Dialysis in AMU Dr Mary Rogerson, Nephrologist, SGH

AMU 3?

What you need to know Type of Dialysis Schedule Dry / Target Weight (recent changes?) BP pre- and post-dialysis Access problems ?Transplant

Types of dialysis Common complications Critical illness / outcomes

What Type of Dialysis? HaemodialysisPeritoneal Dialysis

Tunnelled central venous cannula

What Type of Dialysis? Haemodialysis –Hospital based –Satellite unit Peritoneal Dialysis

Peritoneal dialysis catheter

CAPD Pros Self directed Flexible Portable Free diet/fluids Independence Cons Infection Repetition Leakage Blockage Body Image Storage space Dextrose - based Loss of efficacy

What Type of Dialysis? Haemodialysis –Hospital based –Satellite unit Peritoneal Dialysis –CAPD –IPD

What Type of Dialysis? Haemodialysis –Hospital based –Satellite unit Home HD 5/6 days /week Long/slow, overnight Peritoneal Dialysis –CAPD –IPD Automated / overnight (APD) 6/7 nights/week Assisted APD

Automated peritoneal dialysis Overnight Compact Simple Suits all ages

Home Haemodialysis Compact machine Minimal technology Need to self cannulate Flexible – independent / autonomy Optimal therapy – better outcomes No travelling to unit

Dialysis Concerns Hypotension Hypertension Dyspnoea Chest pain Fever –Peritonitis –Access related infection Diabetes management Bleeding Electrolyte disturbances –Potassium –Magnesium –phosphate

Type of dialysis Haemodialysis Hypotension Electrolytes Fluid imbalance Where/when to dialyse next PD Fluid balance Residual function Nutrition Peritonitis Equipment required

Critical illness in dialysis patients Co-morbidity %: General PopESRD CAD1240 LVH2075 CHF 540

Acute v Chronic RF Outcomes in Critical Care are not the same Consider ITU for single organ failures (+ESRF) Consider overall QoL Patient choice.

Management Fluid restrict Careful pharmacology NSAIDS, ACEI’s okay Limit blood tests (pre-dialysis most useful) Transfuse during dialysis Don’t MEWS for urine output! Consult nephrology for dialysis