Medical Management of Hemodialysis & Peritoneal Dialysis

Hemodialysis and peritoneal dialysis are two primary modalities of renal replacement therapy for individuals with end-stage renal disease. Hemodialysis involves circulating the blood outside the body through a dialysis machine, effectively removing waste products and excess fluids. This procedure is typically performed in a dialysis center, requiring vascular access through an arteriovenous fistula or a temporary catheter. Sessions are scheduled multiple times a week. In contrast, peritoneal dialysis utilizes the peritoneal membrane within the abdominal cavity for dialysis. A catheter, surgically implanted into the peritoneal cavity, allows for the infusion and drainage of dialysate fluid. Peritoneal dialysis offers greater flexibility as it can be performed at home, either through manual exchanges during the day (CAPD) or machine-assisted continuous cycling overnight (APD). Both modalities necessitate strict adherence to dietary restrictions, medication management, and regular monitoring for complications, highlighting the importance of choosing the most suitable approach based on individual patient characteristics and lifestyle preferences.

Hemodialysis

Vascular Access Management

• Arteriovenous Fistula (AVF): Preferred access, monitoring for complications.
• Hemodialysis Catheter: Temporary access or when AVF is not feasible.

Dialysis Schedule

• Typically 3 sessions per week, each lasting 3-4 hours.
• Individualization based on patient needs and clinical status.

Fluid and Electrolyte Management

• Strict control of fluid intake to avoid volume overload.
• Monitoring and adjustment of dialysate electrolyte composition.

Medication Adjustments

• Dosing medications based on the dialysis schedule.
• Avoiding drugs that may accumulate during dialysis.

Blood Pressure Control

• Monitoring and managing hypertension, which is common in dialysis patients.

Anemia Management

• Administration of erythropoiesis-stimulating agents (ESAs) and iron supplementation.

Peritoneal Dialysis

Catheter Care

• Sterile technique during exchanges to prevent infections.
• Regular assessment for signs of catheter dysfunction.

Dialysate Exchange

• Multiple daily exchanges for continuous clearance.
• Automated peritoneal dialysis (APD) for nocturnal therapy.

Fluid and Electrolyte Balance

• Monitoring and adjusting dialysate composition.
• Careful management of fluid status.

Infection Prevention

• Strict adherence to aseptic technique during exchanges.
• Prophylactic antibiotics may be prescribed.

Nutritional Support

• Tailoring diet to compensate for nutrient loss during dialysis.
• Monitoring protein and calorie intake.

Medication Adjustments

• Dosing medications based on the dialysis schedule.
• Attention to medications with peritoneal absorption.

Complications Management (Both Modalities)

Infection Control

• Vigilant monitoring and prompt treatment of infections.
• Prophylactic antibiotics in high-risk situations.

Cardiovascular Health

• Management of hypertension and cardiovascular risk factors.

Bone Health

• Calcium and phosphate control.
• Vitamin D supplementation.