Dialysis

Abstract

Dialysis is a life-saving treatment option for patients with kidney failure. There are several common dialysis modalities commonly used in clinical practice such as hemodialysis (HD), peritoneal (PD), and continuous renal replacement therapy (CRRT) (Sowinski KM, Churchwell MD, Decker BS (2017) Hemodialysis and peritoneal Dialysis. In: Dipiro JT, Talbert RL, Yee GC et al (eds) Pharmacotherapy. A pathophysiologic approach (10 e). McGraw Hill Education, New York). Dialysis is the transfer of uremic solutes from blood to an extracorporeal fluid (dialysate) by diffusion across a semi-permeable membrane (Sowinski KM, Churchwell MD, Decker BS (2017) Hemodialysis and peritoneal Dialysis. In: Dipiro JT, Talbert RL, Yee GC et al (eds) Pharmacotherapy. A pathophysiologic approach (10 e). McGraw Hill Education, New York). This can be accomplished by pumping blood through a dialyzer containing a membrane (HD or CRRT) or by instilling dialysate into the peritoneal cavity and using the peritoneum as a membrane (PD). Solute removal via HD is relatively efficient and can be done intermittently (typically 3 times per week), whereas PD is less efficient and is usually required for 12–24 h every day. Continuous renal replacement therapy is used to treat acute kidney injury (AKI) in critically ill and hemodynamically unstable patients.

There is conflicting information regarding survival differences between PD and HD; however, some reports show no significant difference in survival between the two modalities and it also depends on a number of factors (Sowinski KM, Churchwell MD, Decker BS (2017) Hemodialysis and peritoneal dialysis. In: Dipiro JT, Talbert RL, Yee GC et al (eds) Pharmacotherapy. A pathophysiologic approach (10 e). McGraw Hill Education, New York; Vonesh EF, Snyder JJ, Foley RN, Collins AJ Kidney Int 66:2389–2401, 2004; Miskulin DC, Meyer KB, Athienites NV et al Am J Kidney Dis 39:324–336, 2002). The direct comparison of PD and HD is difficult due to the differences in the nature of the various procedures involved and the complex relationship between patient factors and outcomes (Vonesh EF, Snyder JJ, Foley RN, Collins AJ Kidney Int 66:2389–2401, 2004; Miskulin DC, Meyer KB, Athienites NV et al Am J Kidney Dis 39:324–336, 2002).

Pharmacotherapy regimens are often complicated because many of these patients have multiple comorbidities (Sowinski KM, Churchwell MD, Decker BS (2017) Hemodialysis and peritoneal Dialysis. In: Dipiro JT, Talbert RL, Yee GC et al (eds) Pharmacotherapy. A pathophysiologic approach (10 e). McGraw Hill Education, New York; Vonesh EF, Snyder JJ, Foley RN, Collins AJ Kidney Int 66:2389–2401, 2004; Miskulin DC, Meyer KB, Athienites NV et al Am J Kidney Dis 39:324–336, 2002). In addition, the type of dialysis procedure (HD vs. PD vs. CRRT) have variable effects on the disposition of these medications. Kidney failure patients also have multiple repetitive hospitalizations due to recurrent complications (Possidente CJ, Bailie GR, Hood VL Am J Health-Syst Pharm 56:1961–1964, 1999). On average dialysis patients receive more medications to manage kidney related complications (Possidente CJ, Bailie GR, Hood VL Am J Health-Syst Pharm 56:1961–1964, 1999). Therefore, the number of medication-related problem (MRP) in the dialysis population is large and along with dialysis related procedures lead to decrease in quality of life (Grabe DW, Low CL, Bailie GR, Eisele G Clin Nephrol 47:117–121, 1997).

Advanced Clinical Pharmacy - Research, Development and Practical Applications: “dose adjustments and other considerations in dialysis – including types of dialysis, how these differ and affect PK. As well as understanding the inefficiencies of dialysis and the impact on patient’s life”.