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Paediatric Surgery
Dialysis
Built from Puri — Pediatric Surgery and Pediatric Urology
What’s inside
9 sections · 76 slides
Overview
- What this topic will teach you
- Dialysis in one idea: a semipermeable filter
When a Child Needs Dialysis
Acute kidney injury and end-stage renal disease
- Two ways to replace a failed kidney
- Two clinical situations that call for dialysis
- Indications to start dialysis in acute kidney injury
- Why fluid overload is the number to watch
- Mortality climbs with fluid overload on CRRT
- Deciding when to start dialysis in ESRD
- Measuring kidney function before starting
The Physics of Dialysis
Three ways solutes and water cross the membrane
- The core idea: movement across a semipermeable membrane
- Diffusion: solutes drift from crowded to empty
- Convection: a pressure push drags solutes along
- Ultrafiltration: moving the water itself
Choosing a Modality
Peritoneal dialysis versus hemodialysis
- The two families of dialysis
- Choosing a modality in acute kidney injury
- Acute renal replacement therapy modalities compared
- When peritoneal dialysis cannot be used
- Choosing a modality in chronic kidney disease
Peritoneal Dialysis
Using the belly lining as a built-in filter
- How peritoneal dialysis works
- The peritoneal dialysis catheter
- Why the curled swan-neck catheter is preferred
- One-cuff versus two-cuff catheters and peritonitis
- Swan-neck double-cuff catheters lower infection risk
- Placing the catheter: open or laparoscopic
- Preparing a child for catheter insertion
- Planning the exit site and managing the omentum
- Using the catheter: acute versus chronic timing
- The dialysis solution and its buffer
- The PD prescription: fill volume and dwell
- Chronic PD prescription and adequacy
- Kinder solutions: second-generation PD fluids
- Mechanical complications of PD
- Peritonitis: the feared infection of PD
- Two more serious PD complications
Hemodialysis
Cleaning the blood through an external filter
- How hemodialysis works
- Access for acute hemodialysis
- Access for chronic hemodialysis: think long term
- Anticoagulation during hemodialysis
- The dialyzer
- Continuous renal replacement therapy (CRRT) modalities
- Intermittent hemodialysis
- Clearance profiles of different dialysis techniques
- Continuous renal replacement therapy (CRRT)
- Intensified hemodialysis
- Complications of HD: hypotension
- Complications of HD: disequilibrium and rarer risks
Managing the Comorbidities
Why a dialysed child needs whole-body care
- Why comorbidities dominate chronic dialysis
- Growth failure: the central challenge
- Height gains for children on dialysis
- Why children with CKD fail to grow
- Treating growth failure
- CKD mineral and bone disorder (CKD-MBD)
- Treating CKD-MBD
- Cardiovascular disease
- Anemia
- Cognitive development and quality of life
Outcomes and the Road Ahead
Where dialysed children stand today
- Long-term outcome
- Conclusions and future directions
Putting It Together
The ideas to carry away
- Three ideas to carry away
- The numbers worth remembering
- Viva: an unstable child with acute kidney injury and rising ammonia needs urgent clearance. Which modality, and why not PD?
- References (1/5)
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- References (5/5)
- Pediatric Surgery and Pediatric Urology