Coda Change

Critical kidney and dialo-trauma

17 snips
Feb 13, 2024
Dr. Emily See discusses the critical implications of acute kidney injury and kidney replacement therapy. She introduces the concept of 'dialytrauma,' revealing how certain dialysis practices can harm patients. The podcast highlights the consequences of rapid fluid shifts and intradialytic hypotension, potentially worsening kidney recovery. Evidence shows significant reductions in renal perfusion and the risks of cardiac injury during dialysis. Furthermore, cognitive decline and altered organ perfusion, including the gut and liver, are explored, emphasizing the need for focused research.
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INSIGHT

Dialysis May Worsen Kidney Recovery

  • Initiating dialysis can perpetuate renal injury via intradialytic hypotension and reduced renal perfusion.
  • Animal and historical human data link transient hypotension during dialysis to worsening creatinine and tubular necrosis.
ANECDOTE

War-Era Autopsies Linked Dialysis To New Tubular Damage

  • Vietnam War patient autopsies showed fresh focal tubular necrosis after dialysis sessions weeks following the initial injury.
  • The only temporal hemodynamic events were transient blood pressure drops during repeated haemodialysis.
INSIGHT

Dialysis Reduces Renal Perfusion And Recovery

  • Imaging during intermittent haemodialysis shows renal perfusion drops ~18% and often doesn't fully recover immediately.
  • Reduced perfusion correlates with hypotension, high ultrafiltration and dialysate temperature.
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