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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 heralded as father of bioethics 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 mellitus (3 types) Diagnosing Kidney. Disease/Failure Elevated 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
WORKS CITED 1. Salvatore, David. "Evolution and Physical Principles of Convection-based Dialysis Treatment. " Giornale Italiano Di Nefrologia 29. 55 (2012): 3 -11. Print. 2. Wakasugi, M. , Kawamura, K. , Yamamoto, S. , Kazama, J. J. and Narita, I. (2012), High Mortality Rate of Infectious Diseases in Dialysis Patients: A Comparison With the General Population in Japan. Therapeutic Apheresis and Dialysis, 16: 226– 231. doi: 10. 1111/j. 1744 -9987. 2012. 01062. x 3. Saran, R. , J. L. Bragg-Gresham, N. W. Levin, Z. J. Twardowski, V. Wizemann, A. Saito, N. Kimata, B. W. Gillespie, C. Combe, J. Bommer, T. Akiba, D. L. Mapes, E. W. Young, and F. K. Port. "Longer Treatment Time and Slower Ultrafiltration in Hemodialysis: Associations with Reduced Mortality in the DOPPS. " Kidney International 69. 7 (2006): 1222 -228. Print. 4. "Home Dialysis Central. " Home Dialysis Central. Medical Education Institute, Inc, Oct. 2012. Web. 22 Oct. 2012.