blood sampling on fistula arm (except daily

HD Rx)ndash Avoid sleeping on fistula armndash Grafts (synthetic) may be used to create an AV fistula

Vascular Access CatheterDouble lumen plastic tubeMay be placed in Jugular Subclavian or Femoral

veinMay be temporary or permanentTemporary ndash awaiting fistula or maturationPermanent ndash poor vessels for fistula creation eg

children and diabeticsCatheters must be kept clean dry and dressed to

prevent infection

Effects of HD on Lifestyle Flexibility

ndash Difficult to fit in with school work esp if unit is far from home Home HD offers more flexibility

Travel ndash Necessity to book in advance with HD unit of places of travel

Responsibility amp Independencendash Home HD allows the greatest degree of independence

Sexual Activityndash Anxiety of living with renal failure affects relationship with

partner Sport amp Exercise

ndash Can exercise and participate in most sports Body Image

ndash Esp with fistula patient can be very self conscious about it

Problems with HD Rapid changes in BP

ndash fainting vomiting cramps chest pain irritability fatigue temporary loss of vision

Fluid overload ndash esp in between sessions

Fluid restrictionsndash more stringent with HD than PD

Hyperkalaemia ndash esp in between sessions

Loss of independence Problems with access

ndash poor quality blockage etc Infection (vascular access catheters) Pain with needles Bleeding

ndash from the fistula during or after dialysis Infections

ndash during sessions exit site infections blood-borne viruses eg Hepatitis HIV

Peritoneal Dialysis (PD)Uses natural membrane (peritoneum) for dialysisAccess is by PD catheter a soft plastic tube Catheter and dialysis fluid may be hidden under

clothingSuitability

ndash Excludes patients with prior peritoneal scarring eg peritonitis laparotomy

ndash Excludes patients unable to care for self

Addendum to Principles (PD)Fluid across the membrane faster than solutes

therefore longer dwell times are needed for solute transfer

Protein loss in PD fluid is significant ~ 8-9gdayProtein loss uarrs during peritonitisPD patients require adequate daily protein

averaging 12 ndash 15gkgdayOther substances lost in the dialysate

ndash Amino acids water soluble vitamins some medications and hormones

Calcium and dextrose are absorbed from the dialysate fluid into the circulation

Addendum to Principles (PD)Standard dialysis solution contains

bull Na+ ndash 132 mEqlbull Cl- ndash 96 -102 mEqlbull Ca2+ ndash 25 ndash 35 mEqlbull Mg2+ ndash 05 -15 mEql

Dialysis solution bufferndash Sodium lactatendash Pure HCo3

-

ndash HCo3- Lactate combinations

Lactate is absorbed and converted to HCo3- by

the liverDextrose solution strengths 15 25 425

Types

Continuous Ambulatory Peritoneal Dialysis (CAPD)

Automated peritoneal Dialysis (APD)

CAPDDialysis takes place 24hrs a day 7 days a weekPatient is not attached to a machine for treatmentExchanges are usually carried out by patient after

training by a CAPD nurseMost patients need 3-5 exchanges a day ie

ndash 4-6 hour intervals (Dwell time) 30 mins per exchangeMay use 2-3 litres of fluid in abdomenNo needles are usedLess dietary and fluid restriction

CAPD Exchange

APD

Uses a home based machine to perform exchangesOvernight treatment whilst patient sleepsThe APD machine controls the timing of

exchanges drains the used solution and fills the peritoneal cavity with new solution

Simple procedure for the patient to performRequires about 8-10 hrsMachines are portable with in-built safety features

and requires electricity to operate

PD Access

Done under LA or GA

DIETWhy is diet important

ndash Managing the diet can slow renal disease

ndash The need for dialysis can be delayed

ndash The diet affects how patients feel

CONTROLLING YOUR DIET

Foods to control are those containing Protein

Potassium

Sodium

Phosphorous

Fluid

PROTEINS

Animal protein Dairy (milk cheese)

Meat (steak pork) Poultry (chicken turkey) Eggs

Plant protein Vegetables Breads Cereals

MAJOR SOURCES OF POTASSIUM

MilkPotatoesBananasOrangesDried Fruit

LegumesNutsSalt substituteChocolate

SODIUMRegulates blood volume and pressure

Avoid salt

Use Alternate food seasonings lemon and limes spices seafood seasoning Italian seasoning vinegars peppers

FLUIDS

Healthy kidneys remove fluids as urine

Check for fluid and sodium retention

Need to restrict fluid intake

PHOSPHOROUS

Phosphorus is a mineral which combines with calcium to keep bones and teeth strong

Too little calcium and too much phosphorus

Need to control the phosphorus in the diet

Need to take a phosphate binder or a calcium supplement

VITAMINS

Folic acid

Iron supplements

Do not take OTCrsquos without consulting the doctor

MANAGING YOUR DIET

INDICATORS OF GOOD CONTROL

Weight loss or gain

Blood pressure

Swelling of hands and feet

Blood samples

LAB MONITORING

Haemoglobin Albumin Calcium Phosphorus GFR (24 hour urine)

Sodium Potassium Urea Creatinine

Lifestyle Changes with PD

Flexibilityndash Can be performed almost anywherendash Least impact on work school life (esp APD)

Travelndash Dialysis supplies can be delivered to most parts of the

world travel more flexible APD machines are portable will fit into a car boot can be carried by trainair

Responsibilityndash Requires more responsibility from patient but more

independence

Lifestyle Changes with PDSportsExercise

ndash Most are possiblendash Advice on swimming lifting contact sports

Sexual Activityndash May affect relations based on patient anxiety

Delivery amp Storage of Suppliesndash Home delivery and storagendash A monthrsquos supplies ndash 40 boxes space to storendash Specially recruited and trained delivery staff

Problems with TreatmentMonotomy of treatment

ndash The treatment never goes away against days off with HDBody Image Problems

ndash Esp with a permanent catheterndash Abdominal stretching

Fluid Overloadndash Much less a problem than with HD

Dehydrationndash Less common than fluid overload

Abdominal Discomfortndash Bloated feeling

Problems with TreatmentPoor drainage

ndash Common problem esp with new patientsndash Fibrin plugndash Catheter displacement

Leakagendash Fluid may leak around catheter exit site (May leak

into scrotum)ndash Stop PD temporarilyndash Resite catheter (use new one)

Infectionsndash Exit site infectionsndash Tunnel infectionndash peritonitis

Problems with Treatment

Herniandash Aggravation of pre-existing herniae (repair)ndash Evolution of new herniae

Declining effectiveness of the peritoneumndash eg repeated infectionndash Effect of glucose in the dialysis fluid

Comparison of Dialysis Treatment OptionsPD Unit HD Home HD

Home Dialysis radic times radicConvenient Sessions radic times radicSocializn with other CRF pats times radic timesHome EquipmentSupplies radic times radicSpecial dietfluid allowance radic radic radicSportsexercises participation Most Most Most

Full day activity -workschool radic Not alwys radicDirect assistndashpartnerfamily times times radicTravel radic Delivery of

supplies to most destins easy Some notice req

radic Prior arrangements must be made well in advance

times Prior arrangements must be made well in advance

• DIALYSIS
• CAUSES OF RENAL FAILURE
• 1Renal Failure Diagnosis
• 2 Treatment Options
• Dialysis
• Types
• Diffusion
• Ultrafiltration
• Selection for HDPD
• Slide 10
• Slide 11
• Haemodialysis
• Slide 13
• Requirements for HD
• Performing HD
• HD Unit
• Minimal Self-Care Dialysis
• Home Haemodialysis
• HD Access
• AV Fistula
• Slide 21
• Vascular Access Catheter
• AV Fistula Access
• Slide 24
• Effects of HD on Lifestyle
• Problems with HD
• Peritoneal Dialysis (PD)
• Addendum to Principles (PD)
• Slide 29
• Slide 30
• CAPD
• CAPD Exchange
• APD
• PD Access
• DIET
• CONTROLLING YOUR DIET
• PROTEINS
• MAJOR SOURCES OF POTASSIUM
• SODIUM
• FLUIDS
• PHOSPHOROUS
• VITAMINS
• MANAGING YOUR DIET
• LAB MONITORING
• Lifestyle Changes with PD
• Slide 46
• Problems with Treatment
• Slide 48
• Slide 49
• Comparison of Dialysis Treatment Options

Requirements for HD

Good access to patients circulationGood cardiovascular status (dramatic

changes in BP may occur)

Performing HD

HD may be carried out In a HD UnitAt a Minimal Care Self-Care CentreAt Home

HD Unit

Specially designed Renal Unit within a hospitalPatients must travel to the Unit 3x a weekPatients are unable to move around while on

dialysis may chat read watch TV or eatNursing staff prepare equipment insert the

needles and supervise the sessions

Minimal Self-Care Dialysis

Patients take a more active rolePatients prepare the dialysis machine insert

the needles adjust pump speeds and machine settings and chart their progress under the supervision of dialysis staff

Patients must travel to the unit 3x weekPatients need to be on a fixed schedule

Home HaemodialysisUse of machines set up at homeMachines have many safety devices inbuiltThorough patient trainingRequires the help of a partner at home every timeSuitability is assessed by the haemodialysis team Ideal for patients who value their independence

and need to fit in their treatment around a busy schedule

HD Access

2 types of access for HD ndash Must provide good flowndash Reliable access

A fistula arterio-venous (AV)Vascular Access Catheter

AV Fistula

AV Fistula

Vascular Access Catheter

AV Fistula AccessMatures in about 6 weeksEnsure good working order

ndash Avoid tight clothing or wrist watch on fistula armndash Assess fistula daily notify immediately if not workingndash Avoid BP cuff on fistula armndash Avoid blood sampling on fistula arm (except daily

HD Rx)ndash Avoid sleeping on fistula armndash Grafts (synthetic) may be used to create an AV fistula

Vascular Access CatheterDouble lumen plastic tubeMay be placed in Jugular Subclavian or Femoral

veinMay be temporary or permanentTemporary ndash awaiting fistula or maturationPermanent ndash poor vessels for fistula creation eg

children and diabeticsCatheters must be kept clean dry and dressed to

prevent infection

Effects of HD on Lifestyle Flexibility

ndash Difficult to fit in with school work esp if unit is far from home Home HD offers more flexibility

Travel ndash Necessity to book in advance with HD unit of places of travel

Responsibility amp Independencendash Home HD allows the greatest degree of independence

Sexual Activityndash Anxiety of living with renal failure affects relationship with

partner Sport amp Exercise

ndash Can exercise and participate in most sports Body Image

ndash Esp with fistula patient can be very self conscious about it

Problems with HD Rapid changes in BP

ndash fainting vomiting cramps chest pain irritability fatigue temporary loss of vision

Fluid overload ndash esp in between sessions

Fluid restrictionsndash more stringent with HD than PD

Hyperkalaemia ndash esp in between sessions

Loss of independence Problems with access

ndash poor quality blockage etc Infection (vascular access catheters) Pain with needles Bleeding

ndash from the fistula during or after dialysis Infections

ndash during sessions exit site infections blood-borne viruses eg Hepatitis HIV

Peritoneal Dialysis (PD)Uses natural membrane (peritoneum) for dialysisAccess is by PD catheter a soft plastic tube Catheter and dialysis fluid may be hidden under

clothingSuitability

ndash Excludes patients with prior peritoneal scarring eg peritonitis laparotomy

ndash Excludes patients unable to care for self

Addendum to Principles (PD)Fluid across the membrane faster than solutes

therefore longer dwell times are needed for solute transfer

Protein loss in PD fluid is significant ~ 8-9gdayProtein loss uarrs during peritonitisPD patients require adequate daily protein

averaging 12 ndash 15gkgdayOther substances lost in the dialysate

ndash Amino acids water soluble vitamins some medications and hormones

Calcium and dextrose are absorbed from the dialysate fluid into the circulation

Addendum to Principles (PD)Standard dialysis solution contains

bull Na+ ndash 132 mEqlbull Cl- ndash 96 -102 mEqlbull Ca2+ ndash 25 ndash 35 mEqlbull Mg2+ ndash 05 -15 mEql

Dialysis solution bufferndash Sodium lactatendash Pure HCo3

-

ndash HCo3- Lactate combinations

Lactate is absorbed and converted to HCo3- by

the liverDextrose solution strengths 15 25 425

Types

Continuous Ambulatory Peritoneal Dialysis (CAPD)

Automated peritoneal Dialysis (APD)

CAPDDialysis takes place 24hrs a day 7 days a weekPatient is not attached to a machine for treatmentExchanges are usually carried out by patient after

training by a CAPD nurseMost patients need 3-5 exchanges a day ie

ndash 4-6 hour intervals (Dwell time) 30 mins per exchangeMay use 2-3 litres of fluid in abdomenNo needles are usedLess dietary and fluid restriction

CAPD Exchange

APD

Uses a home based machine to perform exchangesOvernight treatment whilst patient sleepsThe APD machine controls the timing of

exchanges drains the used solution and fills the peritoneal cavity with new solution

Simple procedure for the patient to performRequires about 8-10 hrsMachines are portable with in-built safety features

and requires electricity to operate

PD Access

Done under LA or GA

DIETWhy is diet important

ndash Managing the diet can slow renal disease

ndash The need for dialysis can be delayed

ndash The diet affects how patients feel

CONTROLLING YOUR DIET

Foods to control are those containing Protein

Potassium

Sodium

Phosphorous

Fluid

PROTEINS

Animal protein Dairy (milk cheese)

Meat (steak pork) Poultry (chicken turkey) Eggs

Plant protein Vegetables Breads Cereals

MAJOR SOURCES OF POTASSIUM

MilkPotatoesBananasOrangesDried Fruit

LegumesNutsSalt substituteChocolate

SODIUMRegulates blood volume and pressure

Avoid salt

Use Alternate food seasonings lemon and limes spices seafood seasoning Italian seasoning vinegars peppers

FLUIDS

Healthy kidneys remove fluids as urine

Check for fluid and sodium retention

Need to restrict fluid intake

PHOSPHOROUS

Phosphorus is a mineral which combines with calcium to keep bones and teeth strong

Too little calcium and too much phosphorus

Need to control the phosphorus in the diet

Need to take a phosphate binder or a calcium supplement

VITAMINS

Folic acid

Iron supplements

Do not take OTCrsquos without consulting the doctor

MANAGING YOUR DIET

INDICATORS OF GOOD CONTROL

Weight loss or gain

Blood pressure

Swelling of hands and feet

Blood samples

LAB MONITORING

Haemoglobin Albumin Calcium Phosphorus GFR (24 hour urine)

Sodium Potassium Urea Creatinine

Lifestyle Changes with PD

Flexibilityndash Can be performed almost anywherendash Least impact on work school life (esp APD)

Travelndash Dialysis supplies can be delivered to most parts of the

world travel more flexible APD machines are portable will fit into a car boot can be carried by trainair

Responsibilityndash Requires more responsibility from patient but more

independence

Lifestyle Changes with PDSportsExercise

ndash Most are possiblendash Advice on swimming lifting contact sports

Sexual Activityndash May affect relations based on patient anxiety

Delivery amp Storage of Suppliesndash Home delivery and storagendash A monthrsquos supplies ndash 40 boxes space to storendash Specially recruited and trained delivery staff

Problems with TreatmentMonotomy of treatment

ndash The treatment never goes away against days off with HDBody Image Problems

ndash Esp with a permanent catheterndash Abdominal stretching

Fluid Overloadndash Much less a problem than with HD

Dehydrationndash Less common than fluid overload

Abdominal Discomfortndash Bloated feeling

Problems with TreatmentPoor drainage

ndash Common problem esp with new patientsndash Fibrin plugndash Catheter displacement

Leakagendash Fluid may leak around catheter exit site (May leak

into scrotum)ndash Stop PD temporarilyndash Resite catheter (use new one)

Infectionsndash Exit site infectionsndash Tunnel infectionndash peritonitis

Problems with Treatment

Herniandash Aggravation of pre-existing herniae (repair)ndash Evolution of new herniae

Declining effectiveness of the peritoneumndash eg repeated infectionndash Effect of glucose in the dialysis fluid

Comparison of Dialysis Treatment OptionsPD Unit HD Home HD

Home Dialysis radic times radicConvenient Sessions radic times radicSocializn with other CRF pats times radic timesHome EquipmentSupplies radic times radicSpecial dietfluid allowance radic radic radicSportsexercises participation Most Most Most

Full day activity -workschool radic Not alwys radicDirect assistndashpartnerfamily times times radicTravel radic Delivery of

supplies to most destins easy Some notice req

radic Prior arrangements must be made well in advance

times Prior arrangements must be made well in advance

• DIALYSIS
• CAUSES OF RENAL FAILURE
• 1Renal Failure Diagnosis
• 2 Treatment Options
• Dialysis
• Types
• Diffusion
• Ultrafiltration
• Selection for HDPD
• Slide 10
• Slide 11
• Haemodialysis
• Slide 13
• Requirements for HD
• Performing HD
• HD Unit
• Minimal Self-Care Dialysis
• Home Haemodialysis
• HD Access
• AV Fistula
• Slide 21
• Vascular Access Catheter
• AV Fistula Access
• Slide 24
• Effects of HD on Lifestyle
• Problems with HD
• Peritoneal Dialysis (PD)
• Addendum to Principles (PD)
• Slide 29
• Slide 30
• CAPD
• CAPD Exchange
• APD
• PD Access
• DIET
• CONTROLLING YOUR DIET
• PROTEINS
• MAJOR SOURCES OF POTASSIUM
• SODIUM
• FLUIDS
• PHOSPHOROUS
• VITAMINS
• MANAGING YOUR DIET
• LAB MONITORING
• Lifestyle Changes with PD
• Slide 46
• Problems with Treatment
• Slide 48
• Slide 49
• Comparison of Dialysis Treatment Options

Performing HD

HD may be carried out In a HD UnitAt a Minimal Care Self-Care CentreAt Home

HD Unit

Specially designed Renal Unit within a hospitalPatients must travel to the Unit 3x a weekPatients are unable to move around while on

dialysis may chat read watch TV or eatNursing staff prepare equipment insert the

needles and supervise the sessions

Minimal Self-Care Dialysis

Patients take a more active rolePatients prepare the dialysis machine insert

the needles adjust pump speeds and machine settings and chart their progress under the supervision of dialysis staff

Patients must travel to the unit 3x weekPatients need to be on a fixed schedule

Home HaemodialysisUse of machines set up at homeMachines have many safety devices inbuiltThorough patient trainingRequires the help of a partner at home every timeSuitability is assessed by the haemodialysis team Ideal for patients who value their independence

and need to fit in their treatment around a busy schedule

HD Access

2 types of access for HD ndash Must provide good flowndash Reliable access

A fistula arterio-venous (AV)Vascular Access Catheter

AV Fistula

AV Fistula

Vascular Access Catheter

AV Fistula AccessMatures in about 6 weeksEnsure good working order

ndash Avoid tight clothing or wrist watch on fistula armndash Assess fistula daily notify immediately if not workingndash Avoid BP cuff on fistula armndash Avoid blood sampling on fistula arm (except daily

HD Rx)ndash Avoid sleeping on fistula armndash Grafts (synthetic) may be used to create an AV fistula

Vascular Access CatheterDouble lumen plastic tubeMay be placed in Jugular Subclavian or Femoral

veinMay be temporary or permanentTemporary ndash awaiting fistula or maturationPermanent ndash poor vessels for fistula creation eg

children and diabeticsCatheters must be kept clean dry and dressed to

prevent infection

Effects of HD on Lifestyle Flexibility

ndash Difficult to fit in with school work esp if unit is far from home Home HD offers more flexibility

Travel ndash Necessity to book in advance with HD unit of places of travel

Responsibility amp Independencendash Home HD allows the greatest degree of independence

Sexual Activityndash Anxiety of living with renal failure affects relationship with

partner Sport amp Exercise

ndash Can exercise and participate in most sports Body Image

ndash Esp with fistula patient can be very self conscious about it

Problems with HD Rapid changes in BP

ndash fainting vomiting cramps chest pain irritability fatigue temporary loss of vision

Fluid overload ndash esp in between sessions

Fluid restrictionsndash more stringent with HD than PD

Hyperkalaemia ndash esp in between sessions

Loss of independence Problems with access

ndash poor quality blockage etc Infection (vascular access catheters) Pain with needles Bleeding

ndash from the fistula during or after dialysis Infections

ndash during sessions exit site infections blood-borne viruses eg Hepatitis HIV

Peritoneal Dialysis (PD)Uses natural membrane (peritoneum) for dialysisAccess is by PD catheter a soft plastic tube Catheter and dialysis fluid may be hidden under

clothingSuitability

ndash Excludes patients with prior peritoneal scarring eg peritonitis laparotomy

ndash Excludes patients unable to care for self

Addendum to Principles (PD)Fluid across the membrane faster than solutes

therefore longer dwell times are needed for solute transfer

Protein loss in PD fluid is significant ~ 8-9gdayProtein loss uarrs during peritonitisPD patients require adequate daily protein

averaging 12 ndash 15gkgdayOther substances lost in the dialysate

ndash Amino acids water soluble vitamins some medications and hormones

Calcium and dextrose are absorbed from the dialysate fluid into the circulation

Addendum to Principles (PD)Standard dialysis solution contains

bull Na+ ndash 132 mEqlbull Cl- ndash 96 -102 mEqlbull Ca2+ ndash 25 ndash 35 mEqlbull Mg2+ ndash 05 -15 mEql

Dialysis solution bufferndash Sodium lactatendash Pure HCo3

-

ndash HCo3- Lactate combinations

Lactate is absorbed and converted to HCo3- by

the liverDextrose solution strengths 15 25 425

Types

Continuous Ambulatory Peritoneal Dialysis (CAPD)

Automated peritoneal Dialysis (APD)

CAPDDialysis takes place 24hrs a day 7 days a weekPatient is not attached to a machine for treatmentExchanges are usually carried out by patient after

training by a CAPD nurseMost patients need 3-5 exchanges a day ie

ndash 4-6 hour intervals (Dwell time) 30 mins per exchangeMay use 2-3 litres of fluid in abdomenNo needles are usedLess dietary and fluid restriction

CAPD Exchange

APD

Uses a home based machine to perform exchangesOvernight treatment whilst patient sleepsThe APD machine controls the timing of

exchanges drains the used solution and fills the peritoneal cavity with new solution

Simple procedure for the patient to performRequires about 8-10 hrsMachines are portable with in-built safety features

and requires electricity to operate

PD Access

Done under LA or GA

DIETWhy is diet important

ndash Managing the diet can slow renal disease

ndash The need for dialysis can be delayed

ndash The diet affects how patients feel

CONTROLLING YOUR DIET

Foods to control are those containing Protein

Potassium

Sodium

Phosphorous

Fluid

PROTEINS

Animal protein Dairy (milk cheese)

Meat (steak pork) Poultry (chicken turkey) Eggs

Plant protein Vegetables Breads Cereals

MAJOR SOURCES OF POTASSIUM

MilkPotatoesBananasOrangesDried Fruit

LegumesNutsSalt substituteChocolate

SODIUMRegulates blood volume and pressure

Avoid salt

Use Alternate food seasonings lemon and limes spices seafood seasoning Italian seasoning vinegars peppers

FLUIDS

Healthy kidneys remove fluids as urine

Check for fluid and sodium retention

Need to restrict fluid intake

PHOSPHOROUS

Phosphorus is a mineral which combines with calcium to keep bones and teeth strong

Too little calcium and too much phosphorus

Need to control the phosphorus in the diet

Need to take a phosphate binder or a calcium supplement

VITAMINS

Folic acid

Iron supplements

Do not take OTCrsquos without consulting the doctor

MANAGING YOUR DIET

INDICATORS OF GOOD CONTROL

Weight loss or gain

Blood pressure

Swelling of hands and feet

Blood samples

LAB MONITORING

Haemoglobin Albumin Calcium Phosphorus GFR (24 hour urine)

Sodium Potassium Urea Creatinine

Lifestyle Changes with PD

Flexibilityndash Can be performed almost anywherendash Least impact on work school life (esp APD)

Travelndash Dialysis supplies can be delivered to most parts of the

world travel more flexible APD machines are portable will fit into a car boot can be carried by trainair

Responsibilityndash Requires more responsibility from patient but more

independence

Lifestyle Changes with PDSportsExercise

ndash Most are possiblendash Advice on swimming lifting contact sports

Sexual Activityndash May affect relations based on patient anxiety

Delivery amp Storage of Suppliesndash Home delivery and storagendash A monthrsquos supplies ndash 40 boxes space to storendash Specially recruited and trained delivery staff

Problems with TreatmentMonotomy of treatment

ndash The treatment never goes away against days off with HDBody Image Problems

ndash Esp with a permanent catheterndash Abdominal stretching

Fluid Overloadndash Much less a problem than with HD

Dehydrationndash Less common than fluid overload

Abdominal Discomfortndash Bloated feeling

Problems with TreatmentPoor drainage

ndash Common problem esp with new patientsndash Fibrin plugndash Catheter displacement

Leakagendash Fluid may leak around catheter exit site (May leak

into scrotum)ndash Stop PD temporarilyndash Resite catheter (use new one)

Infectionsndash Exit site infectionsndash Tunnel infectionndash peritonitis

Problems with Treatment

Herniandash Aggravation of pre-existing herniae (repair)ndash Evolution of new herniae

Declining effectiveness of the peritoneumndash eg repeated infectionndash Effect of glucose in the dialysis fluid

Comparison of Dialysis Treatment OptionsPD Unit HD Home HD

Home Dialysis radic times radicConvenient Sessions radic times radicSocializn with other CRF pats times radic timesHome EquipmentSupplies radic times radicSpecial dietfluid allowance radic radic radicSportsexercises participation Most Most Most

Full day activity -workschool radic Not alwys radicDirect assistndashpartnerfamily times times radicTravel radic Delivery of

supplies to most destins easy Some notice req

radic Prior arrangements must be made well in advance

times Prior arrangements must be made well in advance

• DIALYSIS
• CAUSES OF RENAL FAILURE
• 1Renal Failure Diagnosis
• 2 Treatment Options
• Dialysis
• Types
• Diffusion
• Ultrafiltration
• Selection for HDPD
• Slide 10
• Slide 11
• Haemodialysis
• Slide 13
• Requirements for HD
• Performing HD
• HD Unit
• Minimal Self-Care Dialysis
• Home Haemodialysis
• HD Access
• AV Fistula
• Slide 21
• Vascular Access Catheter
• AV Fistula Access
• Slide 24
• Effects of HD on Lifestyle
• Problems with HD
• Peritoneal Dialysis (PD)
• Addendum to Principles (PD)
• Slide 29
• Slide 30
• CAPD
• CAPD Exchange
• APD
• PD Access
• DIET
• CONTROLLING YOUR DIET
• PROTEINS
• MAJOR SOURCES OF POTASSIUM
• SODIUM
• FLUIDS
• PHOSPHOROUS
• VITAMINS
• MANAGING YOUR DIET
• LAB MONITORING
• Lifestyle Changes with PD
• Slide 46
• Problems with Treatment
• Slide 48
• Slide 49
• Comparison of Dialysis Treatment Options

HD Unit

Specially designed Renal Unit within a hospitalPatients must travel to the Unit 3x a weekPatients are unable to move around while on

dialysis may chat read watch TV or eatNursing staff prepare equipment insert the

needles and supervise the sessions

Minimal Self-Care Dialysis

Patients take a more active rolePatients prepare the dialysis machine insert

the needles adjust pump speeds and machine settings and chart their progress under the supervision of dialysis staff

Patients must travel to the unit 3x weekPatients need to be on a fixed schedule

Home HaemodialysisUse of machines set up at homeMachines have many safety devices inbuiltThorough patient trainingRequires the help of a partner at home every timeSuitability is assessed by the haemodialysis team Ideal for patients who value their independence

and need to fit in their treatment around a busy schedule

HD Access

2 types of access for HD ndash Must provide good flowndash Reliable access

A fistula arterio-venous (AV)Vascular Access Catheter

AV Fistula

AV Fistula

Vascular Access Catheter

AV Fistula AccessMatures in about 6 weeksEnsure good working order

ndash Avoid tight clothing or wrist watch on fistula armndash Assess fistula daily notify immediately if not workingndash Avoid BP cuff on fistula armndash Avoid blood sampling on fistula arm (except daily

HD Rx)ndash Avoid sleeping on fistula armndash Grafts (synthetic) may be used to create an AV fistula

Vascular Access CatheterDouble lumen plastic tubeMay be placed in Jugular Subclavian or Femoral

veinMay be temporary or permanentTemporary ndash awaiting fistula or maturationPermanent ndash poor vessels for fistula creation eg

children and diabeticsCatheters must be kept clean dry and dressed to

prevent infection

Effects of HD on Lifestyle Flexibility

ndash Difficult to fit in with school work esp if unit is far from home Home HD offers more flexibility

Travel ndash Necessity to book in advance with HD unit of places of travel

Responsibility amp Independencendash Home HD allows the greatest degree of independence

Sexual Activityndash Anxiety of living with renal failure affects relationship with

partner Sport amp Exercise

ndash Can exercise and participate in most sports Body Image

ndash Esp with fistula patient can be very self conscious about it

Problems with HD Rapid changes in BP

ndash fainting vomiting cramps chest pain irritability fatigue temporary loss of vision

Fluid overload ndash esp in between sessions

Fluid restrictionsndash more stringent with HD than PD

Hyperkalaemia ndash esp in between sessions

Loss of independence Problems with access

ndash poor quality blockage etc Infection (vascular access catheters) Pain with needles Bleeding

ndash from the fistula during or after dialysis Infections

ndash during sessions exit site infections blood-borne viruses eg Hepatitis HIV

Peritoneal Dialysis (PD)Uses natural membrane (peritoneum) for dialysisAccess is by PD catheter a soft plastic tube Catheter and dialysis fluid may be hidden under

clothingSuitability

ndash Excludes patients with prior peritoneal scarring eg peritonitis laparotomy

ndash Excludes patients unable to care for self

Addendum to Principles (PD)Fluid across the membrane faster than solutes

therefore longer dwell times are needed for solute transfer

Protein loss in PD fluid is significant ~ 8-9gdayProtein loss uarrs during peritonitisPD patients require adequate daily protein

averaging 12 ndash 15gkgdayOther substances lost in the dialysate

ndash Amino acids water soluble vitamins some medications and hormones

Calcium and dextrose are absorbed from the dialysate fluid into the circulation

Addendum to Principles (PD)Standard dialysis solution contains

bull Na+ ndash 132 mEqlbull Cl- ndash 96 -102 mEqlbull Ca2+ ndash 25 ndash 35 mEqlbull Mg2+ ndash 05 -15 mEql

Dialysis solution bufferndash Sodium lactatendash Pure HCo3

-

ndash HCo3- Lactate combinations

Lactate is absorbed and converted to HCo3- by

the liverDextrose solution strengths 15 25 425

Types

Continuous Ambulatory Peritoneal Dialysis (CAPD)

Automated peritoneal Dialysis (APD)

CAPDDialysis takes place 24hrs a day 7 days a weekPatient is not attached to a machine for treatmentExchanges are usually carried out by patient after

training by a CAPD nurseMost patients need 3-5 exchanges a day ie

ndash 4-6 hour intervals (Dwell time) 30 mins per exchangeMay use 2-3 litres of fluid in abdomenNo needles are usedLess dietary and fluid restriction

CAPD Exchange

APD

Uses a home based machine to perform exchangesOvernight treatment whilst patient sleepsThe APD machine controls the timing of

exchanges drains the used solution and fills the peritoneal cavity with new solution

Simple procedure for the patient to performRequires about 8-10 hrsMachines are portable with in-built safety features

and requires electricity to operate

PD Access

Done under LA or GA

DIETWhy is diet important

ndash Managing the diet can slow renal disease

ndash The need for dialysis can be delayed

ndash The diet affects how patients feel

CONTROLLING YOUR DIET

Foods to control are those containing Protein

Potassium

Sodium

Phosphorous

Fluid

PROTEINS

Animal protein Dairy (milk cheese)

Meat (steak pork) Poultry (chicken turkey) Eggs

Plant protein Vegetables Breads Cereals

MAJOR SOURCES OF POTASSIUM

MilkPotatoesBananasOrangesDried Fruit

LegumesNutsSalt substituteChocolate

SODIUMRegulates blood volume and pressure

Avoid salt

Use Alternate food seasonings lemon and limes spices seafood seasoning Italian seasoning vinegars peppers

FLUIDS

Healthy kidneys remove fluids as urine

Check for fluid and sodium retention

Need to restrict fluid intake

PHOSPHOROUS

Phosphorus is a mineral which combines with calcium to keep bones and teeth strong

Too little calcium and too much phosphorus

Need to control the phosphorus in the diet

Need to take a phosphate binder or a calcium supplement

VITAMINS

Folic acid

Iron supplements

Do not take OTCrsquos without consulting the doctor

MANAGING YOUR DIET

INDICATORS OF GOOD CONTROL

Weight loss or gain

Blood pressure

Swelling of hands and feet

Blood samples

LAB MONITORING

Haemoglobin Albumin Calcium Phosphorus GFR (24 hour urine)

Sodium Potassium Urea Creatinine

Lifestyle Changes with PD

Flexibilityndash Can be performed almost anywherendash Least impact on work school life (esp APD)

Travelndash Dialysis supplies can be delivered to most parts of the

world travel more flexible APD machines are portable will fit into a car boot can be carried by trainair

Responsibilityndash Requires more responsibility from patient but more

independence

Lifestyle Changes with PDSportsExercise

ndash Most are possiblendash Advice on swimming lifting contact sports

Sexual Activityndash May affect relations based on patient anxiety

Delivery amp Storage of Suppliesndash Home delivery and storagendash A monthrsquos supplies ndash 40 boxes space to storendash Specially recruited and trained delivery staff

Problems with TreatmentMonotomy of treatment

ndash The treatment never goes away against days off with HDBody Image Problems

ndash Esp with a permanent catheterndash Abdominal stretching

Fluid Overloadndash Much less a problem than with HD

Dehydrationndash Less common than fluid overload

Abdominal Discomfortndash Bloated feeling

Problems with TreatmentPoor drainage

ndash Common problem esp with new patientsndash Fibrin plugndash Catheter displacement

Leakagendash Fluid may leak around catheter exit site (May leak

into scrotum)ndash Stop PD temporarilyndash Resite catheter (use new one)

Infectionsndash Exit site infectionsndash Tunnel infectionndash peritonitis

Problems with Treatment

Herniandash Aggravation of pre-existing herniae (repair)ndash Evolution of new herniae

Declining effectiveness of the peritoneumndash eg repeated infectionndash Effect of glucose in the dialysis fluid

Comparison of Dialysis Treatment OptionsPD Unit HD Home HD

Home Dialysis radic times radicConvenient Sessions radic times radicSocializn with other CRF pats times radic timesHome EquipmentSupplies radic times radicSpecial dietfluid allowance radic radic radicSportsexercises participation Most Most Most

Full day activity -workschool radic Not alwys radicDirect assistndashpartnerfamily times times radicTravel radic Delivery of

supplies to most destins easy Some notice req

radic Prior arrangements must be made well in advance

times Prior arrangements must be made well in advance

• DIALYSIS
• CAUSES OF RENAL FAILURE
• 1Renal Failure Diagnosis
• 2 Treatment Options
• Dialysis
• Types
• Diffusion
• Ultrafiltration
• Selection for HDPD
• Slide 10
• Slide 11
• Haemodialysis
• Slide 13
• Requirements for HD
• Performing HD
• HD Unit
• Minimal Self-Care Dialysis
• Home Haemodialysis
• HD Access
• AV Fistula
• Slide 21
• Vascular Access Catheter
• AV Fistula Access
• Slide 24
• Effects of HD on Lifestyle
• Problems with HD
• Peritoneal Dialysis (PD)
• Addendum to Principles (PD)
• Slide 29
• Slide 30
• CAPD
• CAPD Exchange
• APD
• PD Access
• DIET
• CONTROLLING YOUR DIET
• PROTEINS
• MAJOR SOURCES OF POTASSIUM
• SODIUM
• FLUIDS
• PHOSPHOROUS
• VITAMINS
• MANAGING YOUR DIET
• LAB MONITORING
• Lifestyle Changes with PD
• Slide 46
• Problems with Treatment
• Slide 48
• Slide 49
• Comparison of Dialysis Treatment Options

Minimal Self-Care Dialysis

Patients take a more active rolePatients prepare the dialysis machine insert

the needles adjust pump speeds and machine settings and chart their progress under the supervision of dialysis staff

Patients must travel to the unit 3x weekPatients need to be on a fixed schedule

Home HaemodialysisUse of machines set up at homeMachines have many safety devices inbuiltThorough patient trainingRequires the help of a partner at home every timeSuitability is assessed by the haemodialysis team Ideal for patients who value their independence

and need to fit in their treatment around a busy schedule

HD Access

2 types of access for HD ndash Must provide good flowndash Reliable access

A fistula arterio-venous (AV)Vascular Access Catheter

AV Fistula

AV Fistula

Vascular Access Catheter

AV Fistula AccessMatures in about 6 weeksEnsure good working order

ndash Avoid tight clothing or wrist watch on fistula armndash Assess fistula daily notify immediately if not workingndash Avoid BP cuff on fistula armndash Avoid blood sampling on fistula arm (except daily

HD Rx)ndash Avoid sleeping on fistula armndash Grafts (synthetic) may be used to create an AV fistula

Vascular Access CatheterDouble lumen plastic tubeMay be placed in Jugular Subclavian or Femoral

veinMay be temporary or permanentTemporary ndash awaiting fistula or maturationPermanent ndash poor vessels for fistula creation eg

children and diabeticsCatheters must be kept clean dry and dressed to

prevent infection

Effects of HD on Lifestyle Flexibility

ndash Difficult to fit in with school work esp if unit is far from home Home HD offers more flexibility

Travel ndash Necessity to book in advance with HD unit of places of travel

Responsibility amp Independencendash Home HD allows the greatest degree of independence

Sexual Activityndash Anxiety of living with renal failure affects relationship with

partner Sport amp Exercise

ndash Can exercise and participate in most sports Body Image

ndash Esp with fistula patient can be very self conscious about it

Problems with HD Rapid changes in BP

ndash fainting vomiting cramps chest pain irritability fatigue temporary loss of vision

Fluid overload ndash esp in between sessions

Fluid restrictionsndash more stringent with HD than PD

Hyperkalaemia ndash esp in between sessions

Loss of independence Problems with access

ndash poor quality blockage etc Infection (vascular access catheters) Pain with needles Bleeding

ndash from the fistula during or after dialysis Infections

ndash during sessions exit site infections blood-borne viruses eg Hepatitis HIV

Peritoneal Dialysis (PD)Uses natural membrane (peritoneum) for dialysisAccess is by PD catheter a soft plastic tube Catheter and dialysis fluid may be hidden under

clothingSuitability

ndash Excludes patients with prior peritoneal scarring eg peritonitis laparotomy

ndash Excludes patients unable to care for self

Addendum to Principles (PD)Fluid across the membrane faster than solutes

therefore longer dwell times are needed for solute transfer

Protein loss in PD fluid is significant ~ 8-9gdayProtein loss uarrs during peritonitisPD patients require adequate daily protein

averaging 12 ndash 15gkgdayOther substances lost in the dialysate

ndash Amino acids water soluble vitamins some medications and hormones

Calcium and dextrose are absorbed from the dialysate fluid into the circulation

Addendum to Principles (PD)Standard dialysis solution contains

bull Na+ ndash 132 mEqlbull Cl- ndash 96 -102 mEqlbull Ca2+ ndash 25 ndash 35 mEqlbull Mg2+ ndash 05 -15 mEql

Dialysis solution bufferndash Sodium lactatendash Pure HCo3

-

ndash HCo3- Lactate combinations

Lactate is absorbed and converted to HCo3- by

the liverDextrose solution strengths 15 25 425

Types

Continuous Ambulatory Peritoneal Dialysis (CAPD)

Automated peritoneal Dialysis (APD)

CAPDDialysis takes place 24hrs a day 7 days a weekPatient is not attached to a machine for treatmentExchanges are usually carried out by patient after

training by a CAPD nurseMost patients need 3-5 exchanges a day ie

ndash 4-6 hour intervals (Dwell time) 30 mins per exchangeMay use 2-3 litres of fluid in abdomenNo needles are usedLess dietary and fluid restriction

CAPD Exchange

APD

Uses a home based machine to perform exchangesOvernight treatment whilst patient sleepsThe APD machine controls the timing of

exchanges drains the used solution and fills the peritoneal cavity with new solution

Simple procedure for the patient to performRequires about 8-10 hrsMachines are portable with in-built safety features

and requires electricity to operate

PD Access

Done under LA or GA

DIETWhy is diet important

ndash Managing the diet can slow renal disease

ndash The need for dialysis can be delayed

ndash The diet affects how patients feel

CONTROLLING YOUR DIET

Foods to control are those containing Protein

Potassium

Sodium

Phosphorous

Fluid

PROTEINS

Animal protein Dairy (milk cheese)

Meat (steak pork) Poultry (chicken turkey) Eggs

Plant protein Vegetables Breads Cereals

MAJOR SOURCES OF POTASSIUM

MilkPotatoesBananasOrangesDried Fruit

LegumesNutsSalt substituteChocolate

SODIUMRegulates blood volume and pressure

Avoid salt

Use Alternate food seasonings lemon and limes spices seafood seasoning Italian seasoning vinegars peppers

FLUIDS

Healthy kidneys remove fluids as urine

Check for fluid and sodium retention

Need to restrict fluid intake

PHOSPHOROUS

Phosphorus is a mineral which combines with calcium to keep bones and teeth strong

Too little calcium and too much phosphorus

Need to control the phosphorus in the diet

Need to take a phosphate binder or a calcium supplement

VITAMINS

Folic acid

Iron supplements

Do not take OTCrsquos without consulting the doctor

MANAGING YOUR DIET

INDICATORS OF GOOD CONTROL

Weight loss or gain

Blood pressure

Swelling of hands and feet

Blood samples

LAB MONITORING

Haemoglobin Albumin Calcium Phosphorus GFR (24 hour urine)

Sodium Potassium Urea Creatinine

Lifestyle Changes with PD

Flexibilityndash Can be performed almost anywherendash Least impact on work school life (esp APD)

Travelndash Dialysis supplies can be delivered to most parts of the

world travel more flexible APD machines are portable will fit into a car boot can be carried by trainair

Responsibilityndash Requires more responsibility from patient but more

independence

Lifestyle Changes with PDSportsExercise

ndash Most are possiblendash Advice on swimming lifting contact sports

Sexual Activityndash May affect relations based on patient anxiety

Delivery amp Storage of Suppliesndash Home delivery and storagendash A monthrsquos supplies ndash 40 boxes space to storendash Specially recruited and trained delivery staff

Problems with TreatmentMonotomy of treatment

ndash The treatment never goes away against days off with HDBody Image Problems

ndash Esp with a permanent catheterndash Abdominal stretching

Fluid Overloadndash Much less a problem than with HD

Dehydrationndash Less common than fluid overload

Abdominal Discomfortndash Bloated feeling

Problems with TreatmentPoor drainage

ndash Common problem esp with new patientsndash Fibrin plugndash Catheter displacement

Leakagendash Fluid may leak around catheter exit site (May leak

into scrotum)ndash Stop PD temporarilyndash Resite catheter (use new one)

Infectionsndash Exit site infectionsndash Tunnel infectionndash peritonitis

Problems with Treatment

Herniandash Aggravation of pre-existing herniae (repair)ndash Evolution of new herniae

Declining effectiveness of the peritoneumndash eg repeated infectionndash Effect of glucose in the dialysis fluid

Comparison of Dialysis Treatment OptionsPD Unit HD Home HD

Home Dialysis radic times radicConvenient Sessions radic times radicSocializn with other CRF pats times radic timesHome EquipmentSupplies radic times radicSpecial dietfluid allowance radic radic radicSportsexercises participation Most Most Most

Full day activity -workschool radic Not alwys radicDirect assistndashpartnerfamily times times radicTravel radic Delivery of

supplies to most destins easy Some notice req

radic Prior arrangements must be made well in advance

times Prior arrangements must be made well in advance

• DIALYSIS
• CAUSES OF RENAL FAILURE
• 1Renal Failure Diagnosis
• 2 Treatment Options
• Dialysis
• Types
• Diffusion
• Ultrafiltration
• Selection for HDPD
• Slide 10
• Slide 11
• Haemodialysis
• Slide 13
• Requirements for HD
• Performing HD
• HD Unit
• Minimal Self-Care Dialysis
• Home Haemodialysis
• HD Access
• AV Fistula
• Slide 21
• Vascular Access Catheter
• AV Fistula Access
• Slide 24
• Effects of HD on Lifestyle
• Problems with HD
• Peritoneal Dialysis (PD)
• Addendum to Principles (PD)
• Slide 29
• Slide 30
• CAPD
• CAPD Exchange
• APD
• PD Access
• DIET
• CONTROLLING YOUR DIET
• PROTEINS
• MAJOR SOURCES OF POTASSIUM
• SODIUM
• FLUIDS
• PHOSPHOROUS
• VITAMINS
• MANAGING YOUR DIET
• LAB MONITORING
• Lifestyle Changes with PD
• Slide 46
• Problems with Treatment
• Slide 48
• Slide 49
• Comparison of Dialysis Treatment Options

Home HaemodialysisUse of machines set up at homeMachines have many safety devices inbuiltThorough patient trainingRequires the help of a partner at home every timeSuitability is assessed by the haemodialysis team Ideal for patients who value their independence

and need to fit in their treatment around a busy schedule

HD Access

2 types of access for HD ndash Must provide good flowndash Reliable access

A fistula arterio-venous (AV)Vascular Access Catheter

AV Fistula

AV Fistula

Vascular Access Catheter

AV Fistula AccessMatures in about 6 weeksEnsure good working order

ndash Avoid tight clothing or wrist watch on fistula armndash Assess fistula daily notify immediately if not workingndash Avoid BP cuff on fistula armndash Avoid blood sampling on fistula arm (except daily

HD Rx)ndash Avoid sleeping on fistula armndash Grafts (synthetic) may be used to create an AV fistula

Vascular Access CatheterDouble lumen plastic tubeMay be placed in Jugular Subclavian or Femoral

veinMay be temporary or permanentTemporary ndash awaiting fistula or maturationPermanent ndash poor vessels for fistula creation eg

children and diabeticsCatheters must be kept clean dry and dressed to

prevent infection

Effects of HD on Lifestyle Flexibility

ndash Difficult to fit in with school work esp if unit is far from home Home HD offers more flexibility

Travel ndash Necessity to book in advance with HD unit of places of travel

Responsibility amp Independencendash Home HD allows the greatest degree of independence

Sexual Activityndash Anxiety of living with renal failure affects relationship with

partner Sport amp Exercise

ndash Can exercise and participate in most sports Body Image

ndash Esp with fistula patient can be very self conscious about it

Problems with HD Rapid changes in BP

ndash fainting vomiting cramps chest pain irritability fatigue temporary loss of vision

Fluid overload ndash esp in between sessions

Fluid restrictionsndash more stringent with HD than PD

Hyperkalaemia ndash esp in between sessions

Loss of independence Problems with access

ndash poor quality blockage etc Infection (vascular access catheters) Pain with needles Bleeding

ndash from the fistula during or after dialysis Infections

ndash during sessions exit site infections blood-borne viruses eg Hepatitis HIV

Peritoneal Dialysis (PD)Uses natural membrane (peritoneum) for dialysisAccess is by PD catheter a soft plastic tube Catheter and dialysis fluid may be hidden under

clothingSuitability

ndash Excludes patients with prior peritoneal scarring eg peritonitis laparotomy

ndash Excludes patients unable to care for self

Addendum to Principles (PD)Fluid across the membrane faster than solutes

therefore longer dwell times are needed for solute transfer

Protein loss in PD fluid is significant ~ 8-9gdayProtein loss uarrs during peritonitisPD patients require adequate daily protein

averaging 12 ndash 15gkgdayOther substances lost in the dialysate

ndash Amino acids water soluble vitamins some medications and hormones

Calcium and dextrose are absorbed from the dialysate fluid into the circulation

Addendum to Principles (PD)Standard dialysis solution contains

bull Na+ ndash 132 mEqlbull Cl- ndash 96 -102 mEqlbull Ca2+ ndash 25 ndash 35 mEqlbull Mg2+ ndash 05 -15 mEql

Dialysis solution bufferndash Sodium lactatendash Pure HCo3

-

ndash HCo3- Lactate combinations

Lactate is absorbed and converted to HCo3- by

the liverDextrose solution strengths 15 25 425

Types

Continuous Ambulatory Peritoneal Dialysis (CAPD)

Automated peritoneal Dialysis (APD)

CAPDDialysis takes place 24hrs a day 7 days a weekPatient is not attached to a machine for treatmentExchanges are usually carried out by patient after

training by a CAPD nurseMost patients need 3-5 exchanges a day ie

ndash 4-6 hour intervals (Dwell time) 30 mins per exchangeMay use 2-3 litres of fluid in abdomenNo needles are usedLess dietary and fluid restriction

CAPD Exchange

APD

Uses a home based machine to perform exchangesOvernight treatment whilst patient sleepsThe APD machine controls the timing of

exchanges drains the used solution and fills the peritoneal cavity with new solution

Simple procedure for the patient to performRequires about 8-10 hrsMachines are portable with in-built safety features

and requires electricity to operate

PD Access

Done under LA or GA

DIETWhy is diet important

ndash Managing the diet can slow renal disease

ndash The need for dialysis can be delayed

ndash The diet affects how patients feel

CONTROLLING YOUR DIET

Foods to control are those containing Protein

Potassium

Sodium

Phosphorous

Fluid

PROTEINS

Animal protein Dairy (milk cheese)

Meat (steak pork) Poultry (chicken turkey) Eggs

Plant protein Vegetables Breads Cereals

MAJOR SOURCES OF POTASSIUM

MilkPotatoesBananasOrangesDried Fruit

LegumesNutsSalt substituteChocolate

SODIUMRegulates blood volume and pressure

Avoid salt

Use Alternate food seasonings lemon and limes spices seafood seasoning Italian seasoning vinegars peppers

FLUIDS

Healthy kidneys remove fluids as urine

Check for fluid and sodium retention

Need to restrict fluid intake

PHOSPHOROUS

Phosphorus is a mineral which combines with calcium to keep bones and teeth strong

Too little calcium and too much phosphorus

Need to control the phosphorus in the diet

Need to take a phosphate binder or a calcium supplement

VITAMINS

Folic acid

Iron supplements

Do not take OTCrsquos without consulting the doctor

MANAGING YOUR DIET

INDICATORS OF GOOD CONTROL

Weight loss or gain

Blood pressure

Swelling of hands and feet

Blood samples

LAB MONITORING

Haemoglobin Albumin Calcium Phosphorus GFR (24 hour urine)

Sodium Potassium Urea Creatinine

Lifestyle Changes with PD

Flexibilityndash Can be performed almost anywherendash Least impact on work school life (esp APD)

Travelndash Dialysis supplies can be delivered to most parts of the

world travel more flexible APD machines are portable will fit into a car boot can be carried by trainair

Responsibilityndash Requires more responsibility from patient but more

independence

Lifestyle Changes with PDSportsExercise

ndash Most are possiblendash Advice on swimming lifting contact sports

Sexual Activityndash May affect relations based on patient anxiety

Delivery amp Storage of Suppliesndash Home delivery and storagendash A monthrsquos supplies ndash 40 boxes space to storendash Specially recruited and trained delivery staff

Problems with TreatmentMonotomy of treatment

ndash The treatment never goes away against days off with HDBody Image Problems

ndash Esp with a permanent catheterndash Abdominal stretching

Fluid Overloadndash Much less a problem than with HD

Dehydrationndash Less common than fluid overload

Abdominal Discomfortndash Bloated feeling

Problems with TreatmentPoor drainage

ndash Common problem esp with new patientsndash Fibrin plugndash Catheter displacement

Leakagendash Fluid may leak around catheter exit site (May leak

into scrotum)ndash Stop PD temporarilyndash Resite catheter (use new one)

Infectionsndash Exit site infectionsndash Tunnel infectionndash peritonitis

Problems with Treatment

Herniandash Aggravation of pre-existing herniae (repair)ndash Evolution of new herniae

Declining effectiveness of the peritoneumndash eg repeated infectionndash Effect of glucose in the dialysis fluid

Comparison of Dialysis Treatment OptionsPD Unit HD Home HD

Home Dialysis radic times radicConvenient Sessions radic times radicSocializn with other CRF pats times radic timesHome EquipmentSupplies radic times radicSpecial dietfluid allowance radic radic radicSportsexercises participation Most Most Most

Full day activity -workschool radic Not alwys radicDirect assistndashpartnerfamily times times radicTravel radic Delivery of

supplies to most destins easy Some notice req

radic Prior arrangements must be made well in advance

times Prior arrangements must be made well in advance

• DIALYSIS
• CAUSES OF RENAL FAILURE
• 1Renal Failure Diagnosis
• 2 Treatment Options
• Dialysis
• Types
• Diffusion
• Ultrafiltration
• Selection for HDPD
• Slide 10
• Slide 11
• Haemodialysis
• Slide 13
• Requirements for HD
• Performing HD
• HD Unit
• Minimal Self-Care Dialysis
• Home Haemodialysis
• HD Access
• AV Fistula
• Slide 21
• Vascular Access Catheter
• AV Fistula Access
• Slide 24
• Effects of HD on Lifestyle
• Problems with HD
• Peritoneal Dialysis (PD)
• Addendum to Principles (PD)
• Slide 29
• Slide 30
• CAPD
• CAPD Exchange
• APD
• PD Access
• DIET
• CONTROLLING YOUR DIET
• PROTEINS
• MAJOR SOURCES OF POTASSIUM
• SODIUM
• FLUIDS
• PHOSPHOROUS
• VITAMINS
• MANAGING YOUR DIET
• LAB MONITORING
• Lifestyle Changes with PD
• Slide 46
• Problems with Treatment
• Slide 48
• Slide 49
• Comparison of Dialysis Treatment Options

HD Access

2 types of access for HD ndash Must provide good flowndash Reliable access

A fistula arterio-venous (AV)Vascular Access Catheter

AV Fistula

AV Fistula

Vascular Access Catheter

AV Fistula AccessMatures in about 6 weeksEnsure good working order

ndash Avoid tight clothing or wrist watch on fistula armndash Assess fistula daily notify immediately if not workingndash Avoid BP cuff on fistula armndash Avoid blood sampling on fistula arm (except daily

HD Rx)ndash Avoid sleeping on fistula armndash Grafts (synthetic) may be used to create an AV fistula

Vascular Access CatheterDouble lumen plastic tubeMay be placed in Jugular Subclavian or Femoral

veinMay be temporary or permanentTemporary ndash awaiting fistula or maturationPermanent ndash poor vessels for fistula creation eg

children and diabeticsCatheters must be kept clean dry and dressed to

prevent infection

Effects of HD on Lifestyle Flexibility

ndash Difficult to fit in with school work esp if unit is far from home Home HD offers more flexibility

Travel ndash Necessity to book in advance with HD unit of places of travel

Responsibility amp Independencendash Home HD allows the greatest degree of independence

Sexual Activityndash Anxiety of living with renal failure affects relationship with

partner Sport amp Exercise

ndash Can exercise and participate in most sports Body Image

ndash Esp with fistula patient can be very self conscious about it

Problems with HD Rapid changes in BP

ndash fainting vomiting cramps chest pain irritability fatigue temporary loss of vision

Fluid overload ndash esp in between sessions

Fluid restrictionsndash more stringent with HD than PD

Hyperkalaemia ndash esp in between sessions

Loss of independence Problems with access

ndash poor quality blockage etc Infection (vascular access catheters) Pain with needles Bleeding

ndash from the fistula during or after dialysis Infections

ndash during sessions exit site infections blood-borne viruses eg Hepatitis HIV

Peritoneal Dialysis (PD)Uses natural membrane (peritoneum) for dialysisAccess is by PD catheter a soft plastic tube Catheter and dialysis fluid may be hidden under

clothingSuitability

ndash Excludes patients with prior peritoneal scarring eg peritonitis laparotomy

ndash Excludes patients unable to care for self

Addendum to Principles (PD)Fluid across the membrane faster than solutes

therefore longer dwell times are needed for solute transfer

Protein loss in PD fluid is significant ~ 8-9gdayProtein loss uarrs during peritonitisPD patients require adequate daily protein

averaging 12 ndash 15gkgdayOther substances lost in the dialysate

ndash Amino acids water soluble vitamins some medications and hormones

Calcium and dextrose are absorbed from the dialysate fluid into the circulation

Addendum to Principles (PD)Standard dialysis solution contains

bull Na+ ndash 132 mEqlbull Cl- ndash 96 -102 mEqlbull Ca2+ ndash 25 ndash 35 mEqlbull Mg2+ ndash 05 -15 mEql

Dialysis solution bufferndash Sodium lactatendash Pure HCo3

-

ndash HCo3- Lactate combinations

Lactate is absorbed and converted to HCo3- by

the liverDextrose solution strengths 15 25 425

Types

Continuous Ambulatory Peritoneal Dialysis (CAPD)

Automated peritoneal Dialysis (APD)

CAPDDialysis takes place 24hrs a day 7 days a weekPatient is not attached to a machine for treatmentExchanges are usually carried out by patient after

training by a CAPD nurseMost patients need 3-5 exchanges a day ie

ndash 4-6 hour intervals (Dwell time) 30 mins per exchangeMay use 2-3 litres of fluid in abdomenNo needles are usedLess dietary and fluid restriction

CAPD Exchange

APD

Uses a home based machine to perform exchangesOvernight treatment whilst patient sleepsThe APD machine controls the timing of

exchanges drains the used solution and fills the peritoneal cavity with new solution

Simple procedure for the patient to performRequires about 8-10 hrsMachines are portable with in-built safety features

and requires electricity to operate

PD Access

Done under LA or GA

DIETWhy is diet important

ndash Managing the diet can slow renal disease

ndash The need for dialysis can be delayed

ndash The diet affects how patients feel

CONTROLLING YOUR DIET

Foods to control are those containing Protein

Potassium

Sodium

Phosphorous

Fluid

PROTEINS

Animal protein Dairy (milk cheese)

Meat (steak pork) Poultry (chicken turkey) Eggs

Plant protein Vegetables Breads Cereals

MAJOR SOURCES OF POTASSIUM

MilkPotatoesBananasOrangesDried Fruit

LegumesNutsSalt substituteChocolate

SODIUMRegulates blood volume and pressure

Avoid salt

Use Alternate food seasonings lemon and limes spices seafood seasoning Italian seasoning vinegars peppers

FLUIDS

Healthy kidneys remove fluids as urine

Check for fluid and sodium retention

Need to restrict fluid intake

PHOSPHOROUS

Phosphorus is a mineral which combines with calcium to keep bones and teeth strong

Too little calcium and too much phosphorus

Need to control the phosphorus in the diet

Need to take a phosphate binder or a calcium supplement

VITAMINS

Folic acid

Iron supplements

Do not take OTCrsquos without consulting the doctor

MANAGING YOUR DIET

INDICATORS OF GOOD CONTROL

Weight loss or gain

Blood pressure

Swelling of hands and feet

Blood samples

LAB MONITORING

Haemoglobin Albumin Calcium Phosphorus GFR (24 hour urine)

Sodium Potassium Urea Creatinine

Lifestyle Changes with PD

Flexibilityndash Can be performed almost anywherendash Least impact on work school life (esp APD)

Travelndash Dialysis supplies can be delivered to most parts of the

world travel more flexible APD machines are portable will fit into a car boot can be carried by trainair

Responsibilityndash Requires more responsibility from patient but more

independence

Lifestyle Changes with PDSportsExercise

ndash Most are possiblendash Advice on swimming lifting contact sports

Sexual Activityndash May affect relations based on patient anxiety

Delivery amp Storage of Suppliesndash Home delivery and storagendash A monthrsquos supplies ndash 40 boxes space to storendash Specially recruited and trained delivery staff

Problems with TreatmentMonotomy of treatment

ndash The treatment never goes away against days off with HDBody Image Problems

ndash Esp with a permanent catheterndash Abdominal stretching

Fluid Overloadndash Much less a problem than with HD

Dehydrationndash Less common than fluid overload

Abdominal Discomfortndash Bloated feeling

Problems with TreatmentPoor drainage

ndash Common problem esp with new patientsndash Fibrin plugndash Catheter displacement

Leakagendash Fluid may leak around catheter exit site (May leak

into scrotum)ndash Stop PD temporarilyndash Resite catheter (use new one)

Infectionsndash Exit site infectionsndash Tunnel infectionndash peritonitis

Problems with Treatment

Herniandash Aggravation of pre-existing herniae (repair)ndash Evolution of new herniae

Declining effectiveness of the peritoneumndash eg repeated infectionndash Effect of glucose in the dialysis fluid

Comparison of Dialysis Treatment OptionsPD Unit HD Home HD

Home Dialysis radic times radicConvenient Sessions radic times radicSocializn with other CRF pats times radic timesHome EquipmentSupplies radic times radicSpecial dietfluid allowance radic radic radicSportsexercises participation Most Most Most

Full day activity -workschool radic Not alwys radicDirect assistndashpartnerfamily times times radicTravel radic Delivery of

supplies to most destins easy Some notice req

radic Prior arrangements must be made well in advance

times Prior arrangements must be made well in advance

• DIALYSIS
• CAUSES OF RENAL FAILURE
• 1Renal Failure Diagnosis
• 2 Treatment Options
• Dialysis
• Types
• Diffusion
• Ultrafiltration
• Selection for HDPD
• Slide 10
• Slide 11
• Haemodialysis
• Slide 13
• Requirements for HD
• Performing HD
• HD Unit
• Minimal Self-Care Dialysis
• Home Haemodialysis
• HD Access
• AV Fistula
• Slide 21
• Vascular Access Catheter
• AV Fistula Access
• Slide 24
• Effects of HD on Lifestyle
• Problems with HD
• Peritoneal Dialysis (PD)
• Addendum to Principles (PD)
• Slide 29
• Slide 30
• CAPD
• CAPD Exchange
• APD
• PD Access
• DIET
• CONTROLLING YOUR DIET
• PROTEINS
• MAJOR SOURCES OF POTASSIUM
• SODIUM
• FLUIDS
• PHOSPHOROUS
• VITAMINS
• MANAGING YOUR DIET
• LAB MONITORING
• Lifestyle Changes with PD
• Slide 46
• Problems with Treatment
• Slide 48
• Slide 49
• Comparison of Dialysis Treatment Options

AV Fistula

AV Fistula

Vascular Access Catheter

AV Fistula AccessMatures in about 6 weeksEnsure good working order

ndash Avoid tight clothing or wrist watch on fistula armndash Assess fistula daily notify immediately if not workingndash Avoid BP cuff on fistula armndash Avoid blood sampling on fistula arm (except daily

HD Rx)ndash Avoid sleeping on fistula armndash Grafts (synthetic) may be used to create an AV fistula

Vascular Access CatheterDouble lumen plastic tubeMay be placed in Jugular Subclavian or Femoral

veinMay be temporary or permanentTemporary ndash awaiting fistula or maturationPermanent ndash poor vessels for fistula creation eg

children and diabeticsCatheters must be kept clean dry and dressed to

prevent infection

Effects of HD on Lifestyle Flexibility

ndash Difficult to fit in with school work esp if unit is far from home Home HD offers more flexibility

Travel ndash Necessity to book in advance with HD unit of places of travel

Responsibility amp Independencendash Home HD allows the greatest degree of independence

Sexual Activityndash Anxiety of living with renal failure affects relationship with

partner Sport amp Exercise

ndash Can exercise and participate in most sports Body Image

ndash Esp with fistula patient can be very self conscious about it

Problems with HD Rapid changes in BP

ndash fainting vomiting cramps chest pain irritability fatigue temporary loss of vision

Fluid overload ndash esp in between sessions

Fluid restrictionsndash more stringent with HD than PD

Hyperkalaemia ndash esp in between sessions

Loss of independence Problems with access

ndash poor quality blockage etc Infection (vascular access catheters) Pain with needles Bleeding

ndash from the fistula during or after dialysis Infections

ndash during sessions exit site infections blood-borne viruses eg Hepatitis HIV

Peritoneal Dialysis (PD)Uses natural membrane (peritoneum) for dialysisAccess is by PD catheter a soft plastic tube Catheter and dialysis fluid may be hidden under

clothingSuitability

ndash Excludes patients with prior peritoneal scarring eg peritonitis laparotomy

ndash Excludes patients unable to care for self

Addendum to Principles (PD)Fluid across the membrane faster than solutes

therefore longer dwell times are needed for solute transfer

Protein loss in PD fluid is significant ~ 8-9gdayProtein loss uarrs during peritonitisPD patients require adequate daily protein

averaging 12 ndash 15gkgdayOther substances lost in the dialysate

ndash Amino acids water soluble vitamins some medications and hormones

Calcium and dextrose are absorbed from the dialysate fluid into the circulation

Addendum to Principles (PD)Standard dialysis solution contains

bull Na+ ndash 132 mEqlbull Cl- ndash 96 -102 mEqlbull Ca2+ ndash 25 ndash 35 mEqlbull Mg2+ ndash 05 -15 mEql

Dialysis solution bufferndash Sodium lactatendash Pure HCo3

-

ndash HCo3- Lactate combinations

Lactate is absorbed and converted to HCo3- by

the liverDextrose solution strengths 15 25 425

Types

Continuous Ambulatory Peritoneal Dialysis (CAPD)

Automated peritoneal Dialysis (APD)

CAPDDialysis takes place 24hrs a day 7 days a weekPatient is not attached to a machine for treatmentExchanges are usually carried out by patient after

training by a CAPD nurseMost patients need 3-5 exchanges a day ie

ndash 4-6 hour intervals (Dwell time) 30 mins per exchangeMay use 2-3 litres of fluid in abdomenNo needles are usedLess dietary and fluid restriction

CAPD Exchange

APD

Uses a home based machine to perform exchangesOvernight treatment whilst patient sleepsThe APD machine controls the timing of

exchanges drains the used solution and fills the peritoneal cavity with new solution

Simple procedure for the patient to performRequires about 8-10 hrsMachines are portable with in-built safety features

and requires electricity to operate

PD Access

Done under LA or GA

DIETWhy is diet important

ndash Managing the diet can slow renal disease

ndash The need for dialysis can be delayed

ndash The diet affects how patients feel

CONTROLLING YOUR DIET

Foods to control are those containing Protein

Potassium

Sodium

Phosphorous

Fluid

PROTEINS

Animal protein Dairy (milk cheese)

Meat (steak pork) Poultry (chicken turkey) Eggs

Plant protein Vegetables Breads Cereals

MAJOR SOURCES OF POTASSIUM

MilkPotatoesBananasOrangesDried Fruit

LegumesNutsSalt substituteChocolate

SODIUMRegulates blood volume and pressure

Avoid salt

Use Alternate food seasonings lemon and limes spices seafood seasoning Italian seasoning vinegars peppers

FLUIDS

Healthy kidneys remove fluids as urine

Check for fluid and sodium retention

Need to restrict fluid intake

PHOSPHOROUS

Phosphorus is a mineral which combines with calcium to keep bones and teeth strong

Too little calcium and too much phosphorus

Need to control the phosphorus in the diet

Need to take a phosphate binder or a calcium supplement

VITAMINS

Folic acid

Iron supplements

Do not take OTCrsquos without consulting the doctor

MANAGING YOUR DIET

INDICATORS OF GOOD CONTROL

Weight loss or gain

Blood pressure

Swelling of hands and feet

Blood samples

LAB MONITORING

Haemoglobin Albumin Calcium Phosphorus GFR (24 hour urine)

Sodium Potassium Urea Creatinine

Lifestyle Changes with PD

Flexibilityndash Can be performed almost anywherendash Least impact on work school life (esp APD)

Travelndash Dialysis supplies can be delivered to most parts of the

world travel more flexible APD machines are portable will fit into a car boot can be carried by trainair

Responsibilityndash Requires more responsibility from patient but more

independence

Lifestyle Changes with PDSportsExercise

ndash Most are possiblendash Advice on swimming lifting contact sports

Sexual Activityndash May affect relations based on patient anxiety

Delivery amp Storage of Suppliesndash Home delivery and storagendash A monthrsquos supplies ndash 40 boxes space to storendash Specially recruited and trained delivery staff

Problems with TreatmentMonotomy of treatment

ndash The treatment never goes away against days off with HDBody Image Problems

ndash Esp with a permanent catheterndash Abdominal stretching

Fluid Overloadndash Much less a problem than with HD

Dehydrationndash Less common than fluid overload

Abdominal Discomfortndash Bloated feeling

Problems with TreatmentPoor drainage

ndash Common problem esp with new patientsndash Fibrin plugndash Catheter displacement

Leakagendash Fluid may leak around catheter exit site (May leak

into scrotum)ndash Stop PD temporarilyndash Resite catheter (use new one)

Infectionsndash Exit site infectionsndash Tunnel infectionndash peritonitis

Problems with Treatment

Herniandash Aggravation of pre-existing herniae (repair)ndash Evolution of new herniae

Declining effectiveness of the peritoneumndash eg repeated infectionndash Effect of glucose in the dialysis fluid

Comparison of Dialysis Treatment OptionsPD Unit HD Home HD

Home Dialysis radic times radicConvenient Sessions radic times radicSocializn with other CRF pats times radic timesHome EquipmentSupplies radic times radicSpecial dietfluid allowance radic radic radicSportsexercises participation Most Most Most

Full day activity -workschool radic Not alwys radicDirect assistndashpartnerfamily times times radicTravel radic Delivery of

supplies to most destins easy Some notice req

radic Prior arrangements must be made well in advance

times Prior arrangements must be made well in advance

• DIALYSIS
• CAUSES OF RENAL FAILURE
• 1Renal Failure Diagnosis
• 2 Treatment Options
• Dialysis
• Types
• Diffusion
• Ultrafiltration
• Selection for HDPD
• Slide 10
• Slide 11
• Haemodialysis
• Slide 13
• Requirements for HD
• Performing HD
• HD Unit
• Minimal Self-Care Dialysis
• Home Haemodialysis
• HD Access
• AV Fistula
• Slide 21
• Vascular Access Catheter
• AV Fistula Access
• Slide 24
• Effects of HD on Lifestyle
• Problems with HD
• Peritoneal Dialysis (PD)
• Addendum to Principles (PD)
• Slide 29
• Slide 30
• CAPD
• CAPD Exchange
• APD
• PD Access
• DIET
• CONTROLLING YOUR DIET
• PROTEINS
• MAJOR SOURCES OF POTASSIUM
• SODIUM
• FLUIDS
• PHOSPHOROUS
• VITAMINS
• MANAGING YOUR DIET
• LAB MONITORING
• Lifestyle Changes with PD
• Slide 46
• Problems with Treatment
• Slide 48
• Slide 49
• Comparison of Dialysis Treatment Options

AV Fistula

Vascular Access Catheter

AV Fistula AccessMatures in about 6 weeksEnsure good working order

ndash Avoid tight clothing or wrist watch on fistula armndash Assess fistula daily notify immediately if not workingndash Avoid BP cuff on fistula armndash Avoid blood sampling on fistula arm (except daily

HD Rx)ndash Avoid sleeping on fistula armndash Grafts (synthetic) may be used to create an AV fistula

Vascular Access CatheterDouble lumen plastic tubeMay be placed in Jugular Subclavian or Femoral

veinMay be temporary or permanentTemporary ndash awaiting fistula or maturationPermanent ndash poor vessels for fistula creation eg

children and diabeticsCatheters must be kept clean dry and dressed to

prevent infection

Effects of HD on Lifestyle Flexibility

ndash Difficult to fit in with school work esp if unit is far from home Home HD offers more flexibility

Travel ndash Necessity to book in advance with HD unit of places of travel

Responsibility amp Independencendash Home HD allows the greatest degree of independence

Sexual Activityndash Anxiety of living with renal failure affects relationship with

partner Sport amp Exercise

ndash Can exercise and participate in most sports Body Image

ndash Esp with fistula patient can be very self conscious about it

Problems with HD Rapid changes in BP

ndash fainting vomiting cramps chest pain irritability fatigue temporary loss of vision

Fluid overload ndash esp in between sessions

Fluid restrictionsndash more stringent with HD than PD

Hyperkalaemia ndash esp in between sessions

Loss of independence Problems with access

ndash poor quality blockage etc Infection (vascular access catheters) Pain with needles Bleeding

ndash from the fistula during or after dialysis Infections

ndash during sessions exit site infections blood-borne viruses eg Hepatitis HIV

Peritoneal Dialysis (PD)Uses natural membrane (peritoneum) for dialysisAccess is by PD catheter a soft plastic tube Catheter and dialysis fluid may be hidden under

clothingSuitability

ndash Excludes patients with prior peritoneal scarring eg peritonitis laparotomy

ndash Excludes patients unable to care for self

Addendum to Principles (PD)Fluid across the membrane faster than solutes

therefore longer dwell times are needed for solute transfer

Protein loss in PD fluid is significant ~ 8-9gdayProtein loss uarrs during peritonitisPD patients require adequate daily protein

averaging 12 ndash 15gkgdayOther substances lost in the dialysate

ndash Amino acids water soluble vitamins some medications and hormones

Calcium and dextrose are absorbed from the dialysate fluid into the circulation

Addendum to Principles (PD)Standard dialysis solution contains

bull Na+ ndash 132 mEqlbull Cl- ndash 96 -102 mEqlbull Ca2+ ndash 25 ndash 35 mEqlbull Mg2+ ndash 05 -15 mEql

Dialysis solution bufferndash Sodium lactatendash Pure HCo3

-

ndash HCo3- Lactate combinations

Lactate is absorbed and converted to HCo3- by

the liverDextrose solution strengths 15 25 425

Types

Continuous Ambulatory Peritoneal Dialysis (CAPD)

Automated peritoneal Dialysis (APD)

CAPDDialysis takes place 24hrs a day 7 days a weekPatient is not attached to a machine for treatmentExchanges are usually carried out by patient after

training by a CAPD nurseMost patients need 3-5 exchanges a day ie

ndash 4-6 hour intervals (Dwell time) 30 mins per exchangeMay use 2-3 litres of fluid in abdomenNo needles are usedLess dietary and fluid restriction

CAPD Exchange

APD

Uses a home based machine to perform exchangesOvernight treatment whilst patient sleepsThe APD machine controls the timing of

exchanges drains the used solution and fills the peritoneal cavity with new solution

Simple procedure for the patient to performRequires about 8-10 hrsMachines are portable with in-built safety features

and requires electricity to operate

PD Access

Done under LA or GA

DIETWhy is diet important

ndash Managing the diet can slow renal disease

ndash The need for dialysis can be delayed

ndash The diet affects how patients feel

CONTROLLING YOUR DIET

Foods to control are those containing Protein

Potassium

Sodium

Phosphorous

Fluid

PROTEINS

Animal protein Dairy (milk cheese)

Meat (steak pork) Poultry (chicken turkey) Eggs

Plant protein Vegetables Breads Cereals

MAJOR SOURCES OF POTASSIUM

MilkPotatoesBananasOrangesDried Fruit

LegumesNutsSalt substituteChocolate

SODIUMRegulates blood volume and pressure

Avoid salt

Use Alternate food seasonings lemon and limes spices seafood seasoning Italian seasoning vinegars peppers

FLUIDS

Healthy kidneys remove fluids as urine

Check for fluid and sodium retention

Need to restrict fluid intake

PHOSPHOROUS

Phosphorus is a mineral which combines with calcium to keep bones and teeth strong

Too little calcium and too much phosphorus

Need to control the phosphorus in the diet

Need to take a phosphate binder or a calcium supplement

VITAMINS

Folic acid

Iron supplements

Do not take OTCrsquos without consulting the doctor

MANAGING YOUR DIET

INDICATORS OF GOOD CONTROL

Weight loss or gain

Blood pressure

Swelling of hands and feet

Blood samples

LAB MONITORING

Haemoglobin Albumin Calcium Phosphorus GFR (24 hour urine)

Sodium Potassium Urea Creatinine

Lifestyle Changes with PD

Flexibilityndash Can be performed almost anywherendash Least impact on work school life (esp APD)

Travelndash Dialysis supplies can be delivered to most parts of the

world travel more flexible APD machines are portable will fit into a car boot can be carried by trainair

Responsibilityndash Requires more responsibility from patient but more

independence

Lifestyle Changes with PDSportsExercise

ndash Most are possiblendash Advice on swimming lifting contact sports

Sexual Activityndash May affect relations based on patient anxiety

Delivery amp Storage of Suppliesndash Home delivery and storagendash A monthrsquos supplies ndash 40 boxes space to storendash Specially recruited and trained delivery staff

Problems with TreatmentMonotomy of treatment

ndash The treatment never goes away against days off with HDBody Image Problems

ndash Esp with a permanent catheterndash Abdominal stretching

Fluid Overloadndash Much less a problem than with HD

Dehydrationndash Less common than fluid overload

Abdominal Discomfortndash Bloated feeling

Problems with TreatmentPoor drainage

ndash Common problem esp with new patientsndash Fibrin plugndash Catheter displacement

Leakagendash Fluid may leak around catheter exit site (May leak

into scrotum)ndash Stop PD temporarilyndash Resite catheter (use new one)

Infectionsndash Exit site infectionsndash Tunnel infectionndash peritonitis

Problems with Treatment

Herniandash Aggravation of pre-existing herniae (repair)ndash Evolution of new herniae

Declining effectiveness of the peritoneumndash eg repeated infectionndash Effect of glucose in the dialysis fluid

Comparison of Dialysis Treatment OptionsPD Unit HD Home HD

Home Dialysis radic times radicConvenient Sessions radic times radicSocializn with other CRF pats times radic timesHome EquipmentSupplies radic times radicSpecial dietfluid allowance radic radic radicSportsexercises participation Most Most Most

Full day activity -workschool radic Not alwys radicDirect assistndashpartnerfamily times times radicTravel radic Delivery of

supplies to most destins easy Some notice req

radic Prior arrangements must be made well in advance

times Prior arrangements must be made well in advance

• DIALYSIS
• CAUSES OF RENAL FAILURE
• 1Renal Failure Diagnosis
• 2 Treatment Options
• Dialysis
• Types
• Diffusion
• Ultrafiltration
• Selection for HDPD
• Slide 10
• Slide 11
• Haemodialysis
• Slide 13
• Requirements for HD
• Performing HD
• HD Unit
• Minimal Self-Care Dialysis
• Home Haemodialysis
• HD Access
• AV Fistula
• Slide 21
• Vascular Access Catheter
• AV Fistula Access
• Slide 24
• Effects of HD on Lifestyle
• Problems with HD
• Peritoneal Dialysis (PD)
• Addendum to Principles (PD)
• Slide 29
• Slide 30
• CAPD
• CAPD Exchange
• APD
• PD Access
• DIET
• CONTROLLING YOUR DIET
• PROTEINS
• MAJOR SOURCES OF POTASSIUM
• SODIUM
• FLUIDS
• PHOSPHOROUS
• VITAMINS
• MANAGING YOUR DIET
• LAB MONITORING
• Lifestyle Changes with PD
• Slide 46
• Problems with Treatment
• Slide 48
• Slide 49
• Comparison of Dialysis Treatment Options

Vascular Access Catheter

AV Fistula AccessMatures in about 6 weeksEnsure good working order

ndash Avoid tight clothing or wrist watch on fistula armndash Assess fistula daily notify immediately if not workingndash Avoid BP cuff on fistula armndash Avoid blood sampling on fistula arm (except daily

HD Rx)ndash Avoid sleeping on fistula armndash Grafts (synthetic) may be used to create an AV fistula

Vascular Access CatheterDouble lumen plastic tubeMay be placed in Jugular Subclavian or Femoral

veinMay be temporary or permanentTemporary ndash awaiting fistula or maturationPermanent ndash poor vessels for fistula creation eg

children and diabeticsCatheters must be kept clean dry and dressed to

prevent infection

Effects of HD on Lifestyle Flexibility

ndash Difficult to fit in with school work esp if unit is far from home Home HD offers more flexibility

Travel ndash Necessity to book in advance with HD unit of places of travel

Responsibility amp Independencendash Home HD allows the greatest degree of independence

Sexual Activityndash Anxiety of living with renal failure affects relationship with

partner Sport amp Exercise

ndash Can exercise and participate in most sports Body Image

ndash Esp with fistula patient can be very self conscious about it

Problems with HD Rapid changes in BP

ndash fainting vomiting cramps chest pain irritability fatigue temporary loss of vision

Fluid overload ndash esp in between sessions

Fluid restrictionsndash more stringent with HD than PD

Hyperkalaemia ndash esp in between sessions

Loss of independence Problems with access

ndash poor quality blockage etc Infection (vascular access catheters) Pain with needles Bleeding

ndash from the fistula during or after dialysis Infections

ndash during sessions exit site infections blood-borne viruses eg Hepatitis HIV

Peritoneal Dialysis (PD)Uses natural membrane (peritoneum) for dialysisAccess is by PD catheter a soft plastic tube Catheter and dialysis fluid may be hidden under

clothingSuitability

ndash Excludes patients with prior peritoneal scarring eg peritonitis laparotomy

ndash Excludes patients unable to care for self

Addendum to Principles (PD)Fluid across the membrane faster than solutes

therefore longer dwell times are needed for solute transfer

Protein loss in PD fluid is significant ~ 8-9gdayProtein loss uarrs during peritonitisPD patients require adequate daily protein

averaging 12 ndash 15gkgdayOther substances lost in the dialysate

ndash Amino acids water soluble vitamins some medications and hormones

Calcium and dextrose are absorbed from the dialysate fluid into the circulation

Addendum to Principles (PD)Standard dialysis solution contains

bull Na+ ndash 132 mEqlbull Cl- ndash 96 -102 mEqlbull Ca2+ ndash 25 ndash 35 mEqlbull Mg2+ ndash 05 -15 mEql

Dialysis solution bufferndash Sodium lactatendash Pure HCo3

-

ndash HCo3- Lactate combinations

Lactate is absorbed and converted to HCo3- by

the liverDextrose solution strengths 15 25 425

Types

Continuous Ambulatory Peritoneal Dialysis (CAPD)

Automated peritoneal Dialysis (APD)

CAPDDialysis takes place 24hrs a day 7 days a weekPatient is not attached to a machine for treatmentExchanges are usually carried out by patient after

training by a CAPD nurseMost patients need 3-5 exchanges a day ie

ndash 4-6 hour intervals (Dwell time) 30 mins per exchangeMay use 2-3 litres of fluid in abdomenNo needles are usedLess dietary and fluid restriction

CAPD Exchange

APD

Uses a home based machine to perform exchangesOvernight treatment whilst patient sleepsThe APD machine controls the timing of

exchanges drains the used solution and fills the peritoneal cavity with new solution

Simple procedure for the patient to performRequires about 8-10 hrsMachines are portable with in-built safety features

and requires electricity to operate

PD Access

Done under LA or GA

DIETWhy is diet important

ndash Managing the diet can slow renal disease

ndash The need for dialysis can be delayed

ndash The diet affects how patients feel

CONTROLLING YOUR DIET

Foods to control are those containing Protein

Potassium

Sodium

Phosphorous

Fluid

PROTEINS

Animal protein Dairy (milk cheese)

Meat (steak pork) Poultry (chicken turkey) Eggs

Plant protein Vegetables Breads Cereals

MAJOR SOURCES OF POTASSIUM

MilkPotatoesBananasOrangesDried Fruit

LegumesNutsSalt substituteChocolate

SODIUMRegulates blood volume and pressure

Avoid salt

Use Alternate food seasonings lemon and limes spices seafood seasoning Italian seasoning vinegars peppers

FLUIDS

Healthy kidneys remove fluids as urine

Check for fluid and sodium retention

Need to restrict fluid intake

PHOSPHOROUS

Phosphorus is a mineral which combines with calcium to keep bones and teeth strong

Too little calcium and too much phosphorus

Need to control the phosphorus in the diet

Need to take a phosphate binder or a calcium supplement

VITAMINS

Folic acid

Iron supplements

Do not take OTCrsquos without consulting the doctor

MANAGING YOUR DIET

INDICATORS OF GOOD CONTROL

Weight loss or gain

Blood pressure

Swelling of hands and feet

Blood samples

LAB MONITORING

Haemoglobin Albumin Calcium Phosphorus GFR (24 hour urine)

Sodium Potassium Urea Creatinine

Lifestyle Changes with PD

Flexibilityndash Can be performed almost anywherendash Least impact on work school life (esp APD)

Travelndash Dialysis supplies can be delivered to most parts of the

world travel more flexible APD machines are portable will fit into a car boot can be carried by trainair

Responsibilityndash Requires more responsibility from patient but more

independence

Lifestyle Changes with PDSportsExercise

ndash Most are possiblendash Advice on swimming lifting contact sports

Sexual Activityndash May affect relations based on patient anxiety

Delivery amp Storage of Suppliesndash Home delivery and storagendash A monthrsquos supplies ndash 40 boxes space to storendash Specially recruited and trained delivery staff

Problems with TreatmentMonotomy of treatment

ndash The treatment never goes away against days off with HDBody Image Problems

ndash Esp with a permanent catheterndash Abdominal stretching

Fluid Overloadndash Much less a problem than with HD

Dehydrationndash Less common than fluid overload

Abdominal Discomfortndash Bloated feeling

Problems with TreatmentPoor drainage

ndash Common problem esp with new patientsndash Fibrin plugndash Catheter displacement

Leakagendash Fluid may leak around catheter exit site (May leak

into scrotum)ndash Stop PD temporarilyndash Resite catheter (use new one)

Infectionsndash Exit site infectionsndash Tunnel infectionndash peritonitis

Problems with Treatment

Herniandash Aggravation of pre-existing herniae (repair)ndash Evolution of new herniae

Declining effectiveness of the peritoneumndash eg repeated infectionndash Effect of glucose in the dialysis fluid

Comparison of Dialysis Treatment OptionsPD Unit HD Home HD

Home Dialysis radic times radicConvenient Sessions radic times radicSocializn with other CRF pats times radic timesHome EquipmentSupplies radic times radicSpecial dietfluid allowance radic radic radicSportsexercises participation Most Most Most

Full day activity -workschool radic Not alwys radicDirect assistndashpartnerfamily times times radicTravel radic Delivery of

supplies to most destins easy Some notice req

radic Prior arrangements must be made well in advance

times Prior arrangements must be made well in advance

• DIALYSIS
• CAUSES OF RENAL FAILURE
• 1Renal Failure Diagnosis
• 2 Treatment Options
• Dialysis
• Types
• Diffusion
• Ultrafiltration
• Selection for HDPD
• Slide 10
• Slide 11
• Haemodialysis
• Slide 13
• Requirements for HD
• Performing HD
• HD Unit
• Minimal Self-Care Dialysis
• Home Haemodialysis
• HD Access
• AV Fistula
• Slide 21
• Vascular Access Catheter
• AV Fistula Access
• Slide 24
• Effects of HD on Lifestyle
• Problems with HD
• Peritoneal Dialysis (PD)
• Addendum to Principles (PD)
• Slide 29
• Slide 30
• CAPD
• CAPD Exchange
• APD
• PD Access
• DIET
• CONTROLLING YOUR DIET
• PROTEINS
• MAJOR SOURCES OF POTASSIUM
• SODIUM
• FLUIDS
• PHOSPHOROUS
• VITAMINS
• MANAGING YOUR DIET
• LAB MONITORING
• Lifestyle Changes with PD
• Slide 46
• Problems with Treatment
• Slide 48
• Slide 49
• Comparison of Dialysis Treatment Options

AV Fistula AccessMatures in about 6 weeksEnsure good working order

ndash Avoid tight clothing or wrist watch on fistula armndash Assess fistula daily notify immediately if not workingndash Avoid BP cuff on fistula armndash Avoid blood sampling on fistula arm (except daily

HD Rx)ndash Avoid sleeping on fistula armndash Grafts (synthetic) may be used to create an AV fistula

Vascular Access CatheterDouble lumen plastic tubeMay be placed in Jugular Subclavian or Femoral

veinMay be temporary or permanentTemporary ndash awaiting fistula or maturationPermanent ndash poor vessels for fistula creation eg

children and diabeticsCatheters must be kept clean dry and dressed to

prevent infection

Effects of HD on Lifestyle Flexibility

ndash Difficult to fit in with school work esp if unit is far from home Home HD offers more flexibility

Travel ndash Necessity to book in advance with HD unit of places of travel

Responsibility amp Independencendash Home HD allows the greatest degree of independence

Sexual Activityndash Anxiety of living with renal failure affects relationship with

partner Sport amp Exercise

ndash Can exercise and participate in most sports Body Image

ndash Esp with fistula patient can be very self conscious about it

Problems with HD Rapid changes in BP

ndash fainting vomiting cramps chest pain irritability fatigue temporary loss of vision

Fluid overload ndash esp in between sessions

Fluid restrictionsndash more stringent with HD than PD

Hyperkalaemia ndash esp in between sessions

Loss of independence Problems with access

ndash poor quality blockage etc Infection (vascular access catheters) Pain with needles Bleeding

ndash from the fistula during or after dialysis Infections

ndash during sessions exit site infections blood-borne viruses eg Hepatitis HIV

Peritoneal Dialysis (PD)Uses natural membrane (peritoneum) for dialysisAccess is by PD catheter a soft plastic tube Catheter and dialysis fluid may be hidden under

clothingSuitability

ndash Excludes patients with prior peritoneal scarring eg peritonitis laparotomy

ndash Excludes patients unable to care for self

Addendum to Principles (PD)Fluid across the membrane faster than solutes

therefore longer dwell times are needed for solute transfer

Protein loss in PD fluid is significant ~ 8-9gdayProtein loss uarrs during peritonitisPD patients require adequate daily protein

averaging 12 ndash 15gkgdayOther substances lost in the dialysate

ndash Amino acids water soluble vitamins some medications and hormones

Calcium and dextrose are absorbed from the dialysate fluid into the circulation

Addendum to Principles (PD)Standard dialysis solution contains

bull Na+ ndash 132 mEqlbull Cl- ndash 96 -102 mEqlbull Ca2+ ndash 25 ndash 35 mEqlbull Mg2+ ndash 05 -15 mEql

Dialysis solution bufferndash Sodium lactatendash Pure HCo3

-

ndash HCo3- Lactate combinations

Lactate is absorbed and converted to HCo3- by

the liverDextrose solution strengths 15 25 425

Types

Continuous Ambulatory Peritoneal Dialysis (CAPD)

Automated peritoneal Dialysis (APD)

CAPDDialysis takes place 24hrs a day 7 days a weekPatient is not attached to a machine for treatmentExchanges are usually carried out by patient after

training by a CAPD nurseMost patients need 3-5 exchanges a day ie

ndash 4-6 hour intervals (Dwell time) 30 mins per exchangeMay use 2-3 litres of fluid in abdomenNo needles are usedLess dietary and fluid restriction

CAPD Exchange

APD

Uses a home based machine to perform exchangesOvernight treatment whilst patient sleepsThe APD machine controls the timing of

exchanges drains the used solution and fills the peritoneal cavity with new solution

Simple procedure for the patient to performRequires about 8-10 hrsMachines are portable with in-built safety features

and requires electricity to operate

PD Access

Done under LA or GA

DIETWhy is diet important

ndash Managing the diet can slow renal disease

ndash The need for dialysis can be delayed

ndash The diet affects how patients feel

CONTROLLING YOUR DIET

Foods to control are those containing Protein

Potassium

Sodium

Phosphorous

Fluid

PROTEINS

Animal protein Dairy (milk cheese)

Meat (steak pork) Poultry (chicken turkey) Eggs

Plant protein Vegetables Breads Cereals

MAJOR SOURCES OF POTASSIUM

MilkPotatoesBananasOrangesDried Fruit

LegumesNutsSalt substituteChocolate

SODIUMRegulates blood volume and pressure

Avoid salt

Use Alternate food seasonings lemon and limes spices seafood seasoning Italian seasoning vinegars peppers

FLUIDS

Healthy kidneys remove fluids as urine

Check for fluid and sodium retention

Need to restrict fluid intake

PHOSPHOROUS

Phosphorus is a mineral which combines with calcium to keep bones and teeth strong

Too little calcium and too much phosphorus

Need to control the phosphorus in the diet

Need to take a phosphate binder or a calcium supplement

VITAMINS

Folic acid

Iron supplements

Do not take OTCrsquos without consulting the doctor

MANAGING YOUR DIET

INDICATORS OF GOOD CONTROL

Weight loss or gain

Blood pressure

Swelling of hands and feet

Blood samples

LAB MONITORING

Haemoglobin Albumin Calcium Phosphorus GFR (24 hour urine)

Sodium Potassium Urea Creatinine

Lifestyle Changes with PD

Flexibilityndash Can be performed almost anywherendash Least impact on work school life (esp APD)

Travelndash Dialysis supplies can be delivered to most parts of the

world travel more flexible APD machines are portable will fit into a car boot can be carried by trainair

Responsibilityndash Requires more responsibility from patient but more

independence

Lifestyle Changes with PDSportsExercise

ndash Most are possiblendash Advice on swimming lifting contact sports

Sexual Activityndash May affect relations based on patient anxiety

Delivery amp Storage of Suppliesndash Home delivery and storagendash A monthrsquos supplies ndash 40 boxes space to storendash Specially recruited and trained delivery staff

Problems with TreatmentMonotomy of treatment

ndash The treatment never goes away against days off with HDBody Image Problems

ndash Esp with a permanent catheterndash Abdominal stretching

Fluid Overloadndash Much less a problem than with HD

Dehydrationndash Less common than fluid overload

Abdominal Discomfortndash Bloated feeling

Problems with TreatmentPoor drainage

ndash Common problem esp with new patientsndash Fibrin plugndash Catheter displacement

Leakagendash Fluid may leak around catheter exit site (May leak

into scrotum)ndash Stop PD temporarilyndash Resite catheter (use new one)

Infectionsndash Exit site infectionsndash Tunnel infectionndash peritonitis

Problems with Treatment

Herniandash Aggravation of pre-existing herniae (repair)ndash Evolution of new herniae

Declining effectiveness of the peritoneumndash eg repeated infectionndash Effect of glucose in the dialysis fluid

Comparison of Dialysis Treatment OptionsPD Unit HD Home HD

Home Dialysis radic times radicConvenient Sessions radic times radicSocializn with other CRF pats times radic timesHome EquipmentSupplies radic times radicSpecial dietfluid allowance radic radic radicSportsexercises participation Most Most Most

Full day activity -workschool radic Not alwys radicDirect assistndashpartnerfamily times times radicTravel radic Delivery of

supplies to most destins easy Some notice req

radic Prior arrangements must be made well in advance

times Prior arrangements must be made well in advance

• DIALYSIS
• CAUSES OF RENAL FAILURE
• 1Renal Failure Diagnosis
• 2 Treatment Options
• Dialysis
• Types
• Diffusion
• Ultrafiltration
• Selection for HDPD
• Slide 10
• Slide 11
• Haemodialysis
• Slide 13
• Requirements for HD
• Performing HD
• HD Unit
• Minimal Self-Care Dialysis
• Home Haemodialysis
• HD Access
• AV Fistula
• Slide 21
• Vascular Access Catheter
• AV Fistula Access
• Slide 24
• Effects of HD on Lifestyle
• Problems with HD
• Peritoneal Dialysis (PD)
• Addendum to Principles (PD)
• Slide 29
• Slide 30
• CAPD
• CAPD Exchange
• APD
• PD Access
• DIET
• CONTROLLING YOUR DIET
• PROTEINS
• MAJOR SOURCES OF POTASSIUM
• SODIUM
• FLUIDS
• PHOSPHOROUS
• VITAMINS
• MANAGING YOUR DIET
• LAB MONITORING
• Lifestyle Changes with PD
• Slide 46
• Problems with Treatment
• Slide 48
• Slide 49
• Comparison of Dialysis Treatment Options

Vascular Access CatheterDouble lumen plastic tubeMay be placed in Jugular Subclavian or Femoral

veinMay be temporary or permanentTemporary ndash awaiting fistula or maturationPermanent ndash poor vessels for fistula creation eg

children and diabeticsCatheters must be kept clean dry and dressed to

prevent infection

Effects of HD on Lifestyle Flexibility

ndash Difficult to fit in with school work esp if unit is far from home Home HD offers more flexibility

Travel ndash Necessity to book in advance with HD unit of places of travel

Responsibility amp Independencendash Home HD allows the greatest degree of independence

Sexual Activityndash Anxiety of living with renal failure affects relationship with

partner Sport amp Exercise

ndash Can exercise and participate in most sports Body Image

ndash Esp with fistula patient can be very self conscious about it

Problems with HD Rapid changes in BP

ndash fainting vomiting cramps chest pain irritability fatigue temporary loss of vision

Fluid overload ndash esp in between sessions

Fluid restrictionsndash more stringent with HD than PD

Hyperkalaemia ndash esp in between sessions

Loss of independence Problems with access

ndash poor quality blockage etc Infection (vascular access catheters) Pain with needles Bleeding

ndash from the fistula during or after dialysis Infections

ndash during sessions exit site infections blood-borne viruses eg Hepatitis HIV

Peritoneal Dialysis (PD)Uses natural membrane (peritoneum) for dialysisAccess is by PD catheter a soft plastic tube Catheter and dialysis fluid may be hidden under

clothingSuitability

ndash Excludes patients with prior peritoneal scarring eg peritonitis laparotomy

ndash Excludes patients unable to care for self

Addendum to Principles (PD)Fluid across the membrane faster than solutes

therefore longer dwell times are needed for solute transfer

Protein loss in PD fluid is significant ~ 8-9gdayProtein loss uarrs during peritonitisPD patients require adequate daily protein

averaging 12 ndash 15gkgdayOther substances lost in the dialysate

ndash Amino acids water soluble vitamins some medications and hormones

Calcium and dextrose are absorbed from the dialysate fluid into the circulation

Addendum to Principles (PD)Standard dialysis solution contains

bull Na+ ndash 132 mEqlbull Cl- ndash 96 -102 mEqlbull Ca2+ ndash 25 ndash 35 mEqlbull Mg2+ ndash 05 -15 mEql

Dialysis solution bufferndash Sodium lactatendash Pure HCo3

-

ndash HCo3- Lactate combinations

Lactate is absorbed and converted to HCo3- by

the liverDextrose solution strengths 15 25 425

Types

Continuous Ambulatory Peritoneal Dialysis (CAPD)

Automated peritoneal Dialysis (APD)

CAPDDialysis takes place 24hrs a day 7 days a weekPatient is not attached to a machine for treatmentExchanges are usually carried out by patient after

training by a CAPD nurseMost patients need 3-5 exchanges a day ie

ndash 4-6 hour intervals (Dwell time) 30 mins per exchangeMay use 2-3 litres of fluid in abdomenNo needles are usedLess dietary and fluid restriction

CAPD Exchange

APD

Uses a home based machine to perform exchangesOvernight treatment whilst patient sleepsThe APD machine controls the timing of

exchanges drains the used solution and fills the peritoneal cavity with new solution

Simple procedure for the patient to performRequires about 8-10 hrsMachines are portable with in-built safety features

and requires electricity to operate

PD Access

Done under LA or GA

DIETWhy is diet important

ndash Managing the diet can slow renal disease

ndash The need for dialysis can be delayed

ndash The diet affects how patients feel

CONTROLLING YOUR DIET

Foods to control are those containing Protein

Potassium

Sodium

Phosphorous

Fluid

PROTEINS

Animal protein Dairy (milk cheese)

Meat (steak pork) Poultry (chicken turkey) Eggs

Plant protein Vegetables Breads Cereals

MAJOR SOURCES OF POTASSIUM

MilkPotatoesBananasOrangesDried Fruit

LegumesNutsSalt substituteChocolate

SODIUMRegulates blood volume and pressure

Avoid salt

Use Alternate food seasonings lemon and limes spices seafood seasoning Italian seasoning vinegars peppers

FLUIDS

Healthy kidneys remove fluids as urine

Check for fluid and sodium retention

Need to restrict fluid intake

PHOSPHOROUS

Phosphorus is a mineral which combines with calcium to keep bones and teeth strong

Too little calcium and too much phosphorus

Need to control the phosphorus in the diet

Need to take a phosphate binder or a calcium supplement

VITAMINS

Folic acid

Iron supplements

Do not take OTCrsquos without consulting the doctor

MANAGING YOUR DIET

INDICATORS OF GOOD CONTROL

Weight loss or gain

Blood pressure

Swelling of hands and feet

Blood samples

LAB MONITORING

Haemoglobin Albumin Calcium Phosphorus GFR (24 hour urine)

Sodium Potassium Urea Creatinine

Lifestyle Changes with PD

Flexibilityndash Can be performed almost anywherendash Least impact on work school life (esp APD)

Travelndash Dialysis supplies can be delivered to most parts of the

world travel more flexible APD machines are portable will fit into a car boot can be carried by trainair

Responsibilityndash Requires more responsibility from patient but more

independence

Lifestyle Changes with PDSportsExercise

ndash Most are possiblendash Advice on swimming lifting contact sports

Sexual Activityndash May affect relations based on patient anxiety

Delivery amp Storage of Suppliesndash Home delivery and storagendash A monthrsquos supplies ndash 40 boxes space to storendash Specially recruited and trained delivery staff

Problems with TreatmentMonotomy of treatment

ndash The treatment never goes away against days off with HDBody Image Problems

ndash Esp with a permanent catheterndash Abdominal stretching

Fluid Overloadndash Much less a problem than with HD

Dehydrationndash Less common than fluid overload

Abdominal Discomfortndash Bloated feeling

Problems with TreatmentPoor drainage

ndash Common problem esp with new patientsndash Fibrin plugndash Catheter displacement

Leakagendash Fluid may leak around catheter exit site (May leak

into scrotum)ndash Stop PD temporarilyndash Resite catheter (use new one)

Infectionsndash Exit site infectionsndash Tunnel infectionndash peritonitis

Problems with Treatment

Herniandash Aggravation of pre-existing herniae (repair)ndash Evolution of new herniae

Declining effectiveness of the peritoneumndash eg repeated infectionndash Effect of glucose in the dialysis fluid

Comparison of Dialysis Treatment OptionsPD Unit HD Home HD

Home Dialysis radic times radicConvenient Sessions radic times radicSocializn with other CRF pats times radic timesHome EquipmentSupplies radic times radicSpecial dietfluid allowance radic radic radicSportsexercises participation Most Most Most

Full day activity -workschool radic Not alwys radicDirect assistndashpartnerfamily times times radicTravel radic Delivery of

supplies to most destins easy Some notice req

radic Prior arrangements must be made well in advance

times Prior arrangements must be made well in advance

• DIALYSIS
• CAUSES OF RENAL FAILURE
• 1Renal Failure Diagnosis
• 2 Treatment Options
• Dialysis
• Types
• Diffusion
• Ultrafiltration
• Selection for HDPD
• Slide 10
• Slide 11
• Haemodialysis
• Slide 13
• Requirements for HD
• Performing HD
• HD Unit
• Minimal Self-Care Dialysis
• Home Haemodialysis
• HD Access
• AV Fistula
• Slide 21
• Vascular Access Catheter
• AV Fistula Access
• Slide 24
• Effects of HD on Lifestyle
• Problems with HD
• Peritoneal Dialysis (PD)
• Addendum to Principles (PD)
• Slide 29
• Slide 30
• CAPD
• CAPD Exchange
• APD
• PD Access
• DIET
• CONTROLLING YOUR DIET
• PROTEINS
• MAJOR SOURCES OF POTASSIUM
• SODIUM
• FLUIDS
• PHOSPHOROUS
• VITAMINS
• MANAGING YOUR DIET
• LAB MONITORING
• Lifestyle Changes with PD
• Slide 46
• Problems with Treatment
• Slide 48
• Slide 49
• Comparison of Dialysis Treatment Options

Effects of HD on Lifestyle Flexibility

ndash Difficult to fit in with school work esp if unit is far from home Home HD offers more flexibility

Travel ndash Necessity to book in advance with HD unit of places of travel

Responsibility amp Independencendash Home HD allows the greatest degree of independence

Sexual Activityndash Anxiety of living with renal failure affects relationship with

partner Sport amp Exercise

ndash Can exercise and participate in most sports Body Image

ndash Esp with fistula patient can be very self conscious about it

Problems with HD Rapid changes in BP

ndash fainting vomiting cramps chest pain irritability fatigue temporary loss of vision

Fluid overload ndash esp in between sessions

Fluid restrictionsndash more stringent with HD than PD

Hyperkalaemia ndash esp in between sessions

Loss of independence Problems with access

ndash poor quality blockage etc Infection (vascular access catheters) Pain with needles Bleeding

ndash from the fistula during or after dialysis Infections

ndash during sessions exit site infections blood-borne viruses eg Hepatitis HIV

Peritoneal Dialysis (PD)Uses natural membrane (peritoneum) for dialysisAccess is by PD catheter a soft plastic tube Catheter and dialysis fluid may be hidden under

clothingSuitability

ndash Excludes patients with prior peritoneal scarring eg peritonitis laparotomy

ndash Excludes patients unable to care for self

Addendum to Principles (PD)Fluid across the membrane faster than solutes

therefore longer dwell times are needed for solute transfer

Protein loss in PD fluid is significant ~ 8-9gdayProtein loss uarrs during peritonitisPD patients require adequate daily protein

averaging 12 ndash 15gkgdayOther substances lost in the dialysate

ndash Amino acids water soluble vitamins some medications and hormones

Calcium and dextrose are absorbed from the dialysate fluid into the circulation

Addendum to Principles (PD)Standard dialysis solution contains

bull Na+ ndash 132 mEqlbull Cl- ndash 96 -102 mEqlbull Ca2+ ndash 25 ndash 35 mEqlbull Mg2+ ndash 05 -15 mEql

Dialysis solution bufferndash Sodium lactatendash Pure HCo3

-

ndash HCo3- Lactate combinations

Lactate is absorbed and converted to HCo3- by

the liverDextrose solution strengths 15 25 425

Types

Continuous Ambulatory Peritoneal Dialysis (CAPD)

Automated peritoneal Dialysis (APD)

CAPDDialysis takes place 24hrs a day 7 days a weekPatient is not attached to a machine for treatmentExchanges are usually carried out by patient after

training by a CAPD nurseMost patients need 3-5 exchanges a day ie

ndash 4-6 hour intervals (Dwell time) 30 mins per exchangeMay use 2-3 litres of fluid in abdomenNo needles are usedLess dietary and fluid restriction

CAPD Exchange

APD

Uses a home based machine to perform exchangesOvernight treatment whilst patient sleepsThe APD machine controls the timing of

exchanges drains the used solution and fills the peritoneal cavity with new solution

Simple procedure for the patient to performRequires about 8-10 hrsMachines are portable with in-built safety features

and requires electricity to operate

PD Access

Done under LA or GA

DIETWhy is diet important

ndash Managing the diet can slow renal disease

ndash The need for dialysis can be delayed

ndash The diet affects how patients feel

CONTROLLING YOUR DIET

Foods to control are those containing Protein

Potassium

Sodium

Phosphorous

Fluid

PROTEINS

Animal protein Dairy (milk cheese)

Meat (steak pork) Poultry (chicken turkey) Eggs

Plant protein Vegetables Breads Cereals

MAJOR SOURCES OF POTASSIUM

MilkPotatoesBananasOrangesDried Fruit

LegumesNutsSalt substituteChocolate

SODIUMRegulates blood volume and pressure

Avoid salt

Use Alternate food seasonings lemon and limes spices seafood seasoning Italian seasoning vinegars peppers

FLUIDS

Healthy kidneys remove fluids as urine

Check for fluid and sodium retention

Need to restrict fluid intake

PHOSPHOROUS

Phosphorus is a mineral which combines with calcium to keep bones and teeth strong

Too little calcium and too much phosphorus

Need to control the phosphorus in the diet

Need to take a phosphate binder or a calcium supplement

VITAMINS

Folic acid

Iron supplements

Do not take OTCrsquos without consulting the doctor

MANAGING YOUR DIET

INDICATORS OF GOOD CONTROL

Weight loss or gain

Blood pressure

Swelling of hands and feet

Blood samples

LAB MONITORING

Haemoglobin Albumin Calcium Phosphorus GFR (24 hour urine)

Sodium Potassium Urea Creatinine

Lifestyle Changes with PD

Flexibilityndash Can be performed almost anywherendash Least impact on work school life (esp APD)

Travelndash Dialysis supplies can be delivered to most parts of the

world travel more flexible APD machines are portable will fit into a car boot can be carried by trainair

Responsibilityndash Requires more responsibility from patient but more

independence

Lifestyle Changes with PDSportsExercise

ndash Most are possiblendash Advice on swimming lifting contact sports

Sexual Activityndash May affect relations based on patient anxiety

Delivery amp Storage of Suppliesndash Home delivery and storagendash A monthrsquos supplies ndash 40 boxes space to storendash Specially recruited and trained delivery staff

Problems with TreatmentMonotomy of treatment

ndash The treatment never goes away against days off with HDBody Image Problems

ndash Esp with a permanent catheterndash Abdominal stretching

Fluid Overloadndash Much less a problem than with HD

Dehydrationndash Less common than fluid overload

Abdominal Discomfortndash Bloated feeling

Problems with TreatmentPoor drainage

ndash Common problem esp with new patientsndash Fibrin plugndash Catheter displacement

Leakagendash Fluid may leak around catheter exit site (May leak

into scrotum)ndash Stop PD temporarilyndash Resite catheter (use new one)

Infectionsndash Exit site infectionsndash Tunnel infectionndash peritonitis

Problems with Treatment

Herniandash Aggravation of pre-existing herniae (repair)ndash Evolution of new herniae

Declining effectiveness of the peritoneumndash eg repeated infectionndash Effect of glucose in the dialysis fluid

Comparison of Dialysis Treatment OptionsPD Unit HD Home HD

Home Dialysis radic times radicConvenient Sessions radic times radicSocializn with other CRF pats times radic timesHome EquipmentSupplies radic times radicSpecial dietfluid allowance radic radic radicSportsexercises participation Most Most Most

Full day activity -workschool radic Not alwys radicDirect assistndashpartnerfamily times times radicTravel radic Delivery of

supplies to most destins easy Some notice req

radic Prior arrangements must be made well in advance

times Prior arrangements must be made well in advance

• DIALYSIS
• CAUSES OF RENAL FAILURE
• 1Renal Failure Diagnosis
• 2 Treatment Options
• Dialysis
• Types
• Diffusion
• Ultrafiltration
• Selection for HDPD
• Slide 10
• Slide 11
• Haemodialysis
• Slide 13
• Requirements for HD
• Performing HD
• HD Unit
• Minimal Self-Care Dialysis
• Home Haemodialysis
• HD Access
• AV Fistula
• Slide 21
• Vascular Access Catheter
• AV Fistula Access
• Slide 24
• Effects of HD on Lifestyle
• Problems with HD
• Peritoneal Dialysis (PD)
• Addendum to Principles (PD)
• Slide 29
• Slide 30
• CAPD
• CAPD Exchange
• APD
• PD Access
• DIET
• CONTROLLING YOUR DIET
• PROTEINS
• MAJOR SOURCES OF POTASSIUM
• SODIUM
• FLUIDS
• PHOSPHOROUS
• VITAMINS
• MANAGING YOUR DIET
• LAB MONITORING
• Lifestyle Changes with PD
• Slide 46
• Problems with Treatment
• Slide 48
• Slide 49
• Comparison of Dialysis Treatment Options

Problems with HD Rapid changes in BP

ndash fainting vomiting cramps chest pain irritability fatigue temporary loss of vision

Fluid overload ndash esp in between sessions

Fluid restrictionsndash more stringent with HD than PD

Hyperkalaemia ndash esp in between sessions

Loss of independence Problems with access

ndash poor quality blockage etc Infection (vascular access catheters) Pain with needles Bleeding

ndash from the fistula during or after dialysis Infections

ndash during sessions exit site infections blood-borne viruses eg Hepatitis HIV

Peritoneal Dialysis (PD)Uses natural membrane (peritoneum) for dialysisAccess is by PD catheter a soft plastic tube Catheter and dialysis fluid may be hidden under

clothingSuitability

ndash Excludes patients with prior peritoneal scarring eg peritonitis laparotomy

ndash Excludes patients unable to care for self

Addendum to Principles (PD)Fluid across the membrane faster than solutes

therefore longer dwell times are needed for solute transfer

Protein loss in PD fluid is significant ~ 8-9gdayProtein loss uarrs during peritonitisPD patients require adequate daily protein

averaging 12 ndash 15gkgdayOther substances lost in the dialysate

ndash Amino acids water soluble vitamins some medications and hormones

Calcium and dextrose are absorbed from the dialysate fluid into the circulation

Addendum to Principles (PD)Standard dialysis solution contains

bull Na+ ndash 132 mEqlbull Cl- ndash 96 -102 mEqlbull Ca2+ ndash 25 ndash 35 mEqlbull Mg2+ ndash 05 -15 mEql

Dialysis solution bufferndash Sodium lactatendash Pure HCo3

-

ndash HCo3- Lactate combinations

Lactate is absorbed and converted to HCo3- by

the liverDextrose solution strengths 15 25 425

Types

Continuous Ambulatory Peritoneal Dialysis (CAPD)

Automated peritoneal Dialysis (APD)

CAPDDialysis takes place 24hrs a day 7 days a weekPatient is not attached to a machine for treatmentExchanges are usually carried out by patient after

training by a CAPD nurseMost patients need 3-5 exchanges a day ie

ndash 4-6 hour intervals (Dwell time) 30 mins per exchangeMay use 2-3 litres of fluid in abdomenNo needles are usedLess dietary and fluid restriction

CAPD Exchange

APD

Uses a home based machine to perform exchangesOvernight treatment whilst patient sleepsThe APD machine controls the timing of

exchanges drains the used solution and fills the peritoneal cavity with new solution

Simple procedure for the patient to performRequires about 8-10 hrsMachines are portable with in-built safety features

and requires electricity to operate

PD Access

Done under LA or GA

DIETWhy is diet important

ndash Managing the diet can slow renal disease

ndash The need for dialysis can be delayed

ndash The diet affects how patients feel

CONTROLLING YOUR DIET

Foods to control are those containing Protein

Potassium

Sodium

Phosphorous

Fluid

PROTEINS

Animal protein Dairy (milk cheese)

Meat (steak pork) Poultry (chicken turkey) Eggs

Plant protein Vegetables Breads Cereals

MAJOR SOURCES OF POTASSIUM

MilkPotatoesBananasOrangesDried Fruit

LegumesNutsSalt substituteChocolate

SODIUMRegulates blood volume and pressure

Avoid salt

Use Alternate food seasonings lemon and limes spices seafood seasoning Italian seasoning vinegars peppers

FLUIDS

Healthy kidneys remove fluids as urine

Check for fluid and sodium retention

Need to restrict fluid intake

PHOSPHOROUS

Phosphorus is a mineral which combines with calcium to keep bones and teeth strong

Too little calcium and too much phosphorus

Need to control the phosphorus in the diet

Need to take a phosphate binder or a calcium supplement

VITAMINS

Folic acid

Iron supplements

Do not take OTCrsquos without consulting the doctor

MANAGING YOUR DIET

INDICATORS OF GOOD CONTROL

Weight loss or gain

Blood pressure

Swelling of hands and feet

Blood samples

LAB MONITORING

Haemoglobin Albumin Calcium Phosphorus GFR (24 hour urine)

Sodium Potassium Urea Creatinine

Lifestyle Changes with PD

Flexibilityndash Can be performed almost anywherendash Least impact on work school life (esp APD)

Travelndash Dialysis supplies can be delivered to most parts of the

world travel more flexible APD machines are portable will fit into a car boot can be carried by trainair

Responsibilityndash Requires more responsibility from patient but more

independence

Lifestyle Changes with PDSportsExercise

ndash Most are possiblendash Advice on swimming lifting contact sports

Sexual Activityndash May affect relations based on patient anxiety

Delivery amp Storage of Suppliesndash Home delivery and storagendash A monthrsquos supplies ndash 40 boxes space to storendash Specially recruited and trained delivery staff

Problems with TreatmentMonotomy of treatment

ndash The treatment never goes away against days off with HDBody Image Problems

ndash Esp with a permanent catheterndash Abdominal stretching

Fluid Overloadndash Much less a problem than with HD

Dehydrationndash Less common than fluid overload

Abdominal Discomfortndash Bloated feeling

Problems with TreatmentPoor drainage

ndash Common problem esp with new patientsndash Fibrin plugndash Catheter displacement

Leakagendash Fluid may leak around catheter exit site (May leak

into scrotum)ndash Stop PD temporarilyndash Resite catheter (use new one)

Infectionsndash Exit site infectionsndash Tunnel infectionndash peritonitis

Problems with Treatment

Herniandash Aggravation of pre-existing herniae (repair)ndash Evolution of new herniae

Declining effectiveness of the peritoneumndash eg repeated infectionndash Effect of glucose in the dialysis fluid

Comparison of Dialysis Treatment OptionsPD Unit HD Home HD

Home Dialysis radic times radicConvenient Sessions radic times radicSocializn with other CRF pats times radic timesHome EquipmentSupplies radic times radicSpecial dietfluid allowance radic radic radicSportsexercises participation Most Most Most

Full day activity -workschool radic Not alwys radicDirect assistndashpartnerfamily times times radicTravel radic Delivery of

supplies to most destins easy Some notice req

radic Prior arrangements must be made well in advance

times Prior arrangements must be made well in advance

• DIALYSIS
• CAUSES OF RENAL FAILURE
• 1Renal Failure Diagnosis
• 2 Treatment Options
• Dialysis
• Types
• Diffusion
• Ultrafiltration
• Selection for HDPD
• Slide 10
• Slide 11
• Haemodialysis
• Slide 13
• Requirements for HD
• Performing HD
• HD Unit
• Minimal Self-Care Dialysis
• Home Haemodialysis
• HD Access
• AV Fistula
• Slide 21
• Vascular Access Catheter
• AV Fistula Access
• Slide 24
• Effects of HD on Lifestyle
• Problems with HD
• Peritoneal Dialysis (PD)
• Addendum to Principles (PD)
• Slide 29
• Slide 30
• CAPD
• CAPD Exchange
• APD
• PD Access
• DIET
• CONTROLLING YOUR DIET
• PROTEINS
• MAJOR SOURCES OF POTASSIUM
• SODIUM
• FLUIDS
• PHOSPHOROUS
• VITAMINS
• MANAGING YOUR DIET
• LAB MONITORING
• Lifestyle Changes with PD
• Slide 46
• Problems with Treatment
• Slide 48
• Slide 49
• Comparison of Dialysis Treatment Options

Peritoneal Dialysis (PD)Uses natural membrane (peritoneum) for dialysisAccess is by PD catheter a soft plastic tube Catheter and dialysis fluid may be hidden under

clothingSuitability

ndash Excludes patients with prior peritoneal scarring eg peritonitis laparotomy

ndash Excludes patients unable to care for self

Addendum to Principles (PD)Fluid across the membrane faster than solutes

therefore longer dwell times are needed for solute transfer

Protein loss in PD fluid is significant ~ 8-9gdayProtein loss uarrs during peritonitisPD patients require adequate daily protein

averaging 12 ndash 15gkgdayOther substances lost in the dialysate

ndash Amino acids water soluble vitamins some medications and hormones

Calcium and dextrose are absorbed from the dialysate fluid into the circulation

Addendum to Principles (PD)Standard dialysis solution contains

bull Na+ ndash 132 mEqlbull Cl- ndash 96 -102 mEqlbull Ca2+ ndash 25 ndash 35 mEqlbull Mg2+ ndash 05 -15 mEql

Dialysis solution bufferndash Sodium lactatendash Pure HCo3

-

ndash HCo3- Lactate combinations

Lactate is absorbed and converted to HCo3- by

the liverDextrose solution strengths 15 25 425

Types

Continuous Ambulatory Peritoneal Dialysis (CAPD)

Automated peritoneal Dialysis (APD)

CAPDDialysis takes place 24hrs a day 7 days a weekPatient is not attached to a machine for treatmentExchanges are usually carried out by patient after

training by a CAPD nurseMost patients need 3-5 exchanges a day ie

ndash 4-6 hour intervals (Dwell time) 30 mins per exchangeMay use 2-3 litres of fluid in abdomenNo needles are usedLess dietary and fluid restriction

CAPD Exchange

APD

Uses a home based machine to perform exchangesOvernight treatment whilst patient sleepsThe APD machine controls the timing of

exchanges drains the used solution and fills the peritoneal cavity with new solution

Simple procedure for the patient to performRequires about 8-10 hrsMachines are portable with in-built safety features

and requires electricity to operate

PD Access

Done under LA or GA

DIETWhy is diet important

ndash Managing the diet can slow renal disease

ndash The need for dialysis can be delayed

ndash The diet affects how patients feel

CONTROLLING YOUR DIET

Foods to control are those containing Protein

Potassium

Sodium

Phosphorous

Fluid

PROTEINS

Animal protein Dairy (milk cheese)

Meat (steak pork) Poultry (chicken turkey) Eggs

Plant protein Vegetables Breads Cereals

MAJOR SOURCES OF POTASSIUM

MilkPotatoesBananasOrangesDried Fruit

LegumesNutsSalt substituteChocolate

SODIUMRegulates blood volume and pressure

Avoid salt

Use Alternate food seasonings lemon and limes spices seafood seasoning Italian seasoning vinegars peppers

FLUIDS

Healthy kidneys remove fluids as urine

Check for fluid and sodium retention

Need to restrict fluid intake

PHOSPHOROUS

Phosphorus is a mineral which combines with calcium to keep bones and teeth strong

Too little calcium and too much phosphorus

Need to control the phosphorus in the diet

Need to take a phosphate binder or a calcium supplement

VITAMINS

Folic acid

Iron supplements

Do not take OTCrsquos without consulting the doctor

MANAGING YOUR DIET

INDICATORS OF GOOD CONTROL

Weight loss or gain

Blood pressure

Swelling of hands and feet

Blood samples

LAB MONITORING

Haemoglobin Albumin Calcium Phosphorus GFR (24 hour urine)

Sodium Potassium Urea Creatinine

Lifestyle Changes with PD

Flexibilityndash Can be performed almost anywherendash Least impact on work school life (esp APD)

Travelndash Dialysis supplies can be delivered to most parts of the

world travel more flexible APD machines are portable will fit into a car boot can be carried by trainair

Responsibilityndash Requires more responsibility from patient but more

independence

Lifestyle Changes with PDSportsExercise

ndash Most are possiblendash Advice on swimming lifting contact sports

Sexual Activityndash May affect relations based on patient anxiety

Delivery amp Storage of Suppliesndash Home delivery and storagendash A monthrsquos supplies ndash 40 boxes space to storendash Specially recruited and trained delivery staff

Problems with TreatmentMonotomy of treatment

ndash The treatment never goes away against days off with HDBody Image Problems

ndash Esp with a permanent catheterndash Abdominal stretching

Fluid Overloadndash Much less a problem than with HD

Dehydrationndash Less common than fluid overload

Abdominal Discomfortndash Bloated feeling

Problems with TreatmentPoor drainage

ndash Common problem esp with new patientsndash Fibrin plugndash Catheter displacement

Leakagendash Fluid may leak around catheter exit site (May leak

into scrotum)ndash Stop PD temporarilyndash Resite catheter (use new one)

Infectionsndash Exit site infectionsndash Tunnel infectionndash peritonitis

Problems with Treatment

Herniandash Aggravation of pre-existing herniae (repair)ndash Evolution of new herniae

Declining effectiveness of the peritoneumndash eg repeated infectionndash Effect of glucose in the dialysis fluid

Comparison of Dialysis Treatment OptionsPD Unit HD Home HD

Home Dialysis radic times radicConvenient Sessions radic times radicSocializn with other CRF pats times radic timesHome EquipmentSupplies radic times radicSpecial dietfluid allowance radic radic radicSportsexercises participation Most Most Most

Full day activity -workschool radic Not alwys radicDirect assistndashpartnerfamily times times radicTravel radic Delivery of

supplies to most destins easy Some notice req

radic Prior arrangements must be made well in advance

times Prior arrangements must be made well in advance

• DIALYSIS
• CAUSES OF RENAL FAILURE
• 1Renal Failure Diagnosis
• 2 Treatment Options
• Dialysis
• Types
• Diffusion
• Ultrafiltration
• Selection for HDPD
• Slide 10
• Slide 11
• Haemodialysis
• Slide 13
• Requirements for HD
• Performing HD
• HD Unit
• Minimal Self-Care Dialysis
• Home Haemodialysis
• HD Access
• AV Fistula
• Slide 21
• Vascular Access Catheter
• AV Fistula Access
• Slide 24
• Effects of HD on Lifestyle
• Problems with HD
• Peritoneal Dialysis (PD)
• Addendum to Principles (PD)
• Slide 29
• Slide 30
• CAPD
• CAPD Exchange
• APD
• PD Access
• DIET
• CONTROLLING YOUR DIET
• PROTEINS
• MAJOR SOURCES OF POTASSIUM
• SODIUM
• FLUIDS
• PHOSPHOROUS
• VITAMINS
• MANAGING YOUR DIET
• LAB MONITORING
• Lifestyle Changes with PD
• Slide 46
• Problems with Treatment
• Slide 48
• Slide 49
• Comparison of Dialysis Treatment Options

Addendum to Principles (PD)Fluid across the membrane faster than solutes

therefore longer dwell times are needed for solute transfer

Protein loss in PD fluid is significant ~ 8-9gdayProtein loss uarrs during peritonitisPD patients require adequate daily protein

averaging 12 ndash 15gkgdayOther substances lost in the dialysate

ndash Amino acids water soluble vitamins some medications and hormones

Calcium and dextrose are absorbed from the dialysate fluid into the circulation

Addendum to Principles (PD)Standard dialysis solution contains

bull Na+ ndash 132 mEqlbull Cl- ndash 96 -102 mEqlbull Ca2+ ndash 25 ndash 35 mEqlbull Mg2+ ndash 05 -15 mEql

Dialysis solution bufferndash Sodium lactatendash Pure HCo3

-

ndash HCo3- Lactate combinations

Lactate is absorbed and converted to HCo3- by

the liverDextrose solution strengths 15 25 425

Types

Continuous Ambulatory Peritoneal Dialysis (CAPD)

Automated peritoneal Dialysis (APD)

CAPDDialysis takes place 24hrs a day 7 days a weekPatient is not attached to a machine for treatmentExchanges are usually carried out by patient after

training by a CAPD nurseMost patients need 3-5 exchanges a day ie

ndash 4-6 hour intervals (Dwell time) 30 mins per exchangeMay use 2-3 litres of fluid in abdomenNo needles are usedLess dietary and fluid restriction

CAPD Exchange

APD

Uses a home based machine to perform exchangesOvernight treatment whilst patient sleepsThe APD machine controls the timing of

exchanges drains the used solution and fills the peritoneal cavity with new solution

Simple procedure for the patient to performRequires about 8-10 hrsMachines are portable with in-built safety features

and requires electricity to operate

PD Access

Done under LA or GA

DIETWhy is diet important

ndash Managing the diet can slow renal disease

ndash The need for dialysis can be delayed

ndash The diet affects how patients feel

CONTROLLING YOUR DIET

Foods to control are those containing Protein

Potassium

Sodium

Phosphorous

Fluid

PROTEINS

Animal protein Dairy (milk cheese)

Meat (steak pork) Poultry (chicken turkey) Eggs

Plant protein Vegetables Breads Cereals

MAJOR SOURCES OF POTASSIUM

MilkPotatoesBananasOrangesDried Fruit

LegumesNutsSalt substituteChocolate

SODIUMRegulates blood volume and pressure

Avoid salt

Use Alternate food seasonings lemon and limes spices seafood seasoning Italian seasoning vinegars peppers

FLUIDS

Healthy kidneys remove fluids as urine

Check for fluid and sodium retention

Need to restrict fluid intake

PHOSPHOROUS

Phosphorus is a mineral which combines with calcium to keep bones and teeth strong

Too little calcium and too much phosphorus

Need to control the phosphorus in the diet

Need to take a phosphate binder or a calcium supplement

VITAMINS

Folic acid

Iron supplements

Do not take OTCrsquos without consulting the doctor

MANAGING YOUR DIET

INDICATORS OF GOOD CONTROL

Weight loss or gain

Blood pressure

Swelling of hands and feet

Blood samples

LAB MONITORING

Haemoglobin Albumin Calcium Phosphorus GFR (24 hour urine)

Sodium Potassium Urea Creatinine

Lifestyle Changes with PD

Flexibilityndash Can be performed almost anywherendash Least impact on work school life (esp APD)

Travelndash Dialysis supplies can be delivered to most parts of the

world travel more flexible APD machines are portable will fit into a car boot can be carried by trainair

Responsibilityndash Requires more responsibility from patient but more

independence

Lifestyle Changes with PDSportsExercise

ndash Most are possiblendash Advice on swimming lifting contact sports

Sexual Activityndash May affect relations based on patient anxiety

Delivery amp Storage of Suppliesndash Home delivery and storagendash A monthrsquos supplies ndash 40 boxes space to storendash Specially recruited and trained delivery staff

Problems with TreatmentMonotomy of treatment

ndash The treatment never goes away against days off with HDBody Image Problems

ndash Esp with a permanent catheterndash Abdominal stretching

Fluid Overloadndash Much less a problem than with HD

Dehydrationndash Less common than fluid overload

Abdominal Discomfortndash Bloated feeling

Problems with TreatmentPoor drainage

ndash Common problem esp with new patientsndash Fibrin plugndash Catheter displacement

Leakagendash Fluid may leak around catheter exit site (May leak

into scrotum)ndash Stop PD temporarilyndash Resite catheter (use new one)

Infectionsndash Exit site infectionsndash Tunnel infectionndash peritonitis

Problems with Treatment

Herniandash Aggravation of pre-existing herniae (repair)ndash Evolution of new herniae

Declining effectiveness of the peritoneumndash eg repeated infectionndash Effect of glucose in the dialysis fluid

Comparison of Dialysis Treatment OptionsPD Unit HD Home HD

Home Dialysis radic times radicConvenient Sessions radic times radicSocializn with other CRF pats times radic timesHome EquipmentSupplies radic times radicSpecial dietfluid allowance radic radic radicSportsexercises participation Most Most Most

Full day activity -workschool radic Not alwys radicDirect assistndashpartnerfamily times times radicTravel radic Delivery of

supplies to most destins easy Some notice req

radic Prior arrangements must be made well in advance

times Prior arrangements must be made well in advance

• DIALYSIS
• CAUSES OF RENAL FAILURE
• 1Renal Failure Diagnosis
• 2 Treatment Options
• Dialysis
• Types
• Diffusion
• Ultrafiltration
• Selection for HDPD
• Slide 10
• Slide 11
• Haemodialysis
• Slide 13
• Requirements for HD
• Performing HD
• HD Unit
• Minimal Self-Care Dialysis
• Home Haemodialysis
• HD Access
• AV Fistula
• Slide 21
• Vascular Access Catheter
• AV Fistula Access
• Slide 24
• Effects of HD on Lifestyle
• Problems with HD
• Peritoneal Dialysis (PD)
• Addendum to Principles (PD)
• Slide 29
• Slide 30
• CAPD
• CAPD Exchange
• APD
• PD Access
• DIET
• CONTROLLING YOUR DIET
• PROTEINS
• MAJOR SOURCES OF POTASSIUM
• SODIUM
• FLUIDS
• PHOSPHOROUS
• VITAMINS
• MANAGING YOUR DIET
• LAB MONITORING
• Lifestyle Changes with PD
• Slide 46
• Problems with Treatment
• Slide 48
• Slide 49
• Comparison of Dialysis Treatment Options

Addendum to Principles (PD)Standard dialysis solution contains

bull Na+ ndash 132 mEqlbull Cl- ndash 96 -102 mEqlbull Ca2+ ndash 25 ndash 35 mEqlbull Mg2+ ndash 05 -15 mEql

Dialysis solution bufferndash Sodium lactatendash Pure HCo3

-

ndash HCo3- Lactate combinations

Lactate is absorbed and converted to HCo3- by

the liverDextrose solution strengths 15 25 425

Types

Continuous Ambulatory Peritoneal Dialysis (CAPD)

Automated peritoneal Dialysis (APD)

CAPDDialysis takes place 24hrs a day 7 days a weekPatient is not attached to a machine for treatmentExchanges are usually carried out by patient after

training by a CAPD nurseMost patients need 3-5 exchanges a day ie

ndash 4-6 hour intervals (Dwell time) 30 mins per exchangeMay use 2-3 litres of fluid in abdomenNo needles are usedLess dietary and fluid restriction

CAPD Exchange

APD

Uses a home based machine to perform exchangesOvernight treatment whilst patient sleepsThe APD machine controls the timing of

exchanges drains the used solution and fills the peritoneal cavity with new solution

Simple procedure for the patient to performRequires about 8-10 hrsMachines are portable with in-built safety features

and requires electricity to operate

PD Access

Done under LA or GA

DIETWhy is diet important

ndash Managing the diet can slow renal disease

ndash The need for dialysis can be delayed

ndash The diet affects how patients feel

CONTROLLING YOUR DIET

Foods to control are those containing Protein

Potassium

Sodium

Phosphorous

Fluid

PROTEINS

Animal protein Dairy (milk cheese)

Meat (steak pork) Poultry (chicken turkey) Eggs

Plant protein Vegetables Breads Cereals

MAJOR SOURCES OF POTASSIUM

MilkPotatoesBananasOrangesDried Fruit

LegumesNutsSalt substituteChocolate

SODIUMRegulates blood volume and pressure

Avoid salt

Use Alternate food seasonings lemon and limes spices seafood seasoning Italian seasoning vinegars peppers

FLUIDS

Healthy kidneys remove fluids as urine

Check for fluid and sodium retention

Need to restrict fluid intake

PHOSPHOROUS

Phosphorus is a mineral which combines with calcium to keep bones and teeth strong

Too little calcium and too much phosphorus

Need to control the phosphorus in the diet

Need to take a phosphate binder or a calcium supplement

VITAMINS

Folic acid

Iron supplements

Do not take OTCrsquos without consulting the doctor

MANAGING YOUR DIET

INDICATORS OF GOOD CONTROL

Weight loss or gain

Blood pressure

Swelling of hands and feet

Blood samples

LAB MONITORING

Haemoglobin Albumin Calcium Phosphorus GFR (24 hour urine)

Sodium Potassium Urea Creatinine

Lifestyle Changes with PD

Flexibilityndash Can be performed almost anywherendash Least impact on work school life (esp APD)

Travelndash Dialysis supplies can be delivered to most parts of the

world travel more flexible APD machines are portable will fit into a car boot can be carried by trainair

Responsibilityndash Requires more responsibility from patient but more

independence

Lifestyle Changes with PDSportsExercise

ndash Most are possiblendash Advice on swimming lifting contact sports

Sexual Activityndash May affect relations based on patient anxiety

Delivery amp Storage of Suppliesndash Home delivery and storagendash A monthrsquos supplies ndash 40 boxes space to storendash Specially recruited and trained delivery staff

Problems with TreatmentMonotomy of treatment

ndash The treatment never goes away against days off with HDBody Image Problems

ndash Esp with a permanent catheterndash Abdominal stretching

Fluid Overloadndash Much less a problem than with HD

Dehydrationndash Less common than fluid overload

Abdominal Discomfortndash Bloated feeling

Problems with TreatmentPoor drainage

ndash Common problem esp with new patientsndash Fibrin plugndash Catheter displacement

Leakagendash Fluid may leak around catheter exit site (May leak

into scrotum)ndash Stop PD temporarilyndash Resite catheter (use new one)

Infectionsndash Exit site infectionsndash Tunnel infectionndash peritonitis

Problems with Treatment

Herniandash Aggravation of pre-existing herniae (repair)ndash Evolution of new herniae

Declining effectiveness of the peritoneumndash eg repeated infectionndash Effect of glucose in the dialysis fluid

Comparison of Dialysis Treatment OptionsPD Unit HD Home HD

Home Dialysis radic times radicConvenient Sessions radic times radicSocializn with other CRF pats times radic timesHome EquipmentSupplies radic times radicSpecial dietfluid allowance radic radic radicSportsexercises participation Most Most Most

Full day activity -workschool radic Not alwys radicDirect assistndashpartnerfamily times times radicTravel radic Delivery of

supplies to most destins easy Some notice req

radic Prior arrangements must be made well in advance

times Prior arrangements must be made well in advance

• DIALYSIS
• CAUSES OF RENAL FAILURE
• 1Renal Failure Diagnosis
• 2 Treatment Options
• Dialysis
• Types
• Diffusion
• Ultrafiltration
• Selection for HDPD
• Slide 10
• Slide 11
• Haemodialysis
• Slide 13
• Requirements for HD
• Performing HD
• HD Unit
• Minimal Self-Care Dialysis
• Home Haemodialysis
• HD Access
• AV Fistula
• Slide 21
• Vascular Access Catheter
• AV Fistula Access
• Slide 24
• Effects of HD on Lifestyle
• Problems with HD
• Peritoneal Dialysis (PD)
• Addendum to Principles (PD)
• Slide 29
• Slide 30
• CAPD
• CAPD Exchange
• APD
• PD Access
• DIET
• CONTROLLING YOUR DIET
• PROTEINS
• MAJOR SOURCES OF POTASSIUM
• SODIUM
• FLUIDS
• PHOSPHOROUS
• VITAMINS
• MANAGING YOUR DIET
• LAB MONITORING
• Lifestyle Changes with PD
• Slide 46
• Problems with Treatment
• Slide 48
• Slide 49
• Comparison of Dialysis Treatment Options

Types

Continuous Ambulatory Peritoneal Dialysis (CAPD)

Automated peritoneal Dialysis (APD)

CAPDDialysis takes place 24hrs a day 7 days a weekPatient is not attached to a machine for treatmentExchanges are usually carried out by patient after

training by a CAPD nurseMost patients need 3-5 exchanges a day ie

ndash 4-6 hour intervals (Dwell time) 30 mins per exchangeMay use 2-3 litres of fluid in abdomenNo needles are usedLess dietary and fluid restriction

CAPD Exchange

APD

Uses a home based machine to perform exchangesOvernight treatment whilst patient sleepsThe APD machine controls the timing of

exchanges drains the used solution and fills the peritoneal cavity with new solution

Simple procedure for the patient to performRequires about 8-10 hrsMachines are portable with in-built safety features

and requires electricity to operate

PD Access

Done under LA or GA

DIETWhy is diet important

ndash Managing the diet can slow renal disease

ndash The need for dialysis can be delayed

ndash The diet affects how patients feel

CONTROLLING YOUR DIET

Foods to control are those containing Protein

Potassium

Sodium

Phosphorous

Fluid

PROTEINS

Animal protein Dairy (milk cheese)

Meat (steak pork) Poultry (chicken turkey) Eggs

Plant protein Vegetables Breads Cereals

MAJOR SOURCES OF POTASSIUM

MilkPotatoesBananasOrangesDried Fruit

LegumesNutsSalt substituteChocolate

SODIUMRegulates blood volume and pressure

Avoid salt

Use Alternate food seasonings lemon and limes spices seafood seasoning Italian seasoning vinegars peppers

FLUIDS

Healthy kidneys remove fluids as urine

Check for fluid and sodium retention

Need to restrict fluid intake

PHOSPHOROUS

Phosphorus is a mineral which combines with calcium to keep bones and teeth strong

Too little calcium and too much phosphorus

Need to control the phosphorus in the diet

Need to take a phosphate binder or a calcium supplement

VITAMINS

Folic acid

Iron supplements

Do not take OTCrsquos without consulting the doctor

MANAGING YOUR DIET

INDICATORS OF GOOD CONTROL

Weight loss or gain

Blood pressure

Swelling of hands and feet

Blood samples

LAB MONITORING

Haemoglobin Albumin Calcium Phosphorus GFR (24 hour urine)

Sodium Potassium Urea Creatinine

Lifestyle Changes with PD

Flexibilityndash Can be performed almost anywherendash Least impact on work school life (esp APD)

Travelndash Dialysis supplies can be delivered to most parts of the

world travel more flexible APD machines are portable will fit into a car boot can be carried by trainair

Responsibilityndash Requires more responsibility from patient but more

independence

Lifestyle Changes with PDSportsExercise

ndash Most are possiblendash Advice on swimming lifting contact sports

Sexual Activityndash May affect relations based on patient anxiety

Delivery amp Storage of Suppliesndash Home delivery and storagendash A monthrsquos supplies ndash 40 boxes space to storendash Specially recruited and trained delivery staff

Problems with TreatmentMonotomy of treatment

ndash The treatment never goes away against days off with HDBody Image Problems

ndash Esp with a permanent catheterndash Abdominal stretching

Fluid Overloadndash Much less a problem than with HD

Dehydrationndash Less common than fluid overload

Abdominal Discomfortndash Bloated feeling

Problems with TreatmentPoor drainage

ndash Common problem esp with new patientsndash Fibrin plugndash Catheter displacement

Leakagendash Fluid may leak around catheter exit site (May leak

into scrotum)ndash Stop PD temporarilyndash Resite catheter (use new one)

Infectionsndash Exit site infectionsndash Tunnel infectionndash peritonitis

Problems with Treatment

Herniandash Aggravation of pre-existing herniae (repair)ndash Evolution of new herniae

Declining effectiveness of the peritoneumndash eg repeated infectionndash Effect of glucose in the dialysis fluid

Comparison of Dialysis Treatment OptionsPD Unit HD Home HD

Home Dialysis radic times radicConvenient Sessions radic times radicSocializn with other CRF pats times radic timesHome EquipmentSupplies radic times radicSpecial dietfluid allowance radic radic radicSportsexercises participation Most Most Most

Full day activity -workschool radic Not alwys radicDirect assistndashpartnerfamily times times radicTravel radic Delivery of

supplies to most destins easy Some notice req

radic Prior arrangements must be made well in advance

times Prior arrangements must be made well in advance

• DIALYSIS
• CAUSES OF RENAL FAILURE
• 1Renal Failure Diagnosis
• 2 Treatment Options
• Dialysis
• Types
• Diffusion
• Ultrafiltration
• Selection for HDPD
• Slide 10
• Slide 11
• Haemodialysis
• Slide 13
• Requirements for HD
• Performing HD
• HD Unit
• Minimal Self-Care Dialysis
• Home Haemodialysis
• HD Access
• AV Fistula
• Slide 21
• Vascular Access Catheter
• AV Fistula Access
• Slide 24
• Effects of HD on Lifestyle
• Problems with HD
• Peritoneal Dialysis (PD)
• Addendum to Principles (PD)
• Slide 29
• Slide 30
• CAPD
• CAPD Exchange
• APD
• PD Access
• DIET
• CONTROLLING YOUR DIET
• PROTEINS
• MAJOR SOURCES OF POTASSIUM
• SODIUM
• FLUIDS
• PHOSPHOROUS
• VITAMINS
• MANAGING YOUR DIET
• LAB MONITORING
• Lifestyle Changes with PD
• Slide 46
• Problems with Treatment
• Slide 48
• Slide 49
• Comparison of Dialysis Treatment Options

CAPDDialysis takes place 24hrs a day 7 days a weekPatient is not attached to a machine for treatmentExchanges are usually carried out by patient after

training by a CAPD nurseMost patients need 3-5 exchanges a day ie

ndash 4-6 hour intervals (Dwell time) 30 mins per exchangeMay use 2-3 litres of fluid in abdomenNo needles are usedLess dietary and fluid restriction

CAPD Exchange

APD

Uses a home based machine to perform exchangesOvernight treatment whilst patient sleepsThe APD machine controls the timing of

exchanges drains the used solution and fills the peritoneal cavity with new solution

Simple procedure for the patient to performRequires about 8-10 hrsMachines are portable with in-built safety features

and requires electricity to operate

PD Access

Done under LA or GA

DIETWhy is diet important

ndash Managing the diet can slow renal disease

ndash The need for dialysis can be delayed

ndash The diet affects how patients feel

CONTROLLING YOUR DIET

Foods to control are those containing Protein

Potassium

Sodium

Phosphorous

Fluid

PROTEINS

Animal protein Dairy (milk cheese)

Meat (steak pork) Poultry (chicken turkey) Eggs

Plant protein Vegetables Breads Cereals

MAJOR SOURCES OF POTASSIUM

MilkPotatoesBananasOrangesDried Fruit

LegumesNutsSalt substituteChocolate

SODIUMRegulates blood volume and pressure

Avoid salt

Use Alternate food seasonings lemon and limes spices seafood seasoning Italian seasoning vinegars peppers

FLUIDS

Healthy kidneys remove fluids as urine

Check for fluid and sodium retention

Need to restrict fluid intake

PHOSPHOROUS

Phosphorus is a mineral which combines with calcium to keep bones and teeth strong

Too little calcium and too much phosphorus

Need to control the phosphorus in the diet

Need to take a phosphate binder or a calcium supplement

VITAMINS

Folic acid

Iron supplements

Do not take OTCrsquos without consulting the doctor

MANAGING YOUR DIET

INDICATORS OF GOOD CONTROL

Weight loss or gain

Blood pressure

Swelling of hands and feet

Blood samples

LAB MONITORING

Haemoglobin Albumin Calcium Phosphorus GFR (24 hour urine)

Sodium Potassium Urea Creatinine

Lifestyle Changes with PD

Flexibilityndash Can be performed almost anywherendash Least impact on work school life (esp APD)

Travelndash Dialysis supplies can be delivered to most parts of the

world travel more flexible APD machines are portable will fit into a car boot can be carried by trainair

Responsibilityndash Requires more responsibility from patient but more

independence

Lifestyle Changes with PDSportsExercise

ndash Most are possiblendash Advice on swimming lifting contact sports

Sexual Activityndash May affect relations based on patient anxiety

Delivery amp Storage of Suppliesndash Home delivery and storagendash A monthrsquos supplies ndash 40 boxes space to storendash Specially recruited and trained delivery staff

Problems with TreatmentMonotomy of treatment

ndash The treatment never goes away against days off with HDBody Image Problems

ndash Esp with a permanent catheterndash Abdominal stretching

Fluid Overloadndash Much less a problem than with HD

Dehydrationndash Less common than fluid overload

Abdominal Discomfortndash Bloated feeling

Problems with TreatmentPoor drainage

ndash Common problem esp with new patientsndash Fibrin plugndash Catheter displacement

Leakagendash Fluid may leak around catheter exit site (May leak

into scrotum)ndash Stop PD temporarilyndash Resite catheter (use new one)

Infectionsndash Exit site infectionsndash Tunnel infectionndash peritonitis

Problems with Treatment

Herniandash Aggravation of pre-existing herniae (repair)ndash Evolution of new herniae

Declining effectiveness of the peritoneumndash eg repeated infectionndash Effect of glucose in the dialysis fluid

Comparison of Dialysis Treatment OptionsPD Unit HD Home HD

Home Dialysis radic times radicConvenient Sessions radic times radicSocializn with other CRF pats times radic timesHome EquipmentSupplies radic times radicSpecial dietfluid allowance radic radic radicSportsexercises participation Most Most Most

Full day activity -workschool radic Not alwys radicDirect assistndashpartnerfamily times times radicTravel radic Delivery of

supplies to most destins easy Some notice req

radic Prior arrangements must be made well in advance

times Prior arrangements must be made well in advance

• DIALYSIS
• CAUSES OF RENAL FAILURE
• 1Renal Failure Diagnosis
• 2 Treatment Options
• Dialysis
• Types
• Diffusion
• Ultrafiltration
• Selection for HDPD
• Slide 10
• Slide 11
• Haemodialysis
• Slide 13
• Requirements for HD
• Performing HD
• HD Unit
• Minimal Self-Care Dialysis
• Home Haemodialysis
• HD Access
• AV Fistula
• Slide 21
• Vascular Access Catheter
• AV Fistula Access
• Slide 24
• Effects of HD on Lifestyle
• Problems with HD
• Peritoneal Dialysis (PD)
• Addendum to Principles (PD)
• Slide 29
• Slide 30
• CAPD
• CAPD Exchange
• APD
• PD Access
• DIET
• CONTROLLING YOUR DIET
• PROTEINS
• MAJOR SOURCES OF POTASSIUM
• SODIUM
• FLUIDS
• PHOSPHOROUS
• VITAMINS
• MANAGING YOUR DIET
• LAB MONITORING
• Lifestyle Changes with PD
• Slide 46
• Problems with Treatment
• Slide 48
• Slide 49
• Comparison of Dialysis Treatment Options

CAPD Exchange

APD

Uses a home based machine to perform exchangesOvernight treatment whilst patient sleepsThe APD machine controls the timing of

exchanges drains the used solution and fills the peritoneal cavity with new solution

Simple procedure for the patient to performRequires about 8-10 hrsMachines are portable with in-built safety features

and requires electricity to operate

PD Access

Done under LA or GA

DIETWhy is diet important

ndash Managing the diet can slow renal disease

ndash The need for dialysis can be delayed

ndash The diet affects how patients feel

CONTROLLING YOUR DIET

Foods to control are those containing Protein

Potassium

Sodium

Phosphorous

Fluid

PROTEINS

Animal protein Dairy (milk cheese)

Meat (steak pork) Poultry (chicken turkey) Eggs

Plant protein Vegetables Breads Cereals

MAJOR SOURCES OF POTASSIUM

MilkPotatoesBananasOrangesDried Fruit

LegumesNutsSalt substituteChocolate

SODIUMRegulates blood volume and pressure

Avoid salt

Use Alternate food seasonings lemon and limes spices seafood seasoning Italian seasoning vinegars peppers

FLUIDS

Healthy kidneys remove fluids as urine

Check for fluid and sodium retention

Need to restrict fluid intake

PHOSPHOROUS

Phosphorus is a mineral which combines with calcium to keep bones and teeth strong

Too little calcium and too much phosphorus

Need to control the phosphorus in the diet

Need to take a phosphate binder or a calcium supplement

VITAMINS

Folic acid

Iron supplements

Do not take OTCrsquos without consulting the doctor

MANAGING YOUR DIET

INDICATORS OF GOOD CONTROL

Weight loss or gain

Blood pressure

Swelling of hands and feet

Blood samples

LAB MONITORING

Haemoglobin Albumin Calcium Phosphorus GFR (24 hour urine)

Sodium Potassium Urea Creatinine

Lifestyle Changes with PD

Flexibilityndash Can be performed almost anywherendash Least impact on work school life (esp APD)

Travelndash Dialysis supplies can be delivered to most parts of the

world travel more flexible APD machines are portable will fit into a car boot can be carried by trainair

Responsibilityndash Requires more responsibility from patient but more

independence

Lifestyle Changes with PDSportsExercise

ndash Most are possiblendash Advice on swimming lifting contact sports

Sexual Activityndash May affect relations based on patient anxiety

Delivery amp Storage of Suppliesndash Home delivery and storagendash A monthrsquos supplies ndash 40 boxes space to storendash Specially recruited and trained delivery staff

Problems with TreatmentMonotomy of treatment

ndash The treatment never goes away against days off with HDBody Image Problems

ndash Esp with a permanent catheterndash Abdominal stretching

Fluid Overloadndash Much less a problem than with HD

Dehydrationndash Less common than fluid overload

Abdominal Discomfortndash Bloated feeling

Problems with TreatmentPoor drainage

ndash Common problem esp with new patientsndash Fibrin plugndash Catheter displacement

Leakagendash Fluid may leak around catheter exit site (May leak

into scrotum)ndash Stop PD temporarilyndash Resite catheter (use new one)

Infectionsndash Exit site infectionsndash Tunnel infectionndash peritonitis

Problems with Treatment

Herniandash Aggravation of pre-existing herniae (repair)ndash Evolution of new herniae

Declining effectiveness of the peritoneumndash eg repeated infectionndash Effect of glucose in the dialysis fluid

Comparison of Dialysis Treatment OptionsPD Unit HD Home HD

Home Dialysis radic times radicConvenient Sessions radic times radicSocializn with other CRF pats times radic timesHome EquipmentSupplies radic times radicSpecial dietfluid allowance radic radic radicSportsexercises participation Most Most Most

Full day activity -workschool radic Not alwys radicDirect assistndashpartnerfamily times times radicTravel radic Delivery of

supplies to most destins easy Some notice req

radic Prior arrangements must be made well in advance

times Prior arrangements must be made well in advance

• DIALYSIS
• CAUSES OF RENAL FAILURE
• 1Renal Failure Diagnosis
• 2 Treatment Options
• Dialysis
• Types
• Diffusion
• Ultrafiltration
• Selection for HDPD
• Slide 10
• Slide 11
• Haemodialysis
• Slide 13
• Requirements for HD
• Performing HD
• HD Unit
• Minimal Self-Care Dialysis
• Home Haemodialysis
• HD Access
• AV Fistula
• Slide 21
• Vascular Access Catheter
• AV Fistula Access
• Slide 24
• Effects of HD on Lifestyle
• Problems with HD
• Peritoneal Dialysis (PD)
• Addendum to Principles (PD)
• Slide 29
• Slide 30
• CAPD
• CAPD Exchange
• APD
• PD Access
• DIET
• CONTROLLING YOUR DIET
• PROTEINS
• MAJOR SOURCES OF POTASSIUM
• SODIUM
• FLUIDS
• PHOSPHOROUS
• VITAMINS
• MANAGING YOUR DIET
• LAB MONITORING
• Lifestyle Changes with PD
• Slide 46
• Problems with Treatment
• Slide 48
• Slide 49
• Comparison of Dialysis Treatment Options

APD

Uses a home based machine to perform exchangesOvernight treatment whilst patient sleepsThe APD machine controls the timing of

exchanges drains the used solution and fills the peritoneal cavity with new solution

Simple procedure for the patient to performRequires about 8-10 hrsMachines are portable with in-built safety features

and requires electricity to operate

PD Access

Done under LA or GA

DIETWhy is diet important

ndash Managing the diet can slow renal disease

ndash The need for dialysis can be delayed

ndash The diet affects how patients feel

CONTROLLING YOUR DIET

Foods to control are those containing Protein

Potassium

Sodium

Phosphorous

Fluid

PROTEINS

Animal protein Dairy (milk cheese)

Meat (steak pork) Poultry (chicken turkey) Eggs

Plant protein Vegetables Breads Cereals

MAJOR SOURCES OF POTASSIUM

MilkPotatoesBananasOrangesDried Fruit

LegumesNutsSalt substituteChocolate

SODIUMRegulates blood volume and pressure

Avoid salt

Use Alternate food seasonings lemon and limes spices seafood seasoning Italian seasoning vinegars peppers

FLUIDS

Healthy kidneys remove fluids as urine

Check for fluid and sodium retention

Need to restrict fluid intake

PHOSPHOROUS

Phosphorus is a mineral which combines with calcium to keep bones and teeth strong

Too little calcium and too much phosphorus

Need to control the phosphorus in the diet

Need to take a phosphate binder or a calcium supplement

VITAMINS

Folic acid

Iron supplements

Do not take OTCrsquos without consulting the doctor

MANAGING YOUR DIET

INDICATORS OF GOOD CONTROL

Weight loss or gain

Blood pressure

Swelling of hands and feet

Blood samples

LAB MONITORING

Haemoglobin Albumin Calcium Phosphorus GFR (24 hour urine)

Sodium Potassium Urea Creatinine

Lifestyle Changes with PD

Flexibilityndash Can be performed almost anywherendash Least impact on work school life (esp APD)

Travelndash Dialysis supplies can be delivered to most parts of the

world travel more flexible APD machines are portable will fit into a car boot can be carried by trainair

Responsibilityndash Requires more responsibility from patient but more

independence

Lifestyle Changes with PDSportsExercise

ndash Most are possiblendash Advice on swimming lifting contact sports

Sexual Activityndash May affect relations based on patient anxiety

Delivery amp Storage of Suppliesndash Home delivery and storagendash A monthrsquos supplies ndash 40 boxes space to storendash Specially recruited and trained delivery staff

Problems with TreatmentMonotomy of treatment

ndash The treatment never goes away against days off with HDBody Image Problems

ndash Esp with a permanent catheterndash Abdominal stretching

Fluid Overloadndash Much less a problem than with HD

Dehydrationndash Less common than fluid overload

Abdominal Discomfortndash Bloated feeling

Problems with TreatmentPoor drainage

ndash Common problem esp with new patientsndash Fibrin plugndash Catheter displacement

Leakagendash Fluid may leak around catheter exit site (May leak

into scrotum)ndash Stop PD temporarilyndash Resite catheter (use new one)

Infectionsndash Exit site infectionsndash Tunnel infectionndash peritonitis

Problems with Treatment

Herniandash Aggravation of pre-existing herniae (repair)ndash Evolution of new herniae

Declining effectiveness of the peritoneumndash eg repeated infectionndash Effect of glucose in the dialysis fluid

Comparison of Dialysis Treatment OptionsPD Unit HD Home HD

Home Dialysis radic times radicConvenient Sessions radic times radicSocializn with other CRF pats times radic timesHome EquipmentSupplies radic times radicSpecial dietfluid allowance radic radic radicSportsexercises participation Most Most Most

Full day activity -workschool radic Not alwys radicDirect assistndashpartnerfamily times times radicTravel radic Delivery of

supplies to most destins easy Some notice req

radic Prior arrangements must be made well in advance

times Prior arrangements must be made well in advance

• DIALYSIS
• CAUSES OF RENAL FAILURE
• 1Renal Failure Diagnosis
• 2 Treatment Options
• Dialysis
• Types
• Diffusion
• Ultrafiltration
• Selection for HDPD
• Slide 10
• Slide 11
• Haemodialysis
• Slide 13
• Requirements for HD
• Performing HD
• HD Unit
• Minimal Self-Care Dialysis
• Home Haemodialysis
• HD Access
• AV Fistula
• Slide 21
• Vascular Access Catheter
• AV Fistula Access
• Slide 24
• Effects of HD on Lifestyle
• Problems with HD
• Peritoneal Dialysis (PD)
• Addendum to Principles (PD)
• Slide 29
• Slide 30
• CAPD
• CAPD Exchange
• APD
• PD Access
• DIET
• CONTROLLING YOUR DIET
• PROTEINS
• MAJOR SOURCES OF POTASSIUM
• SODIUM
• FLUIDS
• PHOSPHOROUS
• VITAMINS
• MANAGING YOUR DIET
• LAB MONITORING
• Lifestyle Changes with PD
• Slide 46
• Problems with Treatment
• Slide 48
• Slide 49
• Comparison of Dialysis Treatment Options

PD Access

Done under LA or GA

DIETWhy is diet important

ndash Managing the diet can slow renal disease

ndash The need for dialysis can be delayed

ndash The diet affects how patients feel

CONTROLLING YOUR DIET

Foods to control are those containing Protein

Potassium

Sodium

Phosphorous

Fluid

PROTEINS

Animal protein Dairy (milk cheese)

Meat (steak pork) Poultry (chicken turkey) Eggs

Plant protein Vegetables Breads Cereals

MAJOR SOURCES OF POTASSIUM

MilkPotatoesBananasOrangesDried Fruit

LegumesNutsSalt substituteChocolate

SODIUMRegulates blood volume and pressure

Avoid salt

Use Alternate food seasonings lemon and limes spices seafood seasoning Italian seasoning vinegars peppers

FLUIDS

Healthy kidneys remove fluids as urine

Check for fluid and sodium retention

Need to restrict fluid intake

PHOSPHOROUS

Phosphorus is a mineral which combines with calcium to keep bones and teeth strong

Too little calcium and too much phosphorus

Need to control the phosphorus in the diet

Need to take a phosphate binder or a calcium supplement

VITAMINS

Folic acid

Iron supplements

Do not take OTCrsquos without consulting the doctor

MANAGING YOUR DIET

INDICATORS OF GOOD CONTROL

Weight loss or gain

Blood pressure

Swelling of hands and feet

Blood samples

LAB MONITORING

Haemoglobin Albumin Calcium Phosphorus GFR (24 hour urine)

Sodium Potassium Urea Creatinine

Lifestyle Changes with PD

Flexibilityndash Can be performed almost anywherendash Least impact on work school life (esp APD)

Travelndash Dialysis supplies can be delivered to most parts of the

world travel more flexible APD machines are portable will fit into a car boot can be carried by trainair

Responsibilityndash Requires more responsibility from patient but more

independence

Lifestyle Changes with PDSportsExercise

ndash Most are possiblendash Advice on swimming lifting contact sports

Sexual Activityndash May affect relations based on patient anxiety

Delivery amp Storage of Suppliesndash Home delivery and storagendash A monthrsquos supplies ndash 40 boxes space to storendash Specially recruited and trained delivery staff

Problems with TreatmentMonotomy of treatment

ndash The treatment never goes away against days off with HDBody Image Problems

ndash Esp with a permanent catheterndash Abdominal stretching

Fluid Overloadndash Much less a problem than with HD

Dehydrationndash Less common than fluid overload

Abdominal Discomfortndash Bloated feeling

Problems with TreatmentPoor drainage

ndash Common problem esp with new patientsndash Fibrin plugndash Catheter displacement

Leakagendash Fluid may leak around catheter exit site (May leak

into scrotum)ndash Stop PD temporarilyndash Resite catheter (use new one)

Infectionsndash Exit site infectionsndash Tunnel infectionndash peritonitis

Problems with Treatment

Herniandash Aggravation of pre-existing herniae (repair)ndash Evolution of new herniae

Declining effectiveness of the peritoneumndash eg repeated infectionndash Effect of glucose in the dialysis fluid

Comparison of Dialysis Treatment OptionsPD Unit HD Home HD

Home Dialysis radic times radicConvenient Sessions radic times radicSocializn with other CRF pats times radic timesHome EquipmentSupplies radic times radicSpecial dietfluid allowance radic radic radicSportsexercises participation Most Most Most

Full day activity -workschool radic Not alwys radicDirect assistndashpartnerfamily times times radicTravel radic Delivery of

supplies to most destins easy Some notice req

radic Prior arrangements must be made well in advance

times Prior arrangements must be made well in advance

• DIALYSIS
• CAUSES OF RENAL FAILURE
• 1Renal Failure Diagnosis
• 2 Treatment Options
• Dialysis
• Types
• Diffusion
• Ultrafiltration
• Selection for HDPD
• Slide 10
• Slide 11
• Haemodialysis
• Slide 13
• Requirements for HD
• Performing HD
• HD Unit
• Minimal Self-Care Dialysis
• Home Haemodialysis
• HD Access
• AV Fistula
• Slide 21
• Vascular Access Catheter
• AV Fistula Access
• Slide 24
• Effects of HD on Lifestyle
• Problems with HD
• Peritoneal Dialysis (PD)
• Addendum to Principles (PD)
• Slide 29
• Slide 30
• CAPD
• CAPD Exchange
• APD
• PD Access
• DIET
• CONTROLLING YOUR DIET
• PROTEINS
• MAJOR SOURCES OF POTASSIUM
• SODIUM
• FLUIDS
• PHOSPHOROUS
• VITAMINS
• MANAGING YOUR DIET
• LAB MONITORING
• Lifestyle Changes with PD
• Slide 46
• Problems with Treatment
• Slide 48
• Slide 49
• Comparison of Dialysis Treatment Options

DIETWhy is diet important

ndash Managing the diet can slow renal disease

ndash The need for dialysis can be delayed

ndash The diet affects how patients feel

CONTROLLING YOUR DIET

Foods to control are those containing Protein

Potassium

Sodium

Phosphorous

Fluid

PROTEINS

Animal protein Dairy (milk cheese)

Meat (steak pork) Poultry (chicken turkey) Eggs

Plant protein Vegetables Breads Cereals

MAJOR SOURCES OF POTASSIUM

MilkPotatoesBananasOrangesDried Fruit

LegumesNutsSalt substituteChocolate

SODIUMRegulates blood volume and pressure

Avoid salt

Use Alternate food seasonings lemon and limes spices seafood seasoning Italian seasoning vinegars peppers

FLUIDS

Healthy kidneys remove fluids as urine

Check for fluid and sodium retention

Need to restrict fluid intake

PHOSPHOROUS

Phosphorus is a mineral which combines with calcium to keep bones and teeth strong

Too little calcium and too much phosphorus

Need to control the phosphorus in the diet

Need to take a phosphate binder or a calcium supplement

VITAMINS

Folic acid

Iron supplements

Do not take OTCrsquos without consulting the doctor

MANAGING YOUR DIET

INDICATORS OF GOOD CONTROL

Weight loss or gain

Blood pressure

Swelling of hands and feet

Blood samples

LAB MONITORING

Haemoglobin Albumin Calcium Phosphorus GFR (24 hour urine)

Sodium Potassium Urea Creatinine

Lifestyle Changes with PD

Flexibilityndash Can be performed almost anywherendash Least impact on work school life (esp APD)

Travelndash Dialysis supplies can be delivered to most parts of the

world travel more flexible APD machines are portable will fit into a car boot can be carried by trainair

Responsibilityndash Requires more responsibility from patient but more

independence

Lifestyle Changes with PDSportsExercise

ndash Most are possiblendash Advice on swimming lifting contact sports

Sexual Activityndash May affect relations based on patient anxiety

Delivery amp Storage of Suppliesndash Home delivery and storagendash A monthrsquos supplies ndash 40 boxes space to storendash Specially recruited and trained delivery staff

Problems with TreatmentMonotomy of treatment

ndash The treatment never goes away against days off with HDBody Image Problems

ndash Esp with a permanent catheterndash Abdominal stretching

Fluid Overloadndash Much less a problem than with HD

Dehydrationndash Less common than fluid overload

Abdominal Discomfortndash Bloated feeling

Problems with TreatmentPoor drainage

ndash Common problem esp with new patientsndash Fibrin plugndash Catheter displacement

Leakagendash Fluid may leak around catheter exit site (May leak

into scrotum)ndash Stop PD temporarilyndash Resite catheter (use new one)

Infectionsndash Exit site infectionsndash Tunnel infectionndash peritonitis

Problems with Treatment

Herniandash Aggravation of pre-existing herniae (repair)ndash Evolution of new herniae

Declining effectiveness of the peritoneumndash eg repeated infectionndash Effect of glucose in the dialysis fluid

Comparison of Dialysis Treatment OptionsPD Unit HD Home HD

Home Dialysis radic times radicConvenient Sessions radic times radicSocializn with other CRF pats times radic timesHome EquipmentSupplies radic times radicSpecial dietfluid allowance radic radic radicSportsexercises participation Most Most Most

Full day activity -workschool radic Not alwys radicDirect assistndashpartnerfamily times times radicTravel radic Delivery of

supplies to most destins easy Some notice req

radic Prior arrangements must be made well in advance

times Prior arrangements must be made well in advance

• DIALYSIS
• CAUSES OF RENAL FAILURE
• 1Renal Failure Diagnosis
• 2 Treatment Options
• Dialysis
• Types
• Diffusion
• Ultrafiltration
• Selection for HDPD
• Slide 10
• Slide 11
• Haemodialysis
• Slide 13
• Requirements for HD
• Performing HD
• HD Unit
• Minimal Self-Care Dialysis
• Home Haemodialysis
• HD Access
• AV Fistula
• Slide 21
• Vascular Access Catheter
• AV Fistula Access
• Slide 24
• Effects of HD on Lifestyle
• Problems with HD
• Peritoneal Dialysis (PD)
• Addendum to Principles (PD)
• Slide 29
• Slide 30
• CAPD
• CAPD Exchange
• APD
• PD Access
• DIET
• CONTROLLING YOUR DIET
• PROTEINS
• MAJOR SOURCES OF POTASSIUM
• SODIUM
• FLUIDS
• PHOSPHOROUS
• VITAMINS
• MANAGING YOUR DIET
• LAB MONITORING
• Lifestyle Changes with PD
• Slide 46
• Problems with Treatment
• Slide 48
• Slide 49
• Comparison of Dialysis Treatment Options

CONTROLLING YOUR DIET

Foods to control are those containing Protein

Potassium

Sodium

Phosphorous

Fluid

PROTEINS

Animal protein Dairy (milk cheese)

Meat (steak pork) Poultry (chicken turkey) Eggs

Plant protein Vegetables Breads Cereals

MAJOR SOURCES OF POTASSIUM

MilkPotatoesBananasOrangesDried Fruit

LegumesNutsSalt substituteChocolate

SODIUMRegulates blood volume and pressure

Avoid salt

Use Alternate food seasonings lemon and limes spices seafood seasoning Italian seasoning vinegars peppers

FLUIDS

Healthy kidneys remove fluids as urine

Check for fluid and sodium retention

Need to restrict fluid intake

PHOSPHOROUS

Phosphorus is a mineral which combines with calcium to keep bones and teeth strong

Too little calcium and too much phosphorus

Need to control the phosphorus in the diet

Need to take a phosphate binder or a calcium supplement

VITAMINS

Folic acid

Iron supplements

Do not take OTCrsquos without consulting the doctor

MANAGING YOUR DIET

INDICATORS OF GOOD CONTROL

Weight loss or gain

Blood pressure

Swelling of hands and feet

Blood samples

LAB MONITORING

Haemoglobin Albumin Calcium Phosphorus GFR (24 hour urine)

Sodium Potassium Urea Creatinine

Lifestyle Changes with PD

Flexibilityndash Can be performed almost anywherendash Least impact on work school life (esp APD)

Travelndash Dialysis supplies can be delivered to most parts of the

world travel more flexible APD machines are portable will fit into a car boot can be carried by trainair

Responsibilityndash Requires more responsibility from patient but more

independence

Lifestyle Changes with PDSportsExercise

ndash Most are possiblendash Advice on swimming lifting contact sports

Sexual Activityndash May affect relations based on patient anxiety

Delivery amp Storage of Suppliesndash Home delivery and storagendash A monthrsquos supplies ndash 40 boxes space to storendash Specially recruited and trained delivery staff

Problems with TreatmentMonotomy of treatment

ndash The treatment never goes away against days off with HDBody Image Problems

ndash Esp with a permanent catheterndash Abdominal stretching

Fluid Overloadndash Much less a problem than with HD

Dehydrationndash Less common than fluid overload

Abdominal Discomfortndash Bloated feeling

Problems with TreatmentPoor drainage

ndash Common problem esp with new patientsndash Fibrin plugndash Catheter displacement

Leakagendash Fluid may leak around catheter exit site (May leak

into scrotum)ndash Stop PD temporarilyndash Resite catheter (use new one)

Infectionsndash Exit site infectionsndash Tunnel infectionndash peritonitis

Problems with Treatment

Herniandash Aggravation of pre-existing herniae (repair)ndash Evolution of new herniae

Declining effectiveness of the peritoneumndash eg repeated infectionndash Effect of glucose in the dialysis fluid

Comparison of Dialysis Treatment OptionsPD Unit HD Home HD

Home Dialysis radic times radicConvenient Sessions radic times radicSocializn with other CRF pats times radic timesHome EquipmentSupplies radic times radicSpecial dietfluid allowance radic radic radicSportsexercises participation Most Most Most

Full day activity -workschool radic Not alwys radicDirect assistndashpartnerfamily times times radicTravel radic Delivery of

supplies to most destins easy Some notice req

radic Prior arrangements must be made well in advance

times Prior arrangements must be made well in advance

• DIALYSIS
• CAUSES OF RENAL FAILURE
• 1Renal Failure Diagnosis
• 2 Treatment Options
• Dialysis
• Types
• Diffusion
• Ultrafiltration
• Selection for HDPD
• Slide 10
• Slide 11
• Haemodialysis
• Slide 13
• Requirements for HD
• Performing HD
• HD Unit
• Minimal Self-Care Dialysis
• Home Haemodialysis
• HD Access
• AV Fistula
• Slide 21
• Vascular Access Catheter
• AV Fistula Access
• Slide 24
• Effects of HD on Lifestyle
• Problems with HD
• Peritoneal Dialysis (PD)
• Addendum to Principles (PD)
• Slide 29
• Slide 30
• CAPD
• CAPD Exchange
• APD
• PD Access
• DIET
• CONTROLLING YOUR DIET
• PROTEINS
• MAJOR SOURCES OF POTASSIUM
• SODIUM
• FLUIDS
• PHOSPHOROUS
• VITAMINS
• MANAGING YOUR DIET
• LAB MONITORING
• Lifestyle Changes with PD
• Slide 46
• Problems with Treatment
• Slide 48
• Slide 49
• Comparison of Dialysis Treatment Options

PROTEINS

Animal protein Dairy (milk cheese)

Meat (steak pork) Poultry (chicken turkey) Eggs

Plant protein Vegetables Breads Cereals

MAJOR SOURCES OF POTASSIUM

MilkPotatoesBananasOrangesDried Fruit

LegumesNutsSalt substituteChocolate

SODIUMRegulates blood volume and pressure

Avoid salt

Use Alternate food seasonings lemon and limes spices seafood seasoning Italian seasoning vinegars peppers

FLUIDS

Healthy kidneys remove fluids as urine

Check for fluid and sodium retention

Need to restrict fluid intake

PHOSPHOROUS

Phosphorus is a mineral which combines with calcium to keep bones and teeth strong

Too little calcium and too much phosphorus

Need to control the phosphorus in the diet

Need to take a phosphate binder or a calcium supplement

VITAMINS

Folic acid

Iron supplements

Do not take OTCrsquos without consulting the doctor

MANAGING YOUR DIET

INDICATORS OF GOOD CONTROL

Weight loss or gain

Blood pressure

Swelling of hands and feet

Blood samples

LAB MONITORING

Haemoglobin Albumin Calcium Phosphorus GFR (24 hour urine)

Sodium Potassium Urea Creatinine

Lifestyle Changes with PD

Flexibilityndash Can be performed almost anywherendash Least impact on work school life (esp APD)

Travelndash Dialysis supplies can be delivered to most parts of the

world travel more flexible APD machines are portable will fit into a car boot can be carried by trainair

Responsibilityndash Requires more responsibility from patient but more

independence

Lifestyle Changes with PDSportsExercise

ndash Most are possiblendash Advice on swimming lifting contact sports

Sexual Activityndash May affect relations based on patient anxiety

Delivery amp Storage of Suppliesndash Home delivery and storagendash A monthrsquos supplies ndash 40 boxes space to storendash Specially recruited and trained delivery staff

Problems with TreatmentMonotomy of treatment

ndash The treatment never goes away against days off with HDBody Image Problems

ndash Esp with a permanent catheterndash Abdominal stretching

Fluid Overloadndash Much less a problem than with HD

Dehydrationndash Less common than fluid overload

Abdominal Discomfortndash Bloated feeling

Problems with TreatmentPoor drainage

ndash Common problem esp with new patientsndash Fibrin plugndash Catheter displacement

Leakagendash Fluid may leak around catheter exit site (May leak

into scrotum)ndash Stop PD temporarilyndash Resite catheter (use new one)

Infectionsndash Exit site infectionsndash Tunnel infectionndash peritonitis

Problems with Treatment

Herniandash Aggravation of pre-existing herniae (repair)ndash Evolution of new herniae

Declining effectiveness of the peritoneumndash eg repeated infectionndash Effect of glucose in the dialysis fluid

Comparison of Dialysis Treatment OptionsPD Unit HD Home HD

Home Dialysis radic times radicConvenient Sessions radic times radicSocializn with other CRF pats times radic timesHome EquipmentSupplies radic times radicSpecial dietfluid allowance radic radic radicSportsexercises participation Most Most Most

Full day activity -workschool radic Not alwys radicDirect assistndashpartnerfamily times times radicTravel radic Delivery of

supplies to most destins easy Some notice req

radic Prior arrangements must be made well in advance

times Prior arrangements must be made well in advance

• DIALYSIS
• CAUSES OF RENAL FAILURE
• 1Renal Failure Diagnosis
• 2 Treatment Options
• Dialysis
• Types
• Diffusion
• Ultrafiltration
• Selection for HDPD
• Slide 10
• Slide 11
• Haemodialysis
• Slide 13
• Requirements for HD
• Performing HD
• HD Unit
• Minimal Self-Care Dialysis
• Home Haemodialysis
• HD Access
• AV Fistula
• Slide 21
• Vascular Access Catheter
• AV Fistula Access
• Slide 24
• Effects of HD on Lifestyle
• Problems with HD
• Peritoneal Dialysis (PD)
• Addendum to Principles (PD)
• Slide 29
• Slide 30
• CAPD
• CAPD Exchange
• APD
• PD Access
• DIET
• CONTROLLING YOUR DIET
• PROTEINS
• MAJOR SOURCES OF POTASSIUM
• SODIUM
• FLUIDS
• PHOSPHOROUS
• VITAMINS
• MANAGING YOUR DIET
• LAB MONITORING
• Lifestyle Changes with PD
• Slide 46
• Problems with Treatment
• Slide 48
• Slide 49
• Comparison of Dialysis Treatment Options

MAJOR SOURCES OF POTASSIUM

MilkPotatoesBananasOrangesDried Fruit

LegumesNutsSalt substituteChocolate

SODIUMRegulates blood volume and pressure

Avoid salt

Use Alternate food seasonings lemon and limes spices seafood seasoning Italian seasoning vinegars peppers

FLUIDS

Healthy kidneys remove fluids as urine

Check for fluid and sodium retention

Need to restrict fluid intake

PHOSPHOROUS

Phosphorus is a mineral which combines with calcium to keep bones and teeth strong

Too little calcium and too much phosphorus

Need to control the phosphorus in the diet

Need to take a phosphate binder or a calcium supplement

VITAMINS

Folic acid

Iron supplements

Do not take OTCrsquos without consulting the doctor

MANAGING YOUR DIET

INDICATORS OF GOOD CONTROL

Weight loss or gain

Blood pressure

Swelling of hands and feet

Blood samples

LAB MONITORING

Haemoglobin Albumin Calcium Phosphorus GFR (24 hour urine)

Sodium Potassium Urea Creatinine

Lifestyle Changes with PD

Flexibilityndash Can be performed almost anywherendash Least impact on work school life (esp APD)

Travelndash Dialysis supplies can be delivered to most parts of the

world travel more flexible APD machines are portable will fit into a car boot can be carried by trainair

Responsibilityndash Requires more responsibility from patient but more

independence

Lifestyle Changes with PDSportsExercise

ndash Most are possiblendash Advice on swimming lifting contact sports

Sexual Activityndash May affect relations based on patient anxiety

Delivery amp Storage of Suppliesndash Home delivery and storagendash A monthrsquos supplies ndash 40 boxes space to storendash Specially recruited and trained delivery staff

Problems with TreatmentMonotomy of treatment

ndash The treatment never goes away against days off with HDBody Image Problems

ndash Esp with a permanent catheterndash Abdominal stretching

Fluid Overloadndash Much less a problem than with HD

Dehydrationndash Less common than fluid overload

Abdominal Discomfortndash Bloated feeling

Problems with TreatmentPoor drainage

ndash Common problem esp with new patientsndash Fibrin plugndash Catheter displacement

Leakagendash Fluid may leak around catheter exit site (May leak

into scrotum)ndash Stop PD temporarilyndash Resite catheter (use new one)

Infectionsndash Exit site infectionsndash Tunnel infectionndash peritonitis

Problems with Treatment

Herniandash Aggravation of pre-existing herniae (repair)ndash Evolution of new herniae

Declining effectiveness of the peritoneumndash eg repeated infectionndash Effect of glucose in the dialysis fluid

Comparison of Dialysis Treatment OptionsPD Unit HD Home HD

Home Dialysis radic times radicConvenient Sessions radic times radicSocializn with other CRF pats times radic timesHome EquipmentSupplies radic times radicSpecial dietfluid allowance radic radic radicSportsexercises participation Most Most Most

Full day activity -workschool radic Not alwys radicDirect assistndashpartnerfamily times times radicTravel radic Delivery of

supplies to most destins easy Some notice req

radic Prior arrangements must be made well in advance

times Prior arrangements must be made well in advance

• DIALYSIS
• CAUSES OF RENAL FAILURE
• 1Renal Failure Diagnosis
• 2 Treatment Options
• Dialysis
• Types
• Diffusion
• Ultrafiltration
• Selection for HDPD
• Slide 10
• Slide 11
• Haemodialysis
• Slide 13
• Requirements for HD
• Performing HD
• HD Unit
• Minimal Self-Care Dialysis
• Home Haemodialysis
• HD Access
• AV Fistula
• Slide 21
• Vascular Access Catheter
• AV Fistula Access
• Slide 24
• Effects of HD on Lifestyle
• Problems with HD
• Peritoneal Dialysis (PD)
• Addendum to Principles (PD)
• Slide 29
• Slide 30
• CAPD
• CAPD Exchange
• APD
• PD Access
• DIET
• CONTROLLING YOUR DIET
• PROTEINS
• MAJOR SOURCES OF POTASSIUM
• SODIUM
• FLUIDS
• PHOSPHOROUS
• VITAMINS
• MANAGING YOUR DIET
• LAB MONITORING
• Lifestyle Changes with PD
• Slide 46
• Problems with Treatment
• Slide 48
• Slide 49
• Comparison of Dialysis Treatment Options

SODIUMRegulates blood volume and pressure

Avoid salt

Use Alternate food seasonings lemon and limes spices seafood seasoning Italian seasoning vinegars peppers

FLUIDS

Healthy kidneys remove fluids as urine

Check for fluid and sodium retention

Need to restrict fluid intake

PHOSPHOROUS

Phosphorus is a mineral which combines with calcium to keep bones and teeth strong

Too little calcium and too much phosphorus

Need to control the phosphorus in the diet

Need to take a phosphate binder or a calcium supplement

VITAMINS

Folic acid

Iron supplements

Do not take OTCrsquos without consulting the doctor

MANAGING YOUR DIET

INDICATORS OF GOOD CONTROL

Weight loss or gain

Blood pressure

Swelling of hands and feet

Blood samples

LAB MONITORING

Haemoglobin Albumin Calcium Phosphorus GFR (24 hour urine)

Sodium Potassium Urea Creatinine

Lifestyle Changes with PD

Flexibilityndash Can be performed almost anywherendash Least impact on work school life (esp APD)

Travelndash Dialysis supplies can be delivered to most parts of the

world travel more flexible APD machines are portable will fit into a car boot can be carried by trainair

Responsibilityndash Requires more responsibility from patient but more

independence

Lifestyle Changes with PDSportsExercise

ndash Most are possiblendash Advice on swimming lifting contact sports

Sexual Activityndash May affect relations based on patient anxiety

Delivery amp Storage of Suppliesndash Home delivery and storagendash A monthrsquos supplies ndash 40 boxes space to storendash Specially recruited and trained delivery staff

Problems with TreatmentMonotomy of treatment

ndash The treatment never goes away against days off with HDBody Image Problems

ndash Esp with a permanent catheterndash Abdominal stretching

Fluid Overloadndash Much less a problem than with HD

Dehydrationndash Less common than fluid overload

Abdominal Discomfortndash Bloated feeling

Problems with TreatmentPoor drainage

ndash Common problem esp with new patientsndash Fibrin plugndash Catheter displacement

Leakagendash Fluid may leak around catheter exit site (May leak

into scrotum)ndash Stop PD temporarilyndash Resite catheter (use new one)

Infectionsndash Exit site infectionsndash Tunnel infectionndash peritonitis

Problems with Treatment

Herniandash Aggravation of pre-existing herniae (repair)ndash Evolution of new herniae

Declining effectiveness of the peritoneumndash eg repeated infectionndash Effect of glucose in the dialysis fluid

Comparison of Dialysis Treatment OptionsPD Unit HD Home HD

Home Dialysis radic times radicConvenient Sessions radic times radicSocializn with other CRF pats times radic timesHome EquipmentSupplies radic times radicSpecial dietfluid allowance radic radic radicSportsexercises participation Most Most Most

Full day activity -workschool radic Not alwys radicDirect assistndashpartnerfamily times times radicTravel radic Delivery of

supplies to most destins easy Some notice req

radic Prior arrangements must be made well in advance

times Prior arrangements must be made well in advance

• DIALYSIS
• CAUSES OF RENAL FAILURE
• 1Renal Failure Diagnosis
• 2 Treatment Options
• Dialysis
• Types
• Diffusion
• Ultrafiltration
• Selection for HDPD
• Slide 10
• Slide 11
• Haemodialysis
• Slide 13
• Requirements for HD
• Performing HD
• HD Unit
• Minimal Self-Care Dialysis
• Home Haemodialysis
• HD Access
• AV Fistula
• Slide 21
• Vascular Access Catheter
• AV Fistula Access
• Slide 24
• Effects of HD on Lifestyle
• Problems with HD
• Peritoneal Dialysis (PD)
• Addendum to Principles (PD)
• Slide 29
• Slide 30
• CAPD
• CAPD Exchange
• APD
• PD Access
• DIET
• CONTROLLING YOUR DIET
• PROTEINS
• MAJOR SOURCES OF POTASSIUM
• SODIUM
• FLUIDS
• PHOSPHOROUS
• VITAMINS
• MANAGING YOUR DIET
• LAB MONITORING
• Lifestyle Changes with PD
• Slide 46
• Problems with Treatment
• Slide 48
• Slide 49
• Comparison of Dialysis Treatment Options

FLUIDS

Healthy kidneys remove fluids as urine

Check for fluid and sodium retention

Need to restrict fluid intake

PHOSPHOROUS

Phosphorus is a mineral which combines with calcium to keep bones and teeth strong

Too little calcium and too much phosphorus

Need to control the phosphorus in the diet

Need to take a phosphate binder or a calcium supplement

VITAMINS

Folic acid

Iron supplements

Do not take OTCrsquos without consulting the doctor

MANAGING YOUR DIET

INDICATORS OF GOOD CONTROL

Weight loss or gain

Blood pressure

Swelling of hands and feet

Blood samples

LAB MONITORING

Haemoglobin Albumin Calcium Phosphorus GFR (24 hour urine)

Sodium Potassium Urea Creatinine

Lifestyle Changes with PD

Flexibilityndash Can be performed almost anywherendash Least impact on work school life (esp APD)

Travelndash Dialysis supplies can be delivered to most parts of the

world travel more flexible APD machines are portable will fit into a car boot can be carried by trainair

Responsibilityndash Requires more responsibility from patient but more

independence

Lifestyle Changes with PDSportsExercise

ndash Most are possiblendash Advice on swimming lifting contact sports

Sexual Activityndash May affect relations based on patient anxiety

Delivery amp Storage of Suppliesndash Home delivery and storagendash A monthrsquos supplies ndash 40 boxes space to storendash Specially recruited and trained delivery staff

Problems with TreatmentMonotomy of treatment

ndash The treatment never goes away against days off with HDBody Image Problems

ndash Esp with a permanent catheterndash Abdominal stretching

Fluid Overloadndash Much less a problem than with HD

Dehydrationndash Less common than fluid overload

Abdominal Discomfortndash Bloated feeling

Problems with TreatmentPoor drainage

ndash Common problem esp with new patientsndash Fibrin plugndash Catheter displacement

Leakagendash Fluid may leak around catheter exit site (May leak

into scrotum)ndash Stop PD temporarilyndash Resite catheter (use new one)

Infectionsndash Exit site infectionsndash Tunnel infectionndash peritonitis

Problems with Treatment

Herniandash Aggravation of pre-existing herniae (repair)ndash Evolution of new herniae

Declining effectiveness of the peritoneumndash eg repeated infectionndash Effect of glucose in the dialysis fluid

Comparison of Dialysis Treatment OptionsPD Unit HD Home HD

Home Dialysis radic times radicConvenient Sessions radic times radicSocializn with other CRF pats times radic timesHome EquipmentSupplies radic times radicSpecial dietfluid allowance radic radic radicSportsexercises participation Most Most Most

Full day activity -workschool radic Not alwys radicDirect assistndashpartnerfamily times times radicTravel radic Delivery of

supplies to most destins easy Some notice req

radic Prior arrangements must be made well in advance

times Prior arrangements must be made well in advance

• DIALYSIS
• CAUSES OF RENAL FAILURE
• 1Renal Failure Diagnosis
• 2 Treatment Options
• Dialysis
• Types
• Diffusion
• Ultrafiltration
• Selection for HDPD
• Slide 10
• Slide 11
• Haemodialysis
• Slide 13
• Requirements for HD
• Performing HD
• HD Unit
• Minimal Self-Care Dialysis
• Home Haemodialysis
• HD Access
• AV Fistula
• Slide 21
• Vascular Access Catheter
• AV Fistula Access
• Slide 24
• Effects of HD on Lifestyle
• Problems with HD
• Peritoneal Dialysis (PD)
• Addendum to Principles (PD)
• Slide 29
• Slide 30
• CAPD
• CAPD Exchange
• APD
• PD Access
• DIET
• CONTROLLING YOUR DIET
• PROTEINS
• MAJOR SOURCES OF POTASSIUM
• SODIUM
• FLUIDS
• PHOSPHOROUS
• VITAMINS
• MANAGING YOUR DIET
• LAB MONITORING
• Lifestyle Changes with PD
• Slide 46
• Problems with Treatment
• Slide 48
• Slide 49
• Comparison of Dialysis Treatment Options

PHOSPHOROUS

Phosphorus is a mineral which combines with calcium to keep bones and teeth strong

Too little calcium and too much phosphorus

Need to control the phosphorus in the diet

Need to take a phosphate binder or a calcium supplement

VITAMINS

Folic acid

Iron supplements

Do not take OTCrsquos without consulting the doctor

MANAGING YOUR DIET

INDICATORS OF GOOD CONTROL

Weight loss or gain

Blood pressure

Swelling of hands and feet

Blood samples

LAB MONITORING

Haemoglobin Albumin Calcium Phosphorus GFR (24 hour urine)

Sodium Potassium Urea Creatinine

Lifestyle Changes with PD

Flexibilityndash Can be performed almost anywherendash Least impact on work school life (esp APD)

Travelndash Dialysis supplies can be delivered to most parts of the

world travel more flexible APD machines are portable will fit into a car boot can be carried by trainair

Responsibilityndash Requires more responsibility from patient but more

independence

Lifestyle Changes with PDSportsExercise

ndash Most are possiblendash Advice on swimming lifting contact sports

Sexual Activityndash May affect relations based on patient anxiety

Delivery amp Storage of Suppliesndash Home delivery and storagendash A monthrsquos supplies ndash 40 boxes space to storendash Specially recruited and trained delivery staff

Problems with TreatmentMonotomy of treatment

ndash The treatment never goes away against days off with HDBody Image Problems

ndash Esp with a permanent catheterndash Abdominal stretching

Fluid Overloadndash Much less a problem than with HD

Dehydrationndash Less common than fluid overload

Abdominal Discomfortndash Bloated feeling

Problems with TreatmentPoor drainage

ndash Common problem esp with new patientsndash Fibrin plugndash Catheter displacement

Leakagendash Fluid may leak around catheter exit site (May leak

into scrotum)ndash Stop PD temporarilyndash Resite catheter (use new one)

Infectionsndash Exit site infectionsndash Tunnel infectionndash peritonitis

Problems with Treatment

Herniandash Aggravation of pre-existing herniae (repair)ndash Evolution of new herniae

Declining effectiveness of the peritoneumndash eg repeated infectionndash Effect of glucose in the dialysis fluid

Comparison of Dialysis Treatment OptionsPD Unit HD Home HD

Home Dialysis radic times radicConvenient Sessions radic times radicSocializn with other CRF pats times radic timesHome EquipmentSupplies radic times radicSpecial dietfluid allowance radic radic radicSportsexercises participation Most Most Most

Full day activity -workschool radic Not alwys radicDirect assistndashpartnerfamily times times radicTravel radic Delivery of

supplies to most destins easy Some notice req

radic Prior arrangements must be made well in advance

times Prior arrangements must be made well in advance

• DIALYSIS
• CAUSES OF RENAL FAILURE
• 1Renal Failure Diagnosis
• 2 Treatment Options
• Dialysis
• Types
• Diffusion
• Ultrafiltration
• Selection for HDPD
• Slide 10
• Slide 11
• Haemodialysis
• Slide 13
• Requirements for HD
• Performing HD
• HD Unit
• Minimal Self-Care Dialysis
• Home Haemodialysis
• HD Access
• AV Fistula
• Slide 21
• Vascular Access Catheter
• AV Fistula Access
• Slide 24
• Effects of HD on Lifestyle
• Problems with HD
• Peritoneal Dialysis (PD)
• Addendum to Principles (PD)
• Slide 29
• Slide 30
• CAPD
• CAPD Exchange
• APD
• PD Access
• DIET
• CONTROLLING YOUR DIET
• PROTEINS
• MAJOR SOURCES OF POTASSIUM
• SODIUM
• FLUIDS
• PHOSPHOROUS
• VITAMINS
• MANAGING YOUR DIET
• LAB MONITORING
• Lifestyle Changes with PD
• Slide 46
• Problems with Treatment
• Slide 48
• Slide 49
• Comparison of Dialysis Treatment Options

VITAMINS

Folic acid

Iron supplements

Do not take OTCrsquos without consulting the doctor

MANAGING YOUR DIET

INDICATORS OF GOOD CONTROL

Weight loss or gain

Blood pressure

Swelling of hands and feet

Blood samples

LAB MONITORING

Haemoglobin Albumin Calcium Phosphorus GFR (24 hour urine)

Sodium Potassium Urea Creatinine

Lifestyle Changes with PD

Flexibilityndash Can be performed almost anywherendash Least impact on work school life (esp APD)

Travelndash Dialysis supplies can be delivered to most parts of the

world travel more flexible APD machines are portable will fit into a car boot can be carried by trainair

Responsibilityndash Requires more responsibility from patient but more

independence

Lifestyle Changes with PDSportsExercise

ndash Most are possiblendash Advice on swimming lifting contact sports

Sexual Activityndash May affect relations based on patient anxiety

Delivery amp Storage of Suppliesndash Home delivery and storagendash A monthrsquos supplies ndash 40 boxes space to storendash Specially recruited and trained delivery staff

Problems with TreatmentMonotomy of treatment

ndash The treatment never goes away against days off with HDBody Image Problems

ndash Esp with a permanent catheterndash Abdominal stretching

Fluid Overloadndash Much less a problem than with HD

Dehydrationndash Less common than fluid overload

Abdominal Discomfortndash Bloated feeling

Problems with TreatmentPoor drainage

ndash Common problem esp with new patientsndash Fibrin plugndash Catheter displacement

Leakagendash Fluid may leak around catheter exit site (May leak

into scrotum)ndash Stop PD temporarilyndash Resite catheter (use new one)

Infectionsndash Exit site infectionsndash Tunnel infectionndash peritonitis

Problems with Treatment

Herniandash Aggravation of pre-existing herniae (repair)ndash Evolution of new herniae

Declining effectiveness of the peritoneumndash eg repeated infectionndash Effect of glucose in the dialysis fluid

Comparison of Dialysis Treatment OptionsPD Unit HD Home HD

Home Dialysis radic times radicConvenient Sessions radic times radicSocializn with other CRF pats times radic timesHome EquipmentSupplies radic times radicSpecial dietfluid allowance radic radic radicSportsexercises participation Most Most Most

Full day activity -workschool radic Not alwys radicDirect assistndashpartnerfamily times times radicTravel radic Delivery of

supplies to most destins easy Some notice req

radic Prior arrangements must be made well in advance

times Prior arrangements must be made well in advance

• DIALYSIS
• CAUSES OF RENAL FAILURE
• 1Renal Failure Diagnosis
• 2 Treatment Options
• Dialysis
• Types
• Diffusion
• Ultrafiltration
• Selection for HDPD
• Slide 10
• Slide 11
• Haemodialysis
• Slide 13
• Requirements for HD
• Performing HD
• HD Unit
• Minimal Self-Care Dialysis
• Home Haemodialysis
• HD Access
• AV Fistula
• Slide 21
• Vascular Access Catheter
• AV Fistula Access
• Slide 24
• Effects of HD on Lifestyle
• Problems with HD
• Peritoneal Dialysis (PD)
• Addendum to Principles (PD)
• Slide 29
• Slide 30
• CAPD
• CAPD Exchange
• APD
• PD Access
• DIET
• CONTROLLING YOUR DIET
• PROTEINS
• MAJOR SOURCES OF POTASSIUM
• SODIUM
• FLUIDS
• PHOSPHOROUS
• VITAMINS
• MANAGING YOUR DIET
• LAB MONITORING
• Lifestyle Changes with PD
• Slide 46
• Problems with Treatment
• Slide 48
• Slide 49
• Comparison of Dialysis Treatment Options

MANAGING YOUR DIET

INDICATORS OF GOOD CONTROL

Weight loss or gain

Blood pressure

Swelling of hands and feet

Blood samples

LAB MONITORING

Haemoglobin Albumin Calcium Phosphorus GFR (24 hour urine)

Sodium Potassium Urea Creatinine

Lifestyle Changes with PD

Flexibilityndash Can be performed almost anywherendash Least impact on work school life (esp APD)

Travelndash Dialysis supplies can be delivered to most parts of the

world travel more flexible APD machines are portable will fit into a car boot can be carried by trainair

Responsibilityndash Requires more responsibility from patient but more

independence

Lifestyle Changes with PDSportsExercise

ndash Most are possiblendash Advice on swimming lifting contact sports

Sexual Activityndash May affect relations based on patient anxiety

Delivery amp Storage of Suppliesndash Home delivery and storagendash A monthrsquos supplies ndash 40 boxes space to storendash Specially recruited and trained delivery staff

Problems with TreatmentMonotomy of treatment

ndash The treatment never goes away against days off with HDBody Image Problems

ndash Esp with a permanent catheterndash Abdominal stretching

Fluid Overloadndash Much less a problem than with HD

Dehydrationndash Less common than fluid overload

Abdominal Discomfortndash Bloated feeling

Problems with TreatmentPoor drainage

ndash Common problem esp with new patientsndash Fibrin plugndash Catheter displacement

Leakagendash Fluid may leak around catheter exit site (May leak

into scrotum)ndash Stop PD temporarilyndash Resite catheter (use new one)

Infectionsndash Exit site infectionsndash Tunnel infectionndash peritonitis

Problems with Treatment

Herniandash Aggravation of pre-existing herniae (repair)ndash Evolution of new herniae

Declining effectiveness of the peritoneumndash eg repeated infectionndash Effect of glucose in the dialysis fluid

Comparison of Dialysis Treatment OptionsPD Unit HD Home HD

Home Dialysis radic times radicConvenient Sessions radic times radicSocializn with other CRF pats times radic timesHome EquipmentSupplies radic times radicSpecial dietfluid allowance radic radic radicSportsexercises participation Most Most Most

Full day activity -workschool radic Not alwys radicDirect assistndashpartnerfamily times times radicTravel radic Delivery of

supplies to most destins easy Some notice req

radic Prior arrangements must be made well in advance

times Prior arrangements must be made well in advance

• DIALYSIS
• CAUSES OF RENAL FAILURE
• 1Renal Failure Diagnosis
• 2 Treatment Options
• Dialysis
• Types
• Diffusion
• Ultrafiltration
• Selection for HDPD
• Slide 10
• Slide 11
• Haemodialysis
• Slide 13
• Requirements for HD
• Performing HD
• HD Unit
• Minimal Self-Care Dialysis
• Home Haemodialysis
• HD Access
• AV Fistula
• Slide 21
• Vascular Access Catheter
• AV Fistula Access
• Slide 24
• Effects of HD on Lifestyle
• Problems with HD
• Peritoneal Dialysis (PD)
• Addendum to Principles (PD)
• Slide 29
• Slide 30
• CAPD
• CAPD Exchange
• APD
• PD Access
• DIET
• CONTROLLING YOUR DIET
• PROTEINS
• MAJOR SOURCES OF POTASSIUM
• SODIUM
• FLUIDS
• PHOSPHOROUS
• VITAMINS
• MANAGING YOUR DIET
• LAB MONITORING
• Lifestyle Changes with PD
• Slide 46
• Problems with Treatment
• Slide 48
• Slide 49
• Comparison of Dialysis Treatment Options

LAB MONITORING

Haemoglobin Albumin Calcium Phosphorus GFR (24 hour urine)

Sodium Potassium Urea Creatinine

Lifestyle Changes with PD

Flexibilityndash Can be performed almost anywherendash Least impact on work school life (esp APD)

Travelndash Dialysis supplies can be delivered to most parts of the

world travel more flexible APD machines are portable will fit into a car boot can be carried by trainair

Responsibilityndash Requires more responsibility from patient but more

independence

Lifestyle Changes with PDSportsExercise

ndash Most are possiblendash Advice on swimming lifting contact sports

Sexual Activityndash May affect relations based on patient anxiety

Delivery amp Storage of Suppliesndash Home delivery and storagendash A monthrsquos supplies ndash 40 boxes space to storendash Specially recruited and trained delivery staff

Problems with TreatmentMonotomy of treatment

ndash The treatment never goes away against days off with HDBody Image Problems

ndash Esp with a permanent catheterndash Abdominal stretching

Fluid Overloadndash Much less a problem than with HD

Dehydrationndash Less common than fluid overload

Abdominal Discomfortndash Bloated feeling

Problems with TreatmentPoor drainage

ndash Common problem esp with new patientsndash Fibrin plugndash Catheter displacement

Leakagendash Fluid may leak around catheter exit site (May leak

into scrotum)ndash Stop PD temporarilyndash Resite catheter (use new one)

Infectionsndash Exit site infectionsndash Tunnel infectionndash peritonitis

Problems with Treatment

Herniandash Aggravation of pre-existing herniae (repair)ndash Evolution of new herniae

Declining effectiveness of the peritoneumndash eg repeated infectionndash Effect of glucose in the dialysis fluid

Comparison of Dialysis Treatment OptionsPD Unit HD Home HD

Home Dialysis radic times radicConvenient Sessions radic times radicSocializn with other CRF pats times radic timesHome EquipmentSupplies radic times radicSpecial dietfluid allowance radic radic radicSportsexercises participation Most Most Most

Full day activity -workschool radic Not alwys radicDirect assistndashpartnerfamily times times radicTravel radic Delivery of

supplies to most destins easy Some notice req

radic Prior arrangements must be made well in advance

times Prior arrangements must be made well in advance

• DIALYSIS
• CAUSES OF RENAL FAILURE
• 1Renal Failure Diagnosis
• 2 Treatment Options
• Dialysis
• Types
• Diffusion
• Ultrafiltration
• Selection for HDPD
• Slide 10
• Slide 11
• Haemodialysis
• Slide 13
• Requirements for HD
• Performing HD
• HD Unit
• Minimal Self-Care Dialysis
• Home Haemodialysis
• HD Access
• AV Fistula
• Slide 21
• Vascular Access Catheter
• AV Fistula Access
• Slide 24
• Effects of HD on Lifestyle
• Problems with HD
• Peritoneal Dialysis (PD)
• Addendum to Principles (PD)
• Slide 29
• Slide 30
• CAPD
• CAPD Exchange
• APD
• PD Access
• DIET
• CONTROLLING YOUR DIET
• PROTEINS
• MAJOR SOURCES OF POTASSIUM
• SODIUM
• FLUIDS
• PHOSPHOROUS
• VITAMINS
• MANAGING YOUR DIET
• LAB MONITORING
• Lifestyle Changes with PD
• Slide 46
• Problems with Treatment
• Slide 48
• Slide 49
• Comparison of Dialysis Treatment Options

Lifestyle Changes with PD

Flexibilityndash Can be performed almost anywherendash Least impact on work school life (esp APD)

Travelndash Dialysis supplies can be delivered to most parts of the

world travel more flexible APD machines are portable will fit into a car boot can be carried by trainair

Responsibilityndash Requires more responsibility from patient but more

independence

Lifestyle Changes with PDSportsExercise

ndash Most are possiblendash Advice on swimming lifting contact sports

Sexual Activityndash May affect relations based on patient anxiety

Delivery amp Storage of Suppliesndash Home delivery and storagendash A monthrsquos supplies ndash 40 boxes space to storendash Specially recruited and trained delivery staff

Problems with TreatmentMonotomy of treatment

ndash The treatment never goes away against days off with HDBody Image Problems

ndash Esp with a permanent catheterndash Abdominal stretching

Fluid Overloadndash Much less a problem than with HD

Dehydrationndash Less common than fluid overload

Abdominal Discomfortndash Bloated feeling

Problems with TreatmentPoor drainage

ndash Common problem esp with new patientsndash Fibrin plugndash Catheter displacement

Leakagendash Fluid may leak around catheter exit site (May leak

into scrotum)ndash Stop PD temporarilyndash Resite catheter (use new one)

Infectionsndash Exit site infectionsndash Tunnel infectionndash peritonitis

Problems with Treatment

Herniandash Aggravation of pre-existing herniae (repair)ndash Evolution of new herniae

Declining effectiveness of the peritoneumndash eg repeated infectionndash Effect of glucose in the dialysis fluid

Comparison of Dialysis Treatment OptionsPD Unit HD Home HD

Home Dialysis radic times radicConvenient Sessions radic times radicSocializn with other CRF pats times radic timesHome EquipmentSupplies radic times radicSpecial dietfluid allowance radic radic radicSportsexercises participation Most Most Most

Full day activity -workschool radic Not alwys radicDirect assistndashpartnerfamily times times radicTravel radic Delivery of

supplies to most destins easy Some notice req

radic Prior arrangements must be made well in advance

times Prior arrangements must be made well in advance

• DIALYSIS
• CAUSES OF RENAL FAILURE
• 1Renal Failure Diagnosis
• 2 Treatment Options
• Dialysis
• Types
• Diffusion
• Ultrafiltration
• Selection for HDPD
• Slide 10
• Slide 11
• Haemodialysis
• Slide 13
• Requirements for HD
• Performing HD
• HD Unit
• Minimal Self-Care Dialysis
• Home Haemodialysis
• HD Access
• AV Fistula
• Slide 21
• Vascular Access Catheter
• AV Fistula Access
• Slide 24
• Effects of HD on Lifestyle
• Problems with HD
• Peritoneal Dialysis (PD)
• Addendum to Principles (PD)
• Slide 29
• Slide 30
• CAPD
• CAPD Exchange
• APD
• PD Access
• DIET
• CONTROLLING YOUR DIET
• PROTEINS
• MAJOR SOURCES OF POTASSIUM
• SODIUM
• FLUIDS
• PHOSPHOROUS
• VITAMINS
• MANAGING YOUR DIET
• LAB MONITORING
• Lifestyle Changes with PD
• Slide 46
• Problems with Treatment
• Slide 48
• Slide 49
• Comparison of Dialysis Treatment Options

Lifestyle Changes with PDSportsExercise

ndash Most are possiblendash Advice on swimming lifting contact sports

Sexual Activityndash May affect relations based on patient anxiety

Delivery amp Storage of Suppliesndash Home delivery and storagendash A monthrsquos supplies ndash 40 boxes space to storendash Specially recruited and trained delivery staff

Problems with TreatmentMonotomy of treatment

ndash The treatment never goes away against days off with HDBody Image Problems

ndash Esp with a permanent catheterndash Abdominal stretching

Fluid Overloadndash Much less a problem than with HD

Dehydrationndash Less common than fluid overload

Abdominal Discomfortndash Bloated feeling

Problems with TreatmentPoor drainage

ndash Common problem esp with new patientsndash Fibrin plugndash Catheter displacement

Leakagendash Fluid may leak around catheter exit site (May leak

into scrotum)ndash Stop PD temporarilyndash Resite catheter (use new one)

Infectionsndash Exit site infectionsndash Tunnel infectionndash peritonitis

Problems with Treatment

Herniandash Aggravation of pre-existing herniae (repair)ndash Evolution of new herniae

Declining effectiveness of the peritoneumndash eg repeated infectionndash Effect of glucose in the dialysis fluid

Comparison of Dialysis Treatment OptionsPD Unit HD Home HD

Home Dialysis radic times radicConvenient Sessions radic times radicSocializn with other CRF pats times radic timesHome EquipmentSupplies radic times radicSpecial dietfluid allowance radic radic radicSportsexercises participation Most Most Most

Full day activity -workschool radic Not alwys radicDirect assistndashpartnerfamily times times radicTravel radic Delivery of

supplies to most destins easy Some notice req

radic Prior arrangements must be made well in advance

times Prior arrangements must be made well in advance

• DIALYSIS
• CAUSES OF RENAL FAILURE
• 1Renal Failure Diagnosis
• 2 Treatment Options
• Dialysis
• Types
• Diffusion
• Ultrafiltration
• Selection for HDPD
• Slide 10
• Slide 11
• Haemodialysis
• Slide 13
• Requirements for HD
• Performing HD
• HD Unit
• Minimal Self-Care Dialysis
• Home Haemodialysis
• HD Access
• AV Fistula
• Slide 21
• Vascular Access Catheter
• AV Fistula Access
• Slide 24
• Effects of HD on Lifestyle
• Problems with HD
• Peritoneal Dialysis (PD)
• Addendum to Principles (PD)
• Slide 29
• Slide 30
• CAPD
• CAPD Exchange
• APD
• PD Access
• DIET
• CONTROLLING YOUR DIET
• PROTEINS
• MAJOR SOURCES OF POTASSIUM
• SODIUM
• FLUIDS
• PHOSPHOROUS
• VITAMINS
• MANAGING YOUR DIET
• LAB MONITORING
• Lifestyle Changes with PD
• Slide 46
• Problems with Treatment
• Slide 48
• Slide 49
• Comparison of Dialysis Treatment Options

Problems with TreatmentMonotomy of treatment

ndash The treatment never goes away against days off with HDBody Image Problems

ndash Esp with a permanent catheterndash Abdominal stretching

Fluid Overloadndash Much less a problem than with HD

Dehydrationndash Less common than fluid overload

Abdominal Discomfortndash Bloated feeling

Problems with TreatmentPoor drainage

ndash Common problem esp with new patientsndash Fibrin plugndash Catheter displacement

Leakagendash Fluid may leak around catheter exit site (May leak

into scrotum)ndash Stop PD temporarilyndash Resite catheter (use new one)

Infectionsndash Exit site infectionsndash Tunnel infectionndash peritonitis

Problems with Treatment

Herniandash Aggravation of pre-existing herniae (repair)ndash Evolution of new herniae

Declining effectiveness of the peritoneumndash eg repeated infectionndash Effect of glucose in the dialysis fluid

Comparison of Dialysis Treatment OptionsPD Unit HD Home HD

Home Dialysis radic times radicConvenient Sessions radic times radicSocializn with other CRF pats times radic timesHome EquipmentSupplies radic times radicSpecial dietfluid allowance radic radic radicSportsexercises participation Most Most Most

Full day activity -workschool radic Not alwys radicDirect assistndashpartnerfamily times times radicTravel radic Delivery of

supplies to most destins easy Some notice req

radic Prior arrangements must be made well in advance

times Prior arrangements must be made well in advance

• DIALYSIS
• CAUSES OF RENAL FAILURE
• 1Renal Failure Diagnosis
• 2 Treatment Options
• Dialysis
• Types
• Diffusion
• Ultrafiltration
• Selection for HDPD
• Slide 10
• Slide 11
• Haemodialysis
• Slide 13
• Requirements for HD
• Performing HD
• HD Unit
• Minimal Self-Care Dialysis
• Home Haemodialysis
• HD Access
• AV Fistula
• Slide 21
• Vascular Access Catheter
• AV Fistula Access
• Slide 24
• Effects of HD on Lifestyle
• Problems with HD
• Peritoneal Dialysis (PD)
• Addendum to Principles (PD)
• Slide 29
• Slide 30
• CAPD
• CAPD Exchange
• APD
• PD Access
• DIET
• CONTROLLING YOUR DIET
• PROTEINS
• MAJOR SOURCES OF POTASSIUM
• SODIUM
• FLUIDS
• PHOSPHOROUS
• VITAMINS
• MANAGING YOUR DIET
• LAB MONITORING
• Lifestyle Changes with PD
• Slide 46
• Problems with Treatment
• Slide 48
• Slide 49
• Comparison of Dialysis Treatment Options

Problems with TreatmentPoor drainage

ndash Common problem esp with new patientsndash Fibrin plugndash Catheter displacement

Leakagendash Fluid may leak around catheter exit site (May leak

into scrotum)ndash Stop PD temporarilyndash Resite catheter (use new one)

Infectionsndash Exit site infectionsndash Tunnel infectionndash peritonitis

Problems with Treatment

Herniandash Aggravation of pre-existing herniae (repair)ndash Evolution of new herniae

Declining effectiveness of the peritoneumndash eg repeated infectionndash Effect of glucose in the dialysis fluid

Comparison of Dialysis Treatment OptionsPD Unit HD Home HD

Home Dialysis radic times radicConvenient Sessions radic times radicSocializn with other CRF pats times radic timesHome EquipmentSupplies radic times radicSpecial dietfluid allowance radic radic radicSportsexercises participation Most Most Most

Full day activity -workschool radic Not alwys radicDirect assistndashpartnerfamily times times radicTravel radic Delivery of

supplies to most destins easy Some notice req

radic Prior arrangements must be made well in advance

times Prior arrangements must be made well in advance

• DIALYSIS
• CAUSES OF RENAL FAILURE
• 1Renal Failure Diagnosis
• 2 Treatment Options
• Dialysis
• Types
• Diffusion
• Ultrafiltration
• Selection for HDPD
• Slide 10
• Slide 11
• Haemodialysis
• Slide 13
• Requirements for HD
• Performing HD
• HD Unit
• Minimal Self-Care Dialysis
• Home Haemodialysis
• HD Access
• AV Fistula
• Slide 21
• Vascular Access Catheter
• AV Fistula Access
• Slide 24
• Effects of HD on Lifestyle
• Problems with HD
• Peritoneal Dialysis (PD)
• Addendum to Principles (PD)
• Slide 29
• Slide 30
• CAPD
• CAPD Exchange
• APD
• PD Access
• DIET
• CONTROLLING YOUR DIET
• PROTEINS
• MAJOR SOURCES OF POTASSIUM
• SODIUM
• FLUIDS
• PHOSPHOROUS
• VITAMINS
• MANAGING YOUR DIET
• LAB MONITORING
• Lifestyle Changes with PD
• Slide 46
• Problems with Treatment
• Slide 48
• Slide 49
• Comparison of Dialysis Treatment Options

Problems with Treatment

Herniandash Aggravation of pre-existing herniae (repair)ndash Evolution of new herniae

Declining effectiveness of the peritoneumndash eg repeated infectionndash Effect of glucose in the dialysis fluid

Comparison of Dialysis Treatment OptionsPD Unit HD Home HD

Home Dialysis radic times radicConvenient Sessions radic times radicSocializn with other CRF pats times radic timesHome EquipmentSupplies radic times radicSpecial dietfluid allowance radic radic radicSportsexercises participation Most Most Most

Full day activity -workschool radic Not alwys radicDirect assistndashpartnerfamily times times radicTravel radic Delivery of

supplies to most destins easy Some notice req

radic Prior arrangements must be made well in advance

times Prior arrangements must be made well in advance

• DIALYSIS
• CAUSES OF RENAL FAILURE
• 1Renal Failure Diagnosis
• 2 Treatment Options
• Dialysis
• Types
• Diffusion
• Ultrafiltration
• Selection for HDPD
• Slide 10
• Slide 11
• Haemodialysis
• Slide 13
• Requirements for HD
• Performing HD
• HD Unit
• Minimal Self-Care Dialysis
• Home Haemodialysis
• HD Access
• AV Fistula
• Slide 21
• Vascular Access Catheter
• AV Fistula Access
• Slide 24
• Effects of HD on Lifestyle
• Problems with HD
• Peritoneal Dialysis (PD)
• Addendum to Principles (PD)
• Slide 29
• Slide 30
• CAPD
• CAPD Exchange
• APD
• PD Access
• DIET
• CONTROLLING YOUR DIET
• PROTEINS
• MAJOR SOURCES OF POTASSIUM
• SODIUM
• FLUIDS
• PHOSPHOROUS
• VITAMINS
• MANAGING YOUR DIET
• LAB MONITORING
• Lifestyle Changes with PD
• Slide 46
• Problems with Treatment
• Slide 48
• Slide 49
• Comparison of Dialysis Treatment Options

Comparison of Dialysis Treatment OptionsPD Unit HD Home HD

Home Dialysis radic times radicConvenient Sessions radic times radicSocializn with other CRF pats times radic timesHome EquipmentSupplies radic times radicSpecial dietfluid allowance radic radic radicSportsexercises participation Most Most Most

Full day activity -workschool radic Not alwys radicDirect assistndashpartnerfamily times times radicTravel radic Delivery of

supplies to most destins easy Some notice req

radic Prior arrangements must be made well in advance

times Prior arrangements must be made well in advance

• DIALYSIS
• CAUSES OF RENAL FAILURE
• 1Renal Failure Diagnosis
• 2 Treatment Options
• Dialysis
• Types
• Diffusion
• Ultrafiltration
• Selection for HDPD
• Slide 10
• Slide 11
• Haemodialysis
• Slide 13
• Requirements for HD
• Performing HD
• HD Unit
• Minimal Self-Care Dialysis
• Home Haemodialysis
• HD Access
• AV Fistula
• Slide 21
• Vascular Access Catheter
• AV Fistula Access
• Slide 24
• Effects of HD on Lifestyle
• Problems with HD
• Peritoneal Dialysis (PD)
• Addendum to Principles (PD)
• Slide 29
• Slide 30
• CAPD
• CAPD Exchange
• APD
• PD Access
• DIET
• CONTROLLING YOUR DIET
• PROTEINS
• MAJOR SOURCES OF POTASSIUM
• SODIUM
• FLUIDS
• PHOSPHOROUS
• VITAMINS
• MANAGING YOUR DIET
• LAB MONITORING
• Lifestyle Changes with PD
• Slide 46
• Problems with Treatment
• Slide 48
• Slide 49
• Comparison of Dialysis Treatment Options