Nephrology

What is Dialysis?

Dialysis is a medical procedure used to filter waste and excess fluids from the blood when the kidneys can no longer perform this function adequately. It is of two types:

It is of two types:

• Hemodialysis
• Peritoneal dialysis

What is Hemodialysis?

With hemodialysis, a machine removes blood from your body, filters it through a dialyzer (artificial kidney) and returns the cleaned blood to your body. This 3- to 5-hour process may take place in a hospital or a dialysis center three times a week.

Hemodialysis catheter insertion and maintenance

Hemodialysis is a treatment used when your kidneys fail (Stage 5 Kidney Disease) and can no longer clean your blood and remove extra fluid from your body. A hemodialysis access or vascular access is a way to reach your blood for hemodialysis.

If you receive hemodialysis, your access is one of the following:

• An AV fistula made by joining an artery and vein in your arm
• An AV graft made by using a soft tube to join an artery and vein in your arm
• A catheter, a soft tube that is placed in a large vein, usually in your neck
• The National Kidney Foundation (NKF) recommends the AV (arteriovenous) fistula as the preferred choice for a permanent vascular access. The AV graft is the next preferred choice for a permanent access. The catheter is recommended for temporary access. There may be conditions that prevent you from having a fistula or graft and a catheter may be used.

What is a hemodialysis catheter?

The catheter used for hemodialysis is a tunneled catheter because it is placed under the skin. There are two types of tunneled catheters: cuffed or non-cuffed. Non-cuffed tunneled catheters are used for emergencies and for short periods (up to 3 weeks). Tunneled cuffed catheters, a type recommended by the NKF for temporary access, can be used for longer than 3 weeks when:

• An AV fistula or graft has been placed but is not yet ready for use.
• There are no other options for permanent access. For example, when a patient’s blood vessels are not strong enough for a fistula or graft.
• Catheters have two openings inside; one is a red (arterial) opening to draw blood from your vein and out of your body into the dialysis pathway and the other is a blue (venous) opening that allows cleaned blood to return to your body.

Kidney Transplant

A kidney transplant is a surgical procedure where a healthy kidney from a donor is implanted into a person with kidney failure. It's a treatment option for people whose kidneys have failed permanently (end-stage renal disease). The transplanted kidney can come from a living donor, often a family member or friend, or from a deceased donor. After a successful transplant, the new kidney can perform the functions of the failed kidneys, allowing the recipient to live a more normal life without the need for dialysis.

• Physical examination
• Blood tests
• Electrocardiogram (ECG or EKG)
• 2D Echo cardiogram
• Stress test (TMT)
• Coronary angiography

What is Peritoneal Dialysis?

With peritoneal dialysis, tiny blood vessels inside the abdominal lining (peritoneum) filter blood through the aid of a dialysis solution. This solution is a type of cleansing liquid that contains water, salt and other additives.

Peritoneal Dialysis Catheter Insertion

Peritoneal dialysis was first used for the management of end-stage renal disease in 1959.In 1968, Henry Tenckhoff developed the indwelling peritoneal catheter, which was placed via an open surgical technique.
Subsequently, percutaneous and laparoscopic techniques for placement have been utilized.

Peritoneal dialysis has several advantages over hemodialysis including quality of life due to its ability to provide better patient mobility and independence, the simplicity of use, as well as the clinical advantages of maintaining residual renal function and lower mortality in the first years after starting peritoneal dialysis. A disadvantage of peritoneal dialysis is the poor blood pressure control due to fluid overload as well as the risk of peritonitis.

Indications

Chronic peritoneal dialysis is an option for many patients with end-stage renal disease.

Strong indications for peritoneal dialysis include the following:

• Vascular access failure
• Intolerance to hemodialysis
• Congestive heart failure
• Prosthetic valvular disease
• Children aged 0-5 years
• Patient preference
• Distance from a hemodialysis center
• Poor cardiac function
• Peripheral vascular disease

Peritoneal dialysis is preferred in patients with the following conditions:

• Bleeding diathesis
• Multiple myeloma
• Labile diabetes mellitus
• Chronic infections
• Possibility of renal transplantation in the near future
• Age between 6 and 16 years
• Needle anxiety
• Active lifestyle

Renal Biopsy

Also known as a renal biopsy, a kidney biopsy may be performed if you have abnormal urine or blood tests. There are different types of biopsies using different instrumentation, but all involve an incision and recovery.
A renal biopsy is a procedure used to extract kidney tissue for laboratory analysis. The word “renal” describes the kidneys, so a renal biopsy is also called a kidney biopsy.
The test helps your doctor identify the type of kidney disease you have, how severe it is, and the best treatment for it. A renal biopsy can also be used to monitor the effectiveness of kidney treatments and see if there are any complications following a kidney transplant.

There are two ways to perform a renal biopsy:

• Percutaneous biopsy (renal needle biopsy) : This is the most common type of renal biopsy. For this procedure, a doctor inserts a thin biopsy needle through the skin to remove your kidney tissue. They may use an ultrasound or CT scan to direct the needle to a specific area of the kidney
• Open biopsy (surgical biopsy) : For this procedure, your doctor makes a cut in the skin near the kidneys. This allows the physician to look at the kidneys and determine the area from which the tissue samples should be taken.