DIALYSISPRESENTED BY:Chandraprakash Yadav Sharmila Reddy Sneha gopalkrishnan Divya Sridharan

TOPICSBASICS OF KIDNEY DIALYSIS History And Introduction Principle Types Manufacturers Costing

BASICS OF KIDNEY

Location: kidneys are present in the mid-abdominal portion at the Lumbar Vertebral Level in the backside. Size: length is about 9-13 cm. Weight: about 160 gm

FUNCTIONSExcretion of Wastes Acid-base homeostasis Osmolality regulation Blood pressure regulation Hormone secretion

HAT IS KIDNEY FAILURE???Kidney failure occurs due to the damage either in the filtering segment called glomerulus or the collection system called tubules. If the damage is abrupt it is termed as acute kidney failure and if it occurs over a period of time it is termed as chronic kidney disease.

CAUSES 1. 2. 3. 4. 5.

The major causes are:Diabetes Hypertension Obstructive uropathy Hereditary Side effects of medications and radiations

SYMPTOMSBreathlessness and fatigue. Dizziness. Passage of blood in urine. Nausea and vomiting. Swelling of face and legs. Skin rash or itching.

DIALYSISThe word Dialysis comes from the greek word Dialusis meaning dissolution. It is an artificial replacement for lost kidney function in people with renal failure. Dialysis is regarded as a holding measure until a renal transplant can be performed.

PRINCIPLEDr.Willem Kolff , a dutch physician , constructed the first working dialyzer in 1943. Dialysis works on a principles of the diffusion of solutes and ultrafiltration of fluid across a semi-permeable membrane. Blood flows by one side of semipermeable membrane , and a dialysate or dialysis fuild , flows by opposite side.

TYPES

HEMODIALYSIS: In hemodialysis, the patient's blood is pumped through the blood compartment of a dialyzer, exposing it to a partially permeable membrane. Blood flows through the fibers, dialysis solution flows around the outside of the fibers, and water and wastes move between these two solutions. Filtration is done by applying a negative pressure to the dialysate compartment of the dialyzer. This pressure gradient causes water and dissolved solutes to move from blood to dialysate.

ADVANTAGESLow mortality rate. Better control of blood pressure and abdominal cramps. Less diet restriction. Better solute clearance effect for the daily hemodialysis.

DISADVANTAGESRestricts independence. Requires supplies such as high water quality and electricity. Requires reliable technology. Requires time to set up and clean dialysis machine.

PERITONEAL DIALYSISIn peritoneal dialysis, a sterile solution containing glucose is run through a tube into the peritoneal cavity. The peritoneal membrane acts as a semi-permeable membrane. Ultrafiltration occurs via osmosis the dialysis solution used contains a high concentration of glucose, and the resulting osmotic pressure causes fluid to move from the blood into the dialysate

ADVANTAGESFlexible lifestyle and independence No use of needles Therapy resembles natural functioning of the kidney Need not travel to a dialysis centre for treatment Therapy can be done while sleeping and travelling.

DISADVANTAGESTreatment to be done seven days a week at regular intervals. Requires a permanent catheter outside the body. High risk of infection. Weight gain Requires storage space at home.

STEPS IN DIALYSISPRE-DIALYSIS: There are many models of dialysis machines, but typically in modern machines there will be a computer, CRT, a pump, and facility for disposable tubing and filters. The filters are cylindrical, clear plastic outside with the filter material visible inside.

Contd.

The pump does not directly contact the blood. Characteristic of dialysis machines are that most of the blood out of the patients body at any given time is visible. This facilitates troubleshooting, particularly detection of clotting. The patient arrives and is carefully weighed. Standing and sitting blood pressures are taken.

ContdAccess is set up , for patients with a fistula , this means inserting two large gauge needles into the fistula. Fistulas are widely considered the desirable way to get access for hemodialysis, but they take time to set up.

DURING DIALYSIS

The pump and a timer are started. Blood pressure is taken periodically. Most dialysis patients are on moderate to severe fluid restrictive diet since kidney failure usually includes an inability to properly regulate fluid levels in the body.

POST-DIALYSISIn this the patient is disconnected from the plumbing - blood lines . Needle wounds are bandaged with gauze, held for up to 1 hour with direct pressure to stop bleeding, and then taped in place. Temperature, standing and sitting blood pressure, and weight are all measured again.

MANUFACTURERSHI-TECH EQUIPMENT INC. CHEMILIFE ENTERPRISES. INDIAN ION EXCHANGE LTD. SHAKTI POWER TRONIX. GAMBRO. SIEMENS.

COSTINGThe total health related expenditure can be broken up into five categories: Dialysis Erythropoietin Medication:Rs.1000 Lab tests : Rs.1500 Doctors consultation : Rs. 500

Cost for peritoneal dialysis

There are different companies offering PD treatment in India like Baxter, Gambro etc. Baxter costs: Cost of one 2 liter bag: Rs. 170 Total cost of bags assuming 4 exchanges per day, 7 days a week: Rs. 21,000. Cost of one 5 liter bag: Rs. 416 Total cost of bags assuming 2 bags used per night, 7 nights a week: Rs. 25,000 Cost of renting Home Choice machine: Rs. 10,000 per month.

Cost for hemodialysis

Cost of dialysis with new kit: Rs. 2,000 to 3,000 Cost of dialysis with reuse: Rs. 1,250 to Rs. 2,300 Assuming one does thrice a week session and uses a new kit every 2 weeks: Total minimum cost: Rs. 17,000