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Dialsis and transplantation are life-prolonging therapies for many patients with renal insufficiency. The term end-stage renal disease (ESRD) describes the late stages of chronic renal failure. Initially, patients with ESRD are managed with conservative therapy, but eventually they require hemodialysis, peritoneal dialysis, and/or transplantation. Because of limited success with each of these modalities, chronic renal failure should be kidney dialysis, kidney transplantation, kidney transplant, renal dialysis, renal transplantation, dialsis, dialisis, transplant
The correlation of uremic symptoms with renal function varies from patient to patient depending on the cause of renal disease (earlier onset of symptoms in subjects with diabetes mellitus), muscle mass (large, muscular patients tolerate high levels of azotemia), diet, nutritional status, and coexisting conditions. Therefore, it is
DIALSIS AND/OR TRANSPLANTATION
Selection of patients to receive dialysis and/or transplantation is a matter of some debate. Because of the reversible nature of acute renal failure, all patients with this diagnosis should be supported with dialysis, at least for some period of time, to allow return of renal function. In patients with irreversible or chronic renal
The recipient should be free of life-threatening extrarenal complications such as cancer, severe coronary artery disease, and cerebrovascular disease. Provided that diffuse vascular involvement is not present, diabetes mellitus is not a contraindication. Oxalosis may recur in relatively short order in a transplanted kidney and is generally a contraindication for transplantation. Although advanced age may
Criteria for treatment with hemodialysis or peritoneal dialsis are more liberal because dialysis has less morbidity than transplantation in older patients with the aforementioned medical complications. Because of the cost of these programs, some have suggested that entry be restricted in patients of
DIALSIS
HEMODIALSIS
Hemodialysis employs the process of diffusion across a semipermeable membrane to remove unwanted substances from the blood while adding desirable components. A constant flow of blood on one side of the membrane and a cleansing solution (dialysate) on
Hemodialysis equipment consists of three components:the blood delivery system, the composition and delivery system of the dialysate, and the dialyzer itself. Blood is pumped to the dialyzer by a roller pump through lines with appropriate equipment to measure flow and pressures within the system; blood flow should be approximately 300 to 450 mL/min. Negative hydrostatic pressure on the dialsate side of
The principal dialyzer in use in the United States is the hollow fiber or capillary dialyzer, in which membrane material is spun into fine capillaries, thousands of which are packed into bundles with blood flowing through the capillaries while dialysate is circulated on the outside of the fiber bundle. The type of membrane and
PERITONEAL DIALSIS
Peritoneal dialysis, like hemodialsis, may be performed in various settings and with several techniques. In patients with acute renal failure, intermittent peritoneal dialysis (IPD) has largely been replaced by CAVHD or CAVVHD. Chronic peritoneal dialysis was attempted in the late 1940s but was impractical until the development of a permanent peritoneal catheterthe Tenckhoff catheter. Use of this indwelling catheter and closed continuous-cycle dialysate delivery equipment led to treatment protocols with