Hemodialysis vs Peritoneal Dialysis!
Hemodialysis
About hemodialysis: It is one of the most commonly used blood purification therapies at present. The method is to lead the blood out of the body, through the extracorporeal circulation device with a dialyzer, and complete the removal and transport of solutes and water through biophysical mechanisms. It removes various endogenous and exogenous toxins in the blood through diffusion, convection and adsorption, removes the water retained in the body through ultrafiltration and osmosis, and at the same time corrects the electrolyte acid-base balance, so that the internal environment of dialysis patients is close to normal. .
Indications:
1. In end-stage renal disease
2. Acute kidney injury: patients with high decomposition state should be dialysis immediately. If not, consider comprehensively according to the following indicators: anuria for more than 48 hours, blood urea nitrogen greater than or equal to 21.4mmol/l, serum creatinine greater than or equal to 442umol/l, serum potassium greater than or equal to 6.5mmol/l, blood bicarbonate ion less than 15mmol /l or obvious edema, nausea, vomiting, lethargy, restlessness, pulmonary edema, etc.
3. Acute drug poisoning, poison poisoning, etc.
4. Severe water-electrolyte acid-base balance disorder, hemolysis, liver failure, etc.
Relative contraindications:
1. Intracranial hemorrhage or increased intracranial pressure
2. Shock refractory to medication
3. Severe cardiomyopathy and refractory heart failure, severe arrhythmia, etc.
4. Active bleeding.
5. People with mental disorders cannot cooperate with hemodialysis.
Methods of blood purification: hemodialysis, hemofiltration, hemodiafiltration, simple ultrafiltration. blood perfusion. Continuous renal replacement therapy (CRRT), etc.
About dialysis access: the current international standard is autologous arteriovenous fistula (radial artery + cephalic vein). In emergency, central venous catheter can be placed (internal jugular, subclavian, and deep veins of lower extremities can be used), such as internal fistula stenosis flow Due to vascular factors such as poor quality, high internal fistula or reconstruction or artificial blood vessel or balloon dilation may be required. These are also a lot of expenses. Balloon dilation is basically required for artificial blood vessels every 3 months.
Peritoneal dialysis
About peritoneal dialysis: The so-called peritoneal dialysis is the transmembrane transport of solutes and water by two separate fluid systems through a semipermeable membrane, one: peritoneal capillaries, which contain uremic toxins such as urea, creatinine and other solutes. Second: the peritoneal dialysate poured into the abdominal cavity contains electrolyte components, buffers, osmotic agents, and dialysate during the process of staying in the abdominal cavity, the transport is also carried out at the same time, and the toxin-containing dialysate is drained after staying for a period of time. Come out and fill in new dialysate. , even if a peritoneal dialysis fluid exchange is completed.
There are many ways of peritoneal dialysis: there are simple manual operations, and peritoneal dialysis machines are also used for dialysis. The commonly used methods are CAPD (24-hour uninterrupted dialysis) and APD (automatic peritoneal dialysis). Of course, there are also two types of peritoneal dialysis. There are specific divisions. CAPD is currently widely used. Within 24 hours a day, dialysate is left in the abdominal cavity of patients, and solute exchange and ultrafiltration are continuously performed.
Indications:
1. Peritoneal dialysis can be given priority in the following situations: the elderly, infants, and children. Heart, cerebrovascular disease or unstable cardiovascular status. Poor vascular condition or repeated arteriovenous fistula failure. Coagulopathy with marked bleeding or bleeding tendency. Remaining good residual renal function. Preference for home therapists. Patients with inconvenient transportation.
2. Acute kidney injury
3. Toxic diseases, especially hemodialysis contraindications
4. Other congestive heart failure
Contraindications:
Extensive adhesions in the peritoneal cavity, peritoneal dialysis catheters without proper placement, mechanical problems that are difficult to correct, severe peritoneal defects, patients who cannot operate on their own without suitable caregivers, etc.
