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  • imageHemodialysis (HD) involves the perfusion of blood and dialysate on opposite sides of a semipermeable membrane. Solutes are removed from the blood by diffusion and convection. Excess plasma water is removed by ultrafiltration.
  • image Native arteriovenous (AV) fistulas are the preferred access for HD because of fewer complications and a longer survival rate. Venous catheters are plagued by complications such as infection and thrombosis and often deliver low blood flow rates.
  • image Adequacy of HD can be assessed by the Kt/V and urea reduction ratio (URR). The National Kidney Foundation’s Kidney Disease Outcomes Quality Initiative minimum goal Kt/V is greater than 1.2 per treatment and the URR is greater than 65%.
  • image During HD, patients commonly experience hypotension and cramps. Other more serious complications include infection and thrombosis of the vascular access.
  • imagePeritoneal dialysis (PD) involves the instillation of dialysate into the peritoneal cavity via a permanent peritoneal catheter. The peritoneal membrane lines the highly vascularized abdominal viscera and acts as the semipermeable membrane. Solutes are removed from the blood across the peritoneum via diffusion and ultrafiltration. Excess plasma water is removed via ultrafiltration created by osmotic pressure generated by various dextrose or icodextrin concentrations.
  • image Patients on PD are required to instill and drain, manually or via automated systems, several liters of fresh dialysate each day. The more exchanges completed each day results in greater solute removal.
  • imagePeritonitis is a common complication of PD. Initial empiric therapy for peritonitis should include intraperitoneal (IP) antibiotics that are effective against both gram-positive and gram-negative organisms.
  • image Nasal carriage of Staphylococcus aureus is associated with an increased risk of catheter-related infections and peritonitis. Prophylaxis with intranasal mupirocin (twice a day for 5 days every month) or mupirocin (daily) at the exit site can effectively reduce S. aureus infections.

On completion of the chapter, the reader will be able to:

  1. Discuss the epidemiology of end-stage renal disease in United States.

  2. Compare the use of hemodialysis (HD) and peritoneal dialysis (PD) as chronic renal replacement therapies.

  3. Compare and contrast the advantages and disadvantages of HD and PD.

  4. Identify the clinical factors associated with end-stage renal disease that indicate the need to initiate dialysis therapy.

  5. Compare and contrast the vascular access options for initiating HD therapy.

  6. Review pharmacologic and nonpharmacologic treatments for the management of intradialytic hypotension.

  7. Evaluate anticoagulation prophylaxis and treatment options to maintain vascular access patency.

  8. Review pharmacologic and nonpharmacologic treatments for the management of intradialytic muscle cramps.

  9. Propose a treatment plan for a HD catheter-related infection.

  10. Describe the procedures and supplies used for common types of PD.

  11. Describe antibiotic therapy for PD-related peritonitis.

  12. Describe a prophylaxis regimen for catheter-related infection in PD patients.

The three primary treatment options for patients with end-stage renal disease (ESRD) are hemodialysis (HD), peritoneal dialysis (PD), and kidney transplantation. The United States Renal Data System (USRDS) is the national system that “collects, analyzes, and distributes” data relating to patients with ESRD or Stage 5 chronic kidney ...

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