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Renal Replacement Therapies
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Continuous Renal Replacement Therapy (CRRT)
Indications: Acute kidney injury, especially in hemodynamically unstable patients. Procedure: Slow continuous removal of toxins and fluids over 24 hours, using a hemofilter. Potential complications: Hypothermia, bleeding due to anticoagulation, and catheter-related infections.
Peritoneal Dialysis
Indications: End-stage renal disease, patients who want more independence and flexibility, or those with vascular access issues. Procedure: A dialysis solution is infused into the abdominal cavity via a surgically placed catheter; waste and fluid pass into the solution which is then drained. Potential complications: Peritonitis, hernias, weight gain, and catheter-related infections.
Hemofiltration
Indications: Used as a modality of CRRT for patients with acute kidney injury and fluid overload. Procedure: Blood is passed through a series of filters to remove solutes and water based on convection rather than diffusion. Potential complications: Electrolyte imbalances, bleeding, and hypotension.
Hemodialysis
Indications: Chronic kidney disease, end-stage renal disease, acute kidney injury, toxin elimination. Procedure: Patient's blood is filtered through a dialyzer where waste products and excess fluids are removed. Potential complications: Hypotension, muscle cramps, infection, blood clots, and long-term complications like anemia or bone disease.
Plasmapheresis
Indications: Autoimmune disorders affecting the kidney, certain types of glomerulonephritis, and TTP. Procedure: Blood plasma is separated from blood cells and replaced with fresh plasma or a plasma substitute to remove harmful substances. Potential complications: Hypocalcemia (from citrate anticoagulation), allergic reactions, infection, and thrombosis.
Kidney Transplantation
Indications: End-stage renal disease, severe chronic kidney disease. Procedure: A donor kidney is transplanted into the patient; requires immunosuppressive therapy. Potential complications: Rejection of the transplanted organ, infection, recurrence of original kidney disease, and side effects from immunosuppression.
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