There are two modalities of dialysis: hemodialysis and peritoneal dialysis. The indication for dialysis includes end-stage renal disease, acute renal failure, drug and chemical poisoning, acute hyperkalemia, metabolic disorder, and volume overload from congestive heart failure or lung diseases. In the case of renal failure, dialysis therapy is initiated when approximately 90% of normal renal function has been lost.
The absolute contraindications for all forms of dialysis are irreversible dementia or coma, hepatorenal syndrome, and advance malignancy. Both forms of dialysis are effective with proper patient selection. hemodialysis has the advantage of rapid clearance. It is useful in hyperkalemia, volume overload, and drug overdose. Continuous ambulatory peritoneal dialysis has been utilized during the last five years with increasing frequency in the treatment of patients with chronic renal failure. Peritoneal dialysis is preferred in patients who cannot tolerate the hypotensive state or the heparinization required for hemodialysis. Other advantages include portability, safety, fewer medications, no routine anticoagulation, and little change in hematocrit. Severe peritoneal fibro-sis or pleuroperitoneal fistula are the absolute contraindications in peritoneal dialysis.
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