DIALYSIS TREATMENT FOR KIDNEY DISEASE By Zachary Jacobson

History � � First practiced on animals in early 1900’s Developed by Dr. Willem Kolff in 1943 First successful treatment administered in 1945 In 1950’s Dr. Belding Scribner uses Teflon tubing � Scribner bioethics � heralded as father of Scribner starts first outpatient facility in 1962

Introduction � Function of Kidneys � Nephrons, glomeruli and waste tubules � Hormone secretion support homeostasis � Causes of Chronic Kidney Disease/Failure � Hypertension � Diabetes � Diagnosing Kidney. Disease/Failure � Elevated � mellitus (3 types) proteins and/or blood in urine Function of Dialysis � Filter waste and excess fluid from blood

Methods � Dialysis requires surgery to develop access site � 3 � types: fistula, graft, catheter Filter Membrane � Semi-permeable quality allows only smaller materials(i. e. waste) to diffuse across � Larger waste products and excess fluid require ultrafiltration � Dialysate � Composed of sterile water, electrolytes/chemicals and dextrose Dextrose concentration determines osmotic pressure in PD exchange

How it Works (PD) � Peritoneal Dialysis � Creation of access site Permenant Peritoneal Catheter � Dialysate drawn into abdominal cavity � Peritoneum acts as filter Waste stored in dialysate Dextrose level determines ultrafiltration rate � 2 types: CAPD, CCPD � Dialysate drained from cavity

How it works (HD) � Hemodialysis � Blood filtered outside of body Dialyser �Filters through synthetic membrane �Thousands of thin hollow fibers �Countercurrent ultrafiltration �Different types of filters Dialysis Machine �Monitors time, temp, pressure � Blood returned to body through access

Advantages/Disadventages � PD vs. HD � HD uses more predictable membrane � PD is easier to use and more convenient � PD less likely to cause Hypotension � PD may cause trouble breathing � Dialysis patients require special diet and medication to replace hormonal function.

Limitations � � � � PD and HD do not replicate all kidney functions Access sites can move or become infected Limited movement Body image Time per treatment Blood clotting Expensive without health coverage

Future � � � Shorter Dialysis Time Increased Efficiency in Filtration Increased Portability Recycling of Dialysate Simultaneous monitoring and introduction of synthetic hormones

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