Compare_and_Contrast_Essay

Eleven years ago when I became critically ill my kidneys began to fail. As a result of my failing kidneys, hemodialysis was started. Throughout this ordeal, I was unconscious and unable to make any decisions regarding my care, leaving this burden on my family and physicians. In the intensive care unit my hemodialysis continued around the clock for one week. Once I was stabilized, I was transferred out of the intensive care unit to a regular room. Out of ICU, my dialysis continued 3 times a week for the next 2 weeks. Without dialysis for my kidneys, I would not have survived my illness. Hemodialysis and peritoneal dialysis are the two methods of dialysis available to treat renal failure. Each method has different administration techniques and diet specifications, but similarly they extend the life of patients in renal failure. First, hemodialysis and peritoneal dialysis both use the same principles of osmosis and diffusion. During the process of osmosis and diffusion, both methods of dialysis filter excess chemicals, waste products, and fluid from the bloodstream. During hemodialysis, the hemodialyzer membrane provides ultrafiltration, and wastes clearance properties. During peritoneal dialysis, the membrane in the peritoneum has these same ultrafiltration and clearance capabilities. In the Nephrology Nursing Journal, the author says, “Necessary elements include a semipermeable membrane, dialysate solution, and a surgically created access” (Zorzanello, 2004, p. 588). The membrane the author is referring to is the membrane in the hemodialyzer for hemodialysis patients, or the peritoneal membrane in the abdomen of the patient receiving peritoneal dialysis. The dialysate is an important aspect of both hemodialysis and peritoneal dialysis because dialysate contains the osmotic components necessary for removing of excess fluid from the bloodstream. According to Zorzanello, (2004) “the sodium dialysate is varied during hemodialysis to achieve fluid balance, while peritoneal dialysate employs various dextrose concentrations or glucose polymers.” Hemodialysis has the added advantage of machine controlled fluid transfer, but peritoneal dialysis patients are taught to use different dialysate solutions to regulate body water. (Zorzanello, 2004). Specifically, the surgically created access must be well functioning to achieve adequacy in both hemodialysis and peritoneal dialysis. In hemodialysis, the vascular access, often referred to as the port, is created to transfer the patient’s blood from his or her body to the machine, or hemodialyzer. In peritoneal dialysis, the port is a surgical access in which a catheter is put into the abdomen. Peritoneal dialysis takes place through this port to which the dialysate can be connected, and introduced into the patient’s abdomen. After several hours the dialysis is complete, and the dialysate solution is then removed through the same port. Secondly, both methods of dialysis require some changes in diet of the patient. The diet specifications are different for a patient on hemodialysis than they are for a patient receiving peritoneal dialysis. This is important because the patient’s kidneys cannot filter fluids on its’ own. An excess amount of these minerals can cause the body to retain excess fluids, causing additional stress on the kidneys and heart. The patient on hemodialysis has a greater restriction on fluid intake than the patient on peritoneal dialysis. The reason for this is because the patient on hemodialysis is only dialyzed three times each week, whereas the patient on peritoneal dialysis is dialyzed daily. If the patient builds up too much fluid, there is strain on the heart to pump the excess fluid. Potassium restrictions are necessary to prevent a buildup in the bloodstream, which can cause a heart attack. Therefore, because the bloodstream is only cleansed three times weekly, it is necessary to limit the amount of potassium in the diet. The patient on peritoneal dialysis does not have as many restrictions because his or her bloodstream is cleansed daily, reducing the risks of too much mineral or fluid buildup. Dietary guidelines for a patient on peritoneal dialysis will limit salt and fluid intake, but they are not limited as strictly as they are for a hemodialysis patient. Peritoneal dialysis patients have to eat more protein, and potassium containing foods, but fewer calories because the dialysate fluid used in peritoneal dialysis contains glucose which adds calories, and may cause weight gain. The patient receiving hemodialysis has a diet of high protein foods, but limits the amount of potassium rich foods consumed. In addition, the patient should limit fluids, salt, and foods or beverages containing large amounts of phosphorus. (NKUDIC, September, 2010). Dialysis patients will require daily medications as well. The medications may be different for a patient on hemodialysis than they are for a patient on peritoneal dialysis for much of the same reason as diet restrictions. Medications can build up in the bloodstream just as other toxins and fluids. Patients on hemodialysis need to be monitored closely for necessary change in medications. Since the kidneys cannot process the excess medications, there is a significantly higher risk of medication toxicity. Dialysis will cleanse the excess, but when the patient is only getting dialysis three times weekly, the excess medications will build up at a much higher rate than a patient who is peritoneal dialyzing daily. Although there are many similarities between hemodialysis and peritoneal dialysis, there are also many differences. Some of those differences are in the advantages and disadvantages. The main advantage of hemodialysis is that it is always done by a professional so there is less chance for error. Moreover, since it is done in a dialysis center this permits contact with other patients receiving dialysis; therefore, patients’ have the emotional support of each other. Another advantage is that dialysis is done fewer times each week and for a less amount of time. With advantages, also come disadvantages; the advantages of hemodialysis include having to travel to a dialysis center for every treatment. This means that traveling for vacations would involve having to make arrangements at a dialysis center wherever the patient will be traveling. The advantages of choosing peritoneal dialysis are that the patient does the dialysis him or herself. It can be done at home, or anyplace that has sanitary conditions. Some people even choose to set up peritoneal dialysis during their sleeping hours. The food and fluid restrictions are much less than a person on hemodialysis because it is done daily. However, the main disadvantage of peritoneal dialysis is that some people cannot perform such procedures on their own bodies. Peritoneal dialysis also increases the risk for peritonitis, an infection involving the lining of the abdomen resulting from bacteria introduced through the access site. If an infection occurs through the access site, the patient risks becoming septic which is an infection in the bloodstream. The side effects of dialysis include fatigue, malaise, low blood pressure, and the risk of blood clots. Hemodialysis and peritoneal dialysis are very similar yet very different. Both offer life-saving cleansing the body cannot perform naturally. The major differences lie in the technique, surgically prepared access site, frequency of dialysis treatment, diet, medication, and convenience. Hemodialysis and peritoneal dialysis both sustain and extend the life of a patient in renal failure. References Zorzanello, M. M. (Sep/Oct 2004). Peritoneal Dialysis and Hemodialysis: Similarities and Differences. Nephrology Nursing Journal, 31(5), 588-589. National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC) (September, 2010)