Solute passively moves down a concentration
gradient between the dialysate and the
Plasma water and solute move down a
concentration gradient by ultrafiltration and
convection induced by hydrostatic pressure,
Hollow fiber dialyser, most commonly used.
Contains bundles of capillary tubes through
which blood flows, while the dialysate
circulates outside it.
Dialysate flows countercurrent to the blood,
Urea, Creatinine and Potassium flow from
Blood to Dialysate.
Calcium and Bicarbonate flow from Dialysate
Easy access to blood
Prevention of stenosis and thrombosis
Low risk of infection
Internal Jugular vein
• Vein cross cut and
attached end to side
• Takes 2-4 months to
• Low infectious risk,
attached from end to
side on artery and vein.
Requires 2 weeks till
Higher risk of
high infection risk.
Tunelled under skin to
Can be used
High risk of
• Arm veins suitable for access should be
• Wear Medic bracelet.
• Save the non-dominant arm
No B.P measurement
No I/V cannula
No blood draws
• Place vascular access within ayear of
To maintain patency of vascular access.
Unfractionated/LMW Heparin may be used
@40-70U/Kg bolus dose follwed by 0.5-
1.0U/kg/hour in infusion.
C/I to anticoagulation in dialysis?
• Line sepis
• Air emboli
• Blood loss
• Platelet consumption
• Hemodynamic instability
• Electrolyte imbalance
• Heparin induced thrombocytopenia
Dialysate infused into peritoneal cavity,
followed by slow diffusion of solutes e.g
The vascular peritoneal membrane acts as a
Ultrafiltration due to osmotic gradient
generated by glucose in dialysate.
During or immediately after dialysis.
Caused by acute rapid increase in water
content in the brain cells and change in pH of
Anorexia, vomiting, headache, hypotension,
blurred vision, cramps, tremors.
May cause psychosis, confusion, seizures
Inj Valium/Phenytoin for seizures
May be avoided by short dialysis session, low
GFR < 20ml/kg/min
GFR 15-19ml/kg/min: live donor with 6
GFR <15ml/kg/min: any donor
Advanced lung disease
Life expectancy <2 years
Ischemic cardiac disease
Severe peripheral vascular disease
Acute transplant rejection
Graft vs host disease
Post transplant malignancy
Caused due to decreased erythropoietin
Erythropoietin stimulating agents e.g Epoietin
alfa or Darbepoietin alfa may be used if Hb
Calcium salts e.g Calcium acetate, Calcium
carbonate may be given with or without
Vitamin D analogues e.g Calcitriol (1,25
dihydroxycholecalciferol) or Doxercalciferol
(1-alphahydroxyergocalciferol) may be given
in case of elevated or rising PTH levls.
Cinacalcet by increasing sensitivity of calcium
receptors on parathyroid gland to
Etelcalcitide by enhancing calcium receptor
activation by extracellular calcium.