Renal Replacement Therapy

Posted by e-Medical PPT Friday, April 20, 2012
What is it? The medical approach to providing the electrolyte balance, fluid balance, and toxin removal functions of the kidney. How does it work? Uses concentration and pressure gradients to remove solutes (K, Urea, etc…) and solvents (water) from the human body. History of Pediatric Hemofiltration USA, 1985: Dr. Liebermann used SCUF (slow continuous ultrafiltration) to successfully support an anuric neonate with fluid overload Italy, 1986: Dr. Ronco described the successful use of CAVH in four neonates USA, 1987: Dr. Leone described CAVH in older children 1993: A general acceptance of pump-driven CVVH was seen as less problematic than CAVH How is it done? Peritoneal Dialysis Hemodialysis Hemofiltration The choice of which modality to use depends on Patient’s clinical status Resources available Peritoneal Dialysis Fluid placed into peritoneal cavity by catheter Glucose provides solvent gradient for fluid removal from body Can vary concentration of electrolytes to control hyperkalemia Can remove urea and metabolic products Can be intermittent or continuously cycled Peritoneal dialysis Advantages Simple to set up & perform Easy to use in infants Hemodynamic stability No anti-coagulation Bedside peritoneal access Treat severe hypothermia or hyperthermia Disadvantages Unreliable ultrafiltration Slow fluid & solute removal Drainage failure & leakage Catheter obstruction Respiratory compromise Hyperglycemia Peritonitis Not good for hyperammonemia or intoxication with dialyzable poisons Intermittent Hemodialysis Advantages Maximum solute clearance of 3 modalities Best therapy for severe hyperkalemia Limited anti-coagulation time Bedside vascular access can be used Disadvantages Hemodynamic instability Hypoxemia Rapid fluid and electrolyte shifts Complex equipment Specialized personnel Difficult in small infants Continuous Hemofiltration Advantages Easy to use in PICU Rapid electrolyte correction Excellent solute clearances Rapid acid/base correction Controllable fluid balance Tolerated by unstable patients Early use of TPN Bedside vascular access routine Disadvantages Systemic anticoagulation (except citrate) Frequent filter clotting Vascular access in infants

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