Haemodialysis and peritoneal dialysis

image of Haemodialysis and peritoneal dialysis
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Dialysis is a method of treating kidney failure and certain types of toxicities, and includes haemodialysis and peritoneal dialysis. The principles are similar for HD and PD. This chapter explores the principles of dialysis; indications and patient selection; other indications for extracorporeal therapy; outcome; haemodialysis; peritoneal dialysis; together with practical issues such as cost and availability.

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22.1 Solute and fluid removal during dialysis. (a) Blood flows through hollow fibres made of a semipermeable membrane. Small solutes diffuse through pores in the membrane in response to the concentration gradient. (b) Water that is removed from the blood compartment through hydrostatic forces (ultrafiltration) also removes any solutes that are dissolved in that water (convection or solute drag). (c) Substances may adhere to the membrane (adsorption) and thus be removed from the bloodstream.
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22.2 Charcoal haemoperfusion device. Blood is percolated through the cartridge. Toxins bind to the charcoal and thus are removed from the blood.
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22.4 A dog with a non-cuffed, non-tunnelled percutaneously placed temporary dialysis catheter in the jugular vein.
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22.5 A cat being treated with intermittent haemodialysis using a Gambro Phoenix machine.
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22.6 A cat being treated with continuous renal replacement therapy using a Gambro Prismaflex machine.
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22.7 The dialyser houses the semipermeable membrane. Blood travels through the fibres while dialysate fills the space surrounding the fibres.
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22.8 Peritoneal dialysis catheter placed percutaneously. A urinary catheter has been placed in a prescrotal urethrostomy.
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22.9 The peritoneal catheter exit site is covered by a sterile bandage. The spent dialysate is being collected in the bag on the right. Blood may be present in the first few exchanges after catheter placement. Urine volume is also being monitored (bag on left).
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