ESRF and dialysis
Hypertension causes wear and tear on the circulatory system and renal system.
Damage to the high pressure arteries causes atherosclerosis which causes CVD and stroke.
Damage to the kidneys causes chronic kidney disease which also causes hyperuricaemia and gout.
The most common causes of chronic kidney disease are hypertension and diabetes.
Renal function deterioration also occurs naturally with age.
End stage renal failure (ESRF) - this is permanent kidney failure - where the patient's kidney function is deteriorated so much there is no renal functioning capabilities left (kidney function down to 10-20% , glomerular filtration rate GFR <15 ml/min see pic below)
There is no cure for this and the patient requires a kidney transplant. Until then he needs to have continuous dialysis to try to mechanically replace the waste removing role of the kidney.
Key roles of the kidneys:
- Removal of wastes from the blood including medication
- Regulation of sodium and water balance and thus blood pressure
- Regulation of electrolytes
- Regulation of Acid - Base balance
- Production of erythropoietin, the hormone which stimulates the production of red blood cells.
Dialysis is a procedure to remove the wastes from your blood, something normally done by the kidneys. There are two methods, hemodialysis and peritoneal dialysis.
Hemodialysis is dialysis performed by an external device which acts as an artificial kidney. The patient's blood is drawn out and passed through the machine which cleans it then the cleaned blood is returned into the patient. This process takes 4 hours and needs to be done three times a week.
Peritoneal dialysis - The peritoneal cavity is filled with clean solution (dialysate) via a catheter surgically placed in the abdomen. Wastes and extra water and salt are drawn out of the blood vessels and into the solution by osmosis, then the dirty solution is removed from the body.
There are several types of peritoneal dialysis including continuous ambulatory peritoneal dialysis (CAPD).
Continuous ambulatory peritoneal dialysis (CAPD) - put the dialysate solution into the abdomen (see diagram below) (also HK Smart patient), leave it in there for 4-6 hours ('dwell time', over night is called 'long dwell'). Then the solution is removed and replaced with new dialysate ('exchange'). This needs to be done 3-5 times a day. During dwell time the patient can carry on with daily activities (hence 'continuous' and 'ambulatory').
Our patient is on a three exchange a day regimen - 2x2L glucose, and 1x2L icodextrin. Glucose is the most commonly used osmotic agent used in dialysate, icodextrin is the most common alternative to glucose.
The presence of the catheter increases the risk of infectious complications for dialysis patients.
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