Dialysis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Dialysis Main Page
Patient Information
Overview
Classification Hemodialysis Peritoneal Dialysis
Indications

History

Many have played a role in developing dialysis as a practical treatment for renal failure, starting with Thomas Graham of Glasgow, who first presented the principles of solute transport across a semipermeable membrane in 1854. The artificial kidney was first developed by Abel, Rountree and Turner in 1913, the first Peritoneal Dialysis was by Georg Ganter (1923),the first hemodialysis in a human being was by Hass (February 28, 1924) and the artificial kidney was develop a into clinically useful apparatus by Kolff in 1943 - 1945. This research showed that life could be prolonged in patients dying of renal failure. Yet, the technical problems associated with blood access or access to the peritoneum made dialysis limited to patients with acute renal failure until 1960 (though a chronic renal failure patient was treated in 1956 with peritoneal dialysis). In 1960 work on subcutaneous arteriovenous shunt (a plastic tube connected to an artery and a vein) by Scribner and Quinton made hemodialysis available as a treatment for people with chronic renal failure..

Types

There are two main types of dialysis, hemodialysis and peritoneal dialysis.

Starting indications

The decision to initiate dialysis or hemofiltration in patients with renal failure can depend on several factors, which can be divided into acute or chronic indications.

• Acute Indications for Dialysis/Hemofiltration:
  • 1) Hyperkalemia
  • 2) Metabolic Acidosis
  • 3) Fluid overload (which usually manifests as pulmonary oedema)
  • 4) Uremic pericarditis, a potentially life threatening complication of renal failure
  • 5) And in patients without renal failure, acute poisoning with a dialysable drug, such as lithium, or aspirin.
• Chronic Indications for Dialysis:
  • 1) Symptomatic renal failure.
  • 2) Low glomerular filtration rate (GFR) (RRT often recommended to commence at a GFR of less than 10-15 mls/min/1.73m2)
  • 3) Difficulty in medically controlling serum phosphorus or anaemia when the GFR is very low

References

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