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Renal failure occurs when the kidneys lose their ability to filter waste products from the blood effectively. It can be classified into two types: acute renal failure (ARF) and chronic renal failure (CRF).
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Dialysis is a diffusion-based purification process that separates analyte molecules from a complex matrix. This is accomplished by allowing molecules in the solution to pass through a semipermeable membrane into a liquid on the other side. The membrane is usually made of cellulose acetate or cellulose nitrate, and the second liquid must be miscible with the solution. Ions (e.g., chloride or sodium) or organic molecules (e.g., glucose) can pass through the membrane pores, which generally have...
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Peritoneal Dialysis II: Peritoneal Dialysis Systems and Complications01:25

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Peritoneal dialysis (PD) is a medical process that removes waste products and excess fluid from the body using the peritoneal membrane as a natural filter.Peritoneal Dialysis MethodsSeveral methods can be used for peritoneal dialysis, including Acute Intermittent Peritoneal Dialysis, Continuous Ambulatory Peritoneal Dialysis, and Automated Peritoneal Dialysis, also known as Continuous Cyclic Peritoneal Dialysis.Acute Intermittent Peritoneal Dialysis (AIPD) is used for patients with uremic...
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Peritoneal Dialysis I: Introduction and Procedure01:30

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Peritoneal dialysis (PD) is a procedure that facilitates the exchange of solutes, waste products, electrolytes, and excess fluid between the blood in the peritoneal capillaries and a dialysis solution introduced into the peritoneal cavity.Principles of Peritoneal Dialysis (PD)Diffusion: Waste products such as urea and electrolytes move from high concentrations in the blood to low concentrations in the dialysate across the peritoneal membrane. This mechanism is driven by the concentration...
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Peritoneal dialysis, or PD, utilizes the peritoneal membrane as a filter to eliminate excess fluid and waste products. Effective nursing management is essential for ensuring patient safety, preventing complications, and promoting optimal function of the peritoneal dialysis process.Assessment and MonitoringNurses must thoroughly assess the patient before, during, and after each dialysis session. Regular monitoring includes vital signs, daily weight, fluid intake and output, and laboratory values...
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Patients with end-stage renal disease (ESRD) or those experiencing drug overdose often require extracorporeal methods to eliminate accumulated drugs and metabolites. Hemoperfusion, hemofiltration, and dialysis are the primary techniques to rapidly remove harmful substances without disrupting the patient's fluid and electrolyte balance. For those with compromised renal function, dosage adjustments of concurrent medications may be necessary during extracorporeal drug removal.Dialysis is a process...
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Free dialysis in Nepal: Logistical challenges explored.

John Mcgee1, Bimal Pandey2, Abhishek Maskey3

  • 1The Medical College of Wisconsin is a private, accredited medical school and graduate school of sciences located in Milwaukee, Wisconsin, United States.

Hemodialysis International. International Symposium on Home Hemodialysis
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PubMed
Summary

Nepal has seen significant growth in kidney replacement therapy (RRT) services since 2010, with free lifetime hemodialysis (HD) offered since 2016. However, challenges remain in equitable access to RRT across the country.

Keywords:
HemodialysisNepalfree hemodialysisrenal replacement therapyrenal transplantation

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Area of Science:

  • Nephrology
  • Public Health
  • Healthcare Policy

Background:

  • Nepal's Ministry of Health initiated free lifetime hemodialysis (HD) in 2016.
  • Significant expansion in renal replacement therapy (RRT) services has occurred since 2010.
  • Data on RRT in Nepal was last published in 2010.

Purpose of the Study:

  • To provide an updated statistical overview of RRT services in Nepal.
  • To highlight the growth in hemodialysis centers, patient numbers, and nephrologist availability.
  • To assess the financial implications and accessibility challenges of RRT in Nepal.

Main Methods:

  • Data compilation on hemodialysis centers, end-stage renal disease (ESRD) patients, and nephrologists.
  • Estimation of ESRD incidence and population-based rates.
  • Analysis of RRT service distribution and associated costs.

Main Results:

  • In 2016, Nepal had 42 HD centers (223% increase since 2010) serving 1975 ESRD patients (303% increase).
  • 36 nephrologists were registered, with 12 trained in transplantation, and 790 transplants performed.
  • Estimated ESRD incidence is 2900 patients (100 per million population); free dialysis could cost US$6.7 million annually.
  • 50% of HD centers are near Kathmandu, while 48% of the population lacks local HD services.

Conclusions:

  • Nepal has experienced substantial growth in RRT services, particularly hemodialysis.
  • Significant disparities in RRT access exist, with a concentration of services in urban areas.
  • Addressing infrastructure challenges is crucial for ensuring equitable RRT provision nationwide.