RENAL REPLACEMENT THERAPY

Dr.MANOJ PRABHAKAR Resident , Dept. of Paediatrics

RENAL REPLACEMENT THERAPY

DEFINITIONRenal replacement therapy is a therapy that replaces the normal blood filtering functioning of the kidneys.It is used when the kidneys are not functioning well i.e in conditions like Acute or Chronic Kidney Disease.

MODALITIES OF RRTHEMODIALYSIS

PERITONEAL DIALYSIS

RENAL TRANSPLANTATION

DIALYSISAll dialyses modalities can be used to ensure equivalent solute clearence and ultrafiltration.Choice of procedure depends onAge & size of the patientCardiovascular statusAvailability of vascular statusIntegrity of peritoneal membrane and abdominal cavity.Expertise available.

Indications of Dialysis in AKIUremiaHyperkalemiaHyponatremiaFluid overloadMetabolic AcidosisHypercatabolic state

Indications in CKDGFR 70% reduction during subsequent treatments (3.5-4hrs).

Complicaions during Hemodialysis1.Dialysis disequilibrium syndrome: Manifested as seizures2.Muscle Cramps3.Hypotension.4. Nausea & Vomiting5.Itching.

AdvantagesMaximum solute clearance Best tx for severe hyper- K+ Ready availability Limited anti-coagulation time Bedside vascular access

DisadvantagesHemodynamic instability Hypoxemia Rapid fluid + solute shifts Complex equipment Specialized personnel Difficult in small infants

CONTINUOUS RENAL REPLACEMENT THERAPYVariant of HD therapies that are continuous and prolonged.(for days to weeks).

2 types :

CVVH (Continuous venovenous Hemofiltration)Only convective transport without adding dialytic compound.

b) CVVHD (Continuous venovenous hemofiltartion dialysis)Dialytic compound added.

The choice of CVVH or CVVHD is center dependent and also on the need for solute removal , which is usually greater with CVVHD.

Indications for CRRTModality of choice in patients who are critically ill and hemodynamically unstable patients.Neonates and infants with cardiovascular or abdominal surgery.TraumaShock & multi-system failure.Children with inborn errors of metabolism such as urea cycle disorders

Disadvantages of CRRTSame as seen in Hemodialysis.

Continous nature risk greatly multiplied.

Continuous vascular access, very close monitoring very expensive