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Renal Replacement Therapy In Mukundapur, Kolkata - Manipal Hospitals

Renal Replacement Therapy

Renal Replacement Therapy in Mukundapur, Kolkata

In the Paediatric Intensive Care Unit (PICU), Renal Replacement Therapy (RRT) plays a crucial role in managing critically ill children with acute kidney injury (AKI) or chronic kidney disease (CKD). When paediatric patients experience kidney failure due to conditions like sepsis, dehydration, or congenital abnormalities, their delicate physiology requires specialised care.

The need for RRT arises to maintain electrolyte balance, remove waste products, and control fluid levels, vital for stabilising the child's condition. Techniques such as Haemodialysis or Peritoneal Dialysis are tailored to suit the unique needs of paediatric patients, considering factors like size, age, and underlying conditions. Without starting RRT quickly, the build-up of toxins and fluid imbalances can quickly get worse, putting the child's health at risk. Therefore, in the PICU, Renal Replacement Therapy in Mukundapur, Kolkata, serves as a critical intervention, providing optimal renal support and enhancing the chances of recovery for young patients.

FAQ's

Signs and symptoms of renal impairment that indicate a child may require Dialysis include:

  • Fatigue

  • Stomach aches

  • Swelling around the face

  • Frequent urination

  • Abdominal cramps

  • Desiccated skin

  • Loss of appetite

Renal Replacement Therapy (RRT) encompasses various modalities tailored to the patient's needs and clinical condition:

  • Continuous Hemofiltration and Haemodialysis: For extremely ill children with acute renal failure who cannot tolerate other forms of RRT, continuous Hemofiltration and Haemodialysis are temporary therapeutic options. This procedure constantly and continually filters the blood. 

  • Intermittent Haemodialysis: A machine removes fluid, salts, and waste products from the blood. Haemodialysis will be administered to your child at our hospital, often three times a week for three to five hours per session.

  • Peritoneal Dialysis: This kind filters the child's blood using the peritoneum, a membrane that covers the abdominal organs and lines the abdomen. This kind of RRT can be performed manually or with the aid of a machine (Automated Peritoneal Dialysis)

Dialysis maintains the bodily equilibrium of a child by

  • Removing excess fluid aids in lowering blood pressure and preventing oedema.

  • Eliminating wastes such as potassium and phosphorus, which can be harmful to the body if blood levels become excessive. 

There are dietary (food) restrictions for most children receiving Dialysis, though each child is unique. Avoiding foods heavy in potassium, phosphorus, and sodium (salt) is one common restriction. Many children receiving Dialysis have to restrict how much fluid they consume each day to prevent excessive weight gain from the extra water that accumulates in the body in between treatments. To grow and maintain their health, some children receiving Dialysis may also require dietary supplements, such as additional protein and vitamins. 
 

A cleansing solution known as dialysate is injected into the abdomen during Peritoneal Dialysis. Additionally, dialysate absorbs waste and excess water through perforations in the stomach lining and then washes it back out, carrying the waste and water with it. Children require the insertion of a flexible, soft tube called a catheter into their abdomen before beginning Peritoneal Dialysis. Under general anaesthesia, doctors insert the catheter while the child is unconscious.

Children can begin Peritoneal Dialysis treatments once the surgical site has healed, which typically takes two weeks. Some might receive the treatment sooner if necessary.
 

In comparison to in-hospital Dialysis, home Haemodialysis is gentle and slow, yet immensely effective. The benefits of Haemodialysis at home include:

  • It provides you with independence and control over your child's medical care because you are the one doing the therapy.

  • You can work around your child's daily schedule, hobbies, and family time because you can do the therapy while they are asleep. 

  • You can also minimise travel time and associated costs by performing the therapy while your child is asleep. 

  • Your child will need to take fewer medications than they would if they were receiving Peritoneal Dialysis or in-hospital Hemodialysis.

  • It enables your child to attend school more frequently than they would if they were undergoing in-hospital Hemodialysis.

  • It helps your child feel more secure throughout the treatment.

Renal Replacement Therapy (RRT) carries certain risks, including:

  • Complications of catheterisation: This includes haemorrhage, hypotension, thrombosis, pneumothorax, and altered limb perfusion, necessitating careful monitoring and prompt intervention. 

  • Imbalances in electrolytes: These include hypo- and hypernatraemia, hypokalaemia, hyperkalaemia, hypochloraemia, hyperchloraemia, hypocalcaemia, hypercalcaemia, hypophosphataemia, hyperphosphataemia, and hypo- and hypermagnesemia.

  • Haemodynamic instability: This includes hypotension that needs to be corrected after connecting to the filter.

  • Fluid depletion or excess: This may cause hypovolemia or oedema.

  • Infection: Catheter insertion sites are linked to an increased risk of infection.

  • Metabolic acidosis or alkalosis: This is the result of therapeutic adjustments to the acid-base balance.

Under general anaesthesia, Kidney Transplant surgery takes three to four hours to complete. Usually, transplant surgeons make a lower abdominal incision to connect the new kidney to the bladder. Unless the nonfunctioning kidneys are creating complications like high blood pressure or an excessive amount of protein in the urine, they are often kept in place. 

Within a few hours, the new kidney starts to function, and the incision usually heals quickly. In the case of live donations, it typically functions before the patient leaves the operating room. In certain situations, a drain may be used for a few days to collect fluid and keep an eye out for leaks. The transplant team will prescribe medication to assist in controlling discomfort, avoiding infection, and preventing ‌transplanted kidneys from being rejected. Within a week, most patients leave the hospital and can return to their regular diets in a few days.
 

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