Chronic kidney disease is identified by a blood test for creatinine.Higher levels of creatinine indicate a falling glomerular filtration rate and as a result a decreased capability of the kidneys to excrete waste products.Creatinine levels may be normal in the early stages of CKD,and the condition is discovered if urinalysis(testing of a urine sample)shows that the kidney is allowing the loss of protein or red blood cells in to the urine.To fully investigate the underlying cause of kidney damage.Various forms of medical imaging blood of chronic kidney disease in five stages,with stage 1 being the mildest and usually causing fewtests and often renal biopsy(removing small sample of kidney tissue)are employed to find out if there is a reversible cause for the kidney malfunction.
Recent professional guidelines classify the severity  symptoms and stage 5 being a severe illness with poor life expectancy if untreated.Stage 5 CKD is also called established chronic kidney disease.

Chronic Kidney Disease(CKD)

CKD
Is also known as  chronic kidney disease,is a progressive loss in renal function  over a period of months or years.The symptoms of worsening kidney function are unspecific, and might include feeling generally unwell and experiencing a reduced appetite.Often,chronic kidney disease is diagnosed as a result of screening of people known to be  at risk of kidney problems,such as those with high blood pressure and diabetes and those with a  bllod relative with chronic kidney disease.CKD may also be identified when it leads one of its recognazed complications,such as cardiovascular disease,anemia or pericarditis

STEP BY STEP DESCRIPTION

POST DIALYSIS WASHOUT:

Following hemodialysis,patients may experience a syndrome called"washout"The patient feels weak,tremulous,extreme fatigue.patients report they are too tired,too weak to converse,hold a book or even a newspaper."It may also vary in intensity ranging from whole body aching,stiffness in joints and other flu_ like symptoms including headaches,nausea and loss of appetite.The syndrome may begin toward the end of treatment or minutes following the treatment.It may last 30 minutes or 12-14 hours  in a dissipating form.Patients though exhausted have difficulty falling asleep.Ezting a light meal,rest and  quiet help and patient cope with washout until it has'worn away'.

STEP BY STEP DESCRIPTION

POST DIALYSIS:

1.At the time of the prescribed time,the patient is described from the plumbing-blood lines(which is removed and discarded,exceptperhaps for the filter,which may be sterilized and reused for the same patient at a later date).Needle wounds (in case of fistula)are bandaged with gause,held for up to 1 hour with direct pressure to stop bleeding,and then taped in place.the process is similar to getting blood drawn,only it is lengthier,and more fluid or blood is lost.

2.Temperature,standing and sitting blood pressure,and weight are all measured again.Temperature changes may indicate infection.BP discussed above.Weighing is to confirm the removal of the desired amount of fluid.

3.Care staff varifies that the patient is  in condition suitable for leaving.The patient must be able to stand(if previously able),maintain a reasonable blood pressure,and be coherent(if normally coherent)Different rules apply for in-patient treatment.

STEP BY STEP DESCRIPTION

DIALYSIS:

1.The pump and the timer are started.hemodialysis is underway.

2.Periodically(every half hour,nominally)blood pressure is taken,as a practical matter,fluid is also removed during dialysis.Most dialysis patients are on moderate to severe fluid  restrictive diet,since kidney failure usually includes an inability to properly regulate fluid levels in the body.A session of hemodialysis may typically remove 2-5 kilograms of fluid from the patient.The amount of fluid is removed is set by the dialysis nurse according to the patients "estimated dry weight"This is a weight that the care staff believes represents what the patient should weigh without  fluid built up because of  kidney failure .Removing this much fluid can cause low blood pressure .
Monitoring is intented to detect before it becomes severe.Low blood pressure can cause cramping,nausea,shakes,dizziness,lightheadedness ,and unconsciousness .

3.During dialysis,occasionally,patients have low blood pressure and lose consciousness.Often this is temporary and passes after the head is placed down for a short time.

STEP BY STEP DESCRIPTION

STEP BY STEP DESCRIPTION OF HEMODIALYSIS:

Starting hemodialysis often a frightening experience.hemodialysis machines are complicated and dialysis sessions offen are punctuated by alarms.

pre-dialysis:

1.Before or around the time the patient arrives for his sheduledsession,a dialysis machine will be prepared.there are many models of dialysis machines,But tipically in modern machines there will be a computer,CRT,a pump,and facility for disposable tubing and filters.The filters (actually the artificial kidneys)are cylindrical,clear plastic outside with the filter material inside.They are 15-18 inches long, and 2-3 inches thick.They have tubing connectors in both ends.The technician or nurse will set up plumbing on the machine in a moderately complex pattern that has been worked out to move blood through the filter,allow for saline drip,allow for various medications/chemicals to be administered.
2.The pump does not directly contact blood or fluid in the plumbing-it  works by aplying pressure to the tubing,then moving that pressure point arround.Think of a disk with a protrusion in it.Put this in ti a close fitting 270 degree enclosure.
3.The patient arrives and is carefully weighed.Standing and sitting blood pressures are taken.Temperature is taken
4.Access is set up.For patients with a fistula(a surgical modification to an arm or leg vein to make it  more robust,and there fore usable for high capacity blood movement  required by dialysis) this means inserting two large gauge needles in to the fistula.This is painfull for the patient but there are various methods of rumbing  the needles are inserted-the two most common are lignocaine9a local anesthetic injected under the skin )and also a cream called EMLA  applied the skin before 45 minutes needles are inserted.
5.When access has been set up,the patient is then connected to the precconfigured plumbing,creating a complete loop through the pump and filter.

INDICATIONS

2.Chronic Indication.

1.symptomatic renal failure
2.Low glomerular filtration rate
3.Difficulty in medically controlling fluid overload

INDICATIONS

Starting Indication:

The decision to initiate dialysis in patients with renal failure depends on several factors.These can be divided in to acute or chronic indications.

Acute Indications:

1.Acidemia from metabolic acidosis in situations where correction with sodium bicarbonate is impractical or may result in fluid overload.

2.Electrolyte abnormality such as hyperkalemia,especially when combined with AKI.

3.Intoxication,that is,acute poisoning with a dialysable substance.

4.Fluid overload not expected to respondto treatment with duiretics.

5.Complications of uremia,such as pericarditis,encephalopathy,or gastrointestinal bleeding.

HEMOFILTRATION

HEMOFILTRATION:

It is a similar treatment hemodialysis,but it makes use of a different principle.The blood is pumped through a hemofilter or a dialyser as in dialysis ,but no dialysate is used.A pressure gradient is applied ;as a result;water moves across the very permeable membrane rapidly,dragging with it many dissolved substances,importantly noes with large molecular weights which are cleared well by hemodialysis.Salts and water lost from the blood during this process are replaced with a substitution fluid that is infused in to extracorporeal  circuit during the treatment.

ARTICLE

MAIN ARTICLES :

1.Peritoneal dialysis,

In peritoneal dialysis,a sterile solution containing glucose is run through a tube in to the peritoneal
cavity ,the abdominal body cavity around the intestine, where the peritoneal membrane acts as a semi permeable membrane.The peritoneal membrane or peritoneum is a layer of tissue containing blood vessels that lines and surrounds the peritoneal ,or abdominal,cavity and the internal abdominal organs (stomach,spleen,intestine and ).
The  dialysate  is left there for a period of time to absorb waste products,and then it is drained out through tube and discarded. This cycle or exchange is normally is normally repeats 4-5 times during the day,Each time the dialysate fills and empties from the abdomen is called one exchange.The time of dialysate stay in patients abdominal cavity-wastes chemicals and extra chemicals moves from patients blood to the dialysate across the peritoneum.A drain process is the process after the dwell time ,the dialysate full with waste products and extra fluids is drained out of patients blood.
Ultrafiltration occurs via osmosis,the dialysis solution used contains a high concentration of glucose,and the resulting osmotic pressure causes fluid to move from the blood in to the dialysate.as a result, more fluid is drained than was installed.Peritoneal dialysis is less efficient than hemodialysis,but because it is carried out for a longer period of time the net effect in terms of removal of waste products and of salt and water are similar to hemodialysis.Peritoneal dialysis is carried out in home by a patient,although support is helpfull,it is not essential

ARTICLES

Main article:
1.Hemodialysis.

In hemodialysis ,the patients blood is pumped through the blood compartment of a dialyzer,exposing it to a partially permeable membrane.the dialyzer is composed of thousands of tiny synthetic hollow fibers.The fiber wall acts as the semi-permeable membrane.Blood flows through the fibers,dialysis solution flows around the  outside of the fibers,and water and wastes move between these two solution.

The cleansed blood is then returned via the circuit  back two the body.Ultrafiltration occurs by increasing the hydrostatic pressure across the dialyzer membrane.This usually is done by applying a negative pressure to the dialysate compartment of the dialyzer.This pressure gradient causes water and dissolved solutesto move from blood to dialysate,and allows the removal of several  litres of  excess fluid during a typical 3 to 5 hour treatment.

DIALYSIS

PERITONEAL DIALYSIS :

In peritoneal dialysis ,wastes and water are removed from  the body inside  the body using the peritoneal membrane of the peritoneum as a natural semi-permeable  membrane .

wastes and excess water water moves from the blood,across the peritoneal membrane ,and into a special dialysis solution,called dialysate,in the abdominal cavity which has a composition similar to the fluid portion of blood.

DIALYSIS

TYPES:
The two main types of dialysis,
Hemodiaolysis and peritoneal dialysis,remove waste and excess water from the blood in different ways.
Hemodialysis removes waste and water by circulating blood outside the body through an
external filter,called a dialyzer,that contains a semi-permeable membrane.
The blood flows in one direction and the dialysate flows in the opposite.
The counter current flow of the blood and dialysate maximises the concentration gradient of
solutes between the blood and dialysate,which helps to remove more urea and creatinine from the blood.
The concentration,on of the solutes such as(potassium,phosphorus)are undesirably high in the blood,but low or absent in dialysate solution  and constant replacement of the dialysate ensures that the concentration of undesired solutes is kept low on this side of the membrane

The dialysate  solution has levels of minerals like  potassium and calcium that are similar to their
natural concentration in healthy blood.For another solute,

Bicarbonate,dialysis solution level is set at a slightly higher level than in normal blood,to encourage diffusion of bicarbonate in to the blood.

dialysis

SEMI-PERMEABLE MEMBRANE;

It is a thin layer of material that contains various sized holes,or pores.

HEMODIALYSIS

PRINCIPLES:
DILYSIS WORKS ON THE PRINCIPLES OF THE DIFFUSION OF SOLUTES AND ULTRAFILTRAATION OF FLUIDS ACROSS A SEMI-PERMEABLE MEMBRANE.


Diffusion describes  a property of substances in water.

substances in water tend to move from an area of  high concentration to nan area of low concentration.

DIALYSIS

DIALYSIS:

Dialysis is the process for removing waste and excess water from the blood,and is used to proviide an artificial replacement for lost kidney function in people with renal failure.