Essentials Hemodialysis 2008

8/13/2019 Essentials Hemodialysis 2008

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Christopher Keller

Nephrology Fellow

January 11, 2008



Principles of renal replacement therapy

Hemodialysis access

Q&A session





A dialysate containing electrolytes runs

countercurrent on the outside of the

microfibersSolute removal occurs through diffusion





Volume removal occurs by applyingnegative pressure on the dialysate

Managed by a dialysis nurse



PUF = Pure Ultrafiltration

Uses an HD machine with an HD filter

Does not run a dialysateSimply removes volume through

negative pressure from the dialysate

space





Continuous VenoVenous Hemofiltration

Solute removal occurs through

convectionVolume and electrolytes removed are

replaced with a replacement fluid





Requires ICU care (not managed by HD

nurses)

Requires central access; cannot usearm grafts and fistulas

– Why?



Old Machine… New Machine!



Uses the peritoneal membrane as afilter

Two forms – Manual exchanges every 6 hours

– Mostly at night with a cycler machine

Usually used when a patient hasresidual renal function



Can give intraperitoneal antibiotics (IP)

Call renal fellow when a PD patient is

admitted



HD is fast and efficient, but requiresadequate BP and causes significant rapid

fluid shifts

CVVH is gentle, provides hour-by-houradjustments for fluid intake, and provides

better renal replacement over time

PD should be continued in house unless

the patient is unstable or the peritoneum is

compromised









Femoral lines should be removed within3-7 days

IJ lines should be removed within 14days

Patients can go home with a temporary

IJ



Two types: the “Tesio” and the“PermCath”







Both are tunneled, usually into the IJ

Tunneling provides a barrier to infection

Lines can stay in for over a year







Why is it better to have a fistula than a

tunneled line?

Blood flow is faster (400-450 vs 300-350ml/min)

Infection rate is much lower

Mortality benefit to having either a fistula

or a graft versus a line



We can draw labs (tell the fellow)We can give an erythropoetin analog

(Epogen® or Aranesp®)

We can give a vitamin D analog(Hectorol®, Zemplar®, or Calcijex®)

We can give IV iron (Ferrlecit®,

INFeD®, Venofer®) If urgent, we can give antibiotics



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Essentials Hemodialysis 2008