Comparing Peritoneal and Hemodialysis for Kidney Disease

This assignment requires a student to compare and contrast peritoneal dialysis and hemodialysis, two types of renal replacement therapies used to treat patients with end-stage renal disease. The student must discuss the benefits and drawbacks of each method, including their effects on mobility, dietary freedom, and infection risk. The assignment also asks the student to consider the importance of proper catheter care in preventing infections associated with peritoneal dialysis. By analyzing these factors, the student will gain a deeper understanding of the relative advantages and disadvantages of peritoneal dialysis and hemodialysis, enabling them to make informed decisions about which treatment option is most suitable for individual patients.

Nursing
Student’s name:
Institutional:

Task 1: Diagnosis
a.) RENAL FAILURE STAGE
Abe is at the Renal Failure stage of Chronic Kidney Disease. This is the third stage
of chronic kidney disease. At this stage glomerular filtration rate is reduced to 20%-50%.
Abe’s GFR is 20 ml/min which is 16% of the normal (125 ml/min/1.73m2). At this point,
the kidneys are not able to regulate the normal volume and solute composition. Patient
develop oedema, metabolic acidosis, uremia, neurologic manifestation for example
convulsions and encephalopathy, nephron destruction occurs leading to decreased
phosphate excretion, changes in parathyroid function and lipid clearance noted,
intestinal abnormalities are frequent with anorexia, nausea and vomiting.
b.)
The pathology test will would best indicate Abe’s renal function is Glomerular
filtration rate. This is because it describes the rate of flow of filtered fluid through the
kidney. Measure how kidneys are working through concentration of creatinine, urea as
well as electrolytes to determine renal function (Webster, Nagler, Morton, & Masson,
2017). Glomerular filtration rate not only helps in detecting presences of renal
abnormality but also assist in monitoring those already with or at risk of renal
impairment. Moreover, it’s useful in calculating appropriate dose of drugs which can be
cleared by kidney.
Task 2: Health promotion
a.) EDUCATIONAL POINTS TO PREVENT DISEASE PROGRESSION
Diet changes, reduce salt (sodium) in diet. Limitprocessed food such as frozen
dinner, canned fish rather eat unprocessed food such as lean beef, and avoid the over
the counter drugs with sodium bicarbonate. Limit potassium intake. Don’t eat whole-
grain breads, wheat and milk. Limit phosphorus and protein rich food. Potassium and
phosphorous cause weakness, muscle cramps, and irregular heartbeats while sodium
limit reduce high blood pressure (Tomson, & Bailey, 2011). Regular physical exercise
also helps lower blood sugar and blood pressure. Achieving a health weight improve
heart and lung health.

Good blood pressure control and changes in lifestyle can help manage high blood
pressure, for example, quitting smoking, regular body exercise, cutting down on alcohol
and appropriate use medications also to control blood pressure. Smoking cause poorly
and uncontrolled blood pressure and also affects medicines used to treat high blood
pressure. Moreover, smoking slows blood flow to organs like kidney (Go, Chertow, Fan,
McCulloch & Hsu, 2014).
Help reduce stress. It may take time to adjust to the disease and patient to keep
involved in pleasures, activities and responsibilities of daily life. Share your feelings with
family, relatives and close friends or joining support group (Go et al ,2014).
Taking medications as prescribed. Taking medication as prescribe by medical
practitioner and avoid over the counter drugs such as anti-inflammatory drugs because
they can damage the kidney.
Diabetes control through conservative management, for example, exercise, taking drugs
as prescribed, regular check-ups and managing stress. Ensure also that there early
management of complications of diabetes especially nephropathy (Tomson, & Bailey,
2011).
b.) HEALTH IMPROVEMENT INTERVENTIONS
1. Diet modification
Early protein restriction (daily intake to be 0.6kg), potassium restriction (Burton, &
Harris, 2011). Salt and water restriction, daily water intake be 500mls plus output this
slows progression of disease.
2. Management of complications
i) Anemia, treatment with hematocrit. Rule out iron and vitamin B12 deficiency.
Administer recombinant erythropoietin since stimulate red blood cell production
(Locatelli et.al 2011).
ii) Hypertension
Use of loop diuretics like furosemide and metformin and angiotensin converting enzyme
inhibitor such as Ramipril to reduce blood pressure (Reddi, 2016) and restrict sodium
intake.
iii) Hyperkalemia
Dietary restriction of food potassium containing food (Kidney Health Australia, 2012).

iv) Renal osteodystrophy
Reducing serum phosphate by restricting diet, use of aluminum based antacids and oral
phosphate binders to bind phosphate. Administer calcium carbonate orally to increase
level of calcium for bone formation.
3. Pharmacological intervention
Administer intravenous calcium to counteract cardiac toxicity, intravenous glucose and
insulin to enhance potassium reuptake and also sodium carbonate to correct metabolic
acidosis (Kraut, & Madias, 2016).
4. Emergency dialysis
This is the final recourse for the patient if he is unresponsive to conservative
management and also if the glomerular filtration rate decreases to less than 15ml/min,
that is, End stage Renal disease.
Task 3: Treatment options
COMPARE AND CONTRAST RISK AND BENEFITS OF PERITONEAL DIALYSI AND
HAEMODIALYSIS
BENEFITS
Peritoneal dialysis is less costly as compared to Haemodialysis because hospitalization
rate is lower among the patients thus less cost of paying hospital bill. In Hemodialysis
there is less patient responsibility because of hospitalization and patient care is mostly
done by nephrology nurse or nephrologist (Levy, Brown, & Lawrence, 2016).
Peritoneal dialysis also enhances patient autonomy and this influence on prevention of
peritonitis and offers Patient survival. Moreover, patient satisfaction is well achieved in
peritoneal dialysis since the patients are more Involved in their treatment as opposed to
haemodialysis. Residual renal function (RRF) is more maintained. This is a major
contributor.
In peritoneal dialysis Thrombosis rate is unaffected and catheter- related problems are
infrequent as compared to haemodialysis. There is fewer dietary Restrictions in
peritoneal dialysis while haemodialysis has more dietary restrictions for it to be more
effective (Sinnakirouchenan, & Holley, 2011). Hemodialysis carries a relatively Low risk
of infection than that of peritoneal dialysis since it has a better tolerance.
RISKS

Peritoneal dialysis has higher technique failure, that is, membrane failure and infection
of the abdominal lining (Fento et.al, 2010), it disrupts daily schedule since it is a
continuous treatment and all exchanges must be performed 7 days a week. There is
weight gain since the dialysate contain sugar (dextrose). Risk of hernia in peritoneal
dialysis because holding of fluids for long in abdomen strain muscles. Also patient and
care giver burnout happens when there is continuous stress or distress.
Hemodialysis has risk of hypotension particularly in diabetic Patients and also bone
disease due to abnormal hormone level which causes calcium and phosphorous level to
be out balance. Risk anemia due to blood loss and muscle itching due to high level of
phosphorous because phosphorous is not effectively removed during dialysis (Levy,
Brown, & Lawrence, 2016).
There is also risk of infection due to catheterization, respiratory compromise such as
shortness of breath, pericarditis and inflammation of the membrane around which leads
to sudden cardiac death in people undergoing dialysis. Risk of irregular heartbeat likely
to also occur due to high level of potassium in blood leading to cardiac arrhythmias.
RECOMMENDATION FOR APPROPRIATE TREATMENT
I would recommend peritoneal dialysis. It’s a treatment that uses the lining of the
abdomen
(peritoneum) and a cleaning solution which is the dialysate to purify blood. Dialysate
absorb waste and fluid from the blood. I would recommend this for Abe because it is not
done in a dialysis center but he can do it at home so long as it’s done in a clean and dry
place. It’s also less costly as compared to haemodialysis and it allows more freedom to
work, travel or to do other activities. There is also more freedom of what to eat and drink
in peritoneal dialysis than in Hemodialysis. This is because peritoneal dialysis ha fewer
dietary restrictions (Sinnakirouchenan, & Holley, 2011). The most important thing that
Abe need to be careful is to prevent infection which mostly occurs through the catheter,
it happens when the incision is not cleaned well or when he is connecting or
disconnecting from dialysate bags.

References
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Tomson, C., & Bailey, P. (2011). Management of chronic kidney
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