Dialysis in HIV Infected Patients Hemodialysis Vs Peritoneal Dialysis

Introduction:

Chronic kidney disease (CKD) in HIV patients requiring dialysis poses unique challenges and considerations. HIV infection itself increases the risk of kidney disease, and the presence of CKD further complicates the management of these individuals.Here we report one such case.

CASE REPORT: A 54 years old male,retro positive individual on ART drugs,long standing T2DM and Systemic Hypertension,developed CKD due to Diabetic nephropathy,progressed to stageV CKD(ESRD).

He admitted with chest pain and uremic complications,and was initiated on Hemodialysis. On cardiac evaluation diagnosed to have coronary artery disease and advised medical management at present.

Handling a HIV Positive Individual In Hemodialysis:

1. Standard Precautions: It is essential to follow standard precautions, including wearing gloves, gowns, masks, and eye protection.
2. Dialysis Technique: Ensure that the dialysis technique is sterile, with strict aseptic technique.Double cleaning of the machine and left 12 hours idle.No reuse of the dialyzer.
3. Risk of Needle stick injury is high compared to the routine patients.

Since the risks of cardiac complications in CAD patients during hemodialysis is high like arrhythmia,hypotension including sudden cardiac death compared to peritoneal dialysis,after obtaining informed consent he was taken in for PD .

Peritoneal dialysis (PD) is a type of dialysis that involves the insertion of a catheter into the abdominal cavity to remove waste products and excess fluid from the body. PD can be performed at home or in a medical facility and is a suitable treatment option for patients with end-stage renal disease (ESRD). However, for patients who are HIV positive, special precautions need to be taken to avoid the risk of transmission.

Handling a HIV Positive Individual in Peritoneal Dialysis:

1.The first step in handling an HIV positive patient is to ensure that the peritoneal dialysis technician has been properly trained in infection control procedures. This includes the use of personal protective equipment (PPE) such as gloves, gowns, and masks, as well as proper hand hygiene techniques.

2.When setting up the PD equipment, the peritoneal dialysis technician should take care to avoid any exposure to the patient’s blood or bodily fluids.

3.Disposal of PD fluid:The used bag should be discarded in the double bagging method. We should discard into the toilet to keep the bag in the low level to prevent spitting back.

In conclusion,the important things to be considered here are,

Increased Risk: HIV infection is associated with an increased risk of developing kidney disease, including CKD. Factors contributing to this risk include direct viral effects, coexisting conditions (such as hypertension and diabetes), and certain antiretroviral medications.

Viral load suppression: Achieving and maintaining viral load suppression in HIV patients on dialysis is crucial. Effective antiretroviral therapy (ART) is necessary to preserve immune function and reduce the risk of opportunistic infections. Special attention should be given to drug selection to minimize the potential for adverse interactions with dialysis treatments.

Adherence to therapy: Adherence to both antiretroviral medications and dialysis treatments is vital for optimal outcomes. Comprehensive patient education, support systems, and regular follow-up are essential to promote treatment adherence and ensure effective disease management.

Potential complications: HIV patients on dialysis may be at an increased risk of certain complications, including infections (such as peritonitis in peritoneal dialysis), vascular access-related issues, and cardiovascular disease. Close monitoring and proactive management are required to minimize these risks.

In summary, managing CKD on dialysis in HIV patients necessitates a comprehensive, multidisciplinary approach. Through close collaboration, it is possible to provide these patients with effective care and improve their overall health outcomes.