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CKD 4
Definition of CKD
Duration
GFR
Kidney damage
Abnormality in urine
USG renal biopsy
Transplant
Stages of CKD
KDIGO 2012: CGA
Stages of CKD
Excretory
Regulatory
Endocrine
Metabolic
Hemodialysis
Peritoneal dialysis
2. Transplant
3. Supportive care, only
Availability
Money
Kidney
Wish of the
patient
Why ???
Vascular access
1. Temporary
2. Permanent
AV fistula
AV graft
Central venous catheters (jugular,
femoral, subclavian)
Simple (non cuffed)
Tunnelled (cuffed/permcath)
Principles of Dialysis
Diffusion
Ultrafiltration
Maintenance HD
Three times/week, life long
4 hours/each session
With adequate blood flow
Complications of HD
Hypotension
Cramps
Nausea vomiting
Chest pain
Allergic manifestations
Infection, fever
Dialysis disequilibrium syndrome,
DDS
Peritoneal dialysis
Different types of PD
Intermittent peritoneal dialysis (IPD)
Continuous ambulatory peritoneal dialysis
(CAPD)
Nocturnal intermittent peritoneal dialysis
(NIPD)
Continuous cyclic peritoneal dialysis (CCPD)
Automated peritoneal dialysis (APD)
Complications of PD
Infection:
Peritonitis
Tunnel
Exit site
Hernia
Backache
Hydrothorax
Hyperglycemia
Hypertriglyceridemia/dyslipidemia
Chronic encapsulating peritonitis
Ultrafiltration failure
Compare HD vs PD
Cost
Accessibility
Finding slots
Vascular access
Freedom of mobility
Hemodynamic instability
Freedom to drink water, diet, protein
Problem of anemia
Issues of peritonitis
Preservation of residual renal function
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