TY  - CHAP
M1  - Book, Section
TI  - Hemodialysis and Peritoneal Dialysis
A1  - Sowinski, Kevin M.
A1  - Churchwell, Mariann D.
A1  - Decker, Brian S.
A2  - DiPiro, Joseph T.
A2  - Yee, Gary C.
A2  - Posey, L. Michael
A2  - Haines, Stuart T.
A2  - Nolin, Thomas D.
A2  - Ellingrod, Vicki
Y1  - 2020
N1  - 
T2  - Pharmacotherapy: A Pathophysiologic Approach, 11e
AB  - KEY  CONCEPTSHemodialysis  (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.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.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%.During  HD,  patients  commonly  experience  hypotension  and  cramps.  Other  more  serious  complications  include  infection  and  thrombosis  of  the  vascular  access.Peritoneal  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.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.Peritonitis  is  a  common  complication  of  PD.  Initial  empiric  therapy  for  peritonitis  should  include  intraperitoneal  antibiotics  that  are  effective  against  both  gram-positive  and  gram-negative  organisms.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.  
SN  - 
PB  - McGraw-Hill Education
CY  - New York, NY
Y2  - 2024/04/19
UR  - accesspharmacy.mhmedical.com/content.aspx?aid=1182441414
ER  -