90945 Dialysis procedure other than hemodialysis (eg, peritoneal dialysis, hemofiltration, or other continuous renal replacement therapies), with single evaluation by a physician or other qualified health care professional

Name of the Procedure:

Peritoneal Dialysis, Hemofiltration, or Continuous Renal Replacement Therapy (CRRT)

Summary

These dialysis procedures are alternative methods to hemodialysis used to clean the blood and remove excess fluids and toxins when the kidneys are not adequately functioning. They can be continuous or intermittent and conducted inside the body or through extracorporeal methods.

Purpose

These procedures address kidney failure or severe kidney dysfunction. The primary goals are to:

• Remove waste products and excess fluids from the blood.
• Correct electrolyte imbalances.
• Prevent the buildup of toxins.

Indications

• Chronic kidney disease.
• Acute kidney injury.
• Severe fluid overload.
• Patients who cannot undergo hemodialysis due to vascular issues or other contraindications.

Preparation

• Follow fasting instructions if required (usually not needed for peritoneal dialysis).
• Adjust medications as advised by the healthcare professional.
• Undergo necessary diagnostic tests, such as blood tests and imaging studies.

Procedure Description

Peritoneal Dialysis:

1. A catheter is surgically placed into the peritoneal cavity.
2. Dialysis solution is introduced into the peritoneal cavity via the catheter.
3. Waste products and excess fluids pass through the peritoneum into the dialysis solution.
4. The solution is drained out and replaced with fresh solution multiple times a day or through an automated machine at night.

Hemofiltration:

1. Blood is withdrawn from the patient and passed through a hemofilter using a dialysis machine.
2. The hemofilter removes waste products and excess fluids.
3. The cleansed blood is returned to the patient.

Continuous Renal Replacement Therapy (CRRT):

1. Similar to hemofiltration but occurs continuously, typically in an intensive care unit (ICU).
2. Blood is filtered continuously to manage severe cases of kidney failure.

Duration

• Peritoneal Dialysis: Each session can take 30-40 minutes, performed multiple times daily or overnight.
• Hemofiltration: Several hours at a time.
• CRRT: Continuous 24-hour treatment.

Setting

• Peritoneal Dialysis: Often performed at home, after initial training.
• Hemofiltration and CRRT: Typically done in a hospital or ICU.

Personnel

• Physicians or Nephrologists.
• Trained nurses or dialysis technicians.
• Possibly an anesthesiologist if anesthesia is involved for catheter placement.

Risks and Complications

• Infection of the catheter site or peritoneum.
• Abdominal pain or bloating (for peritoneal dialysis).
• Low blood pressure or electrolyte imbalances.
• Blood clotting issues (for hemofiltration and CRRT).

Benefits

• Effective removal of waste products and excess fluids.
• Can be a viable alternative for patients unable to undergo hemodialysis.
• Offers continuous or flexible treatment options tailored to patient needs.

Recovery

• Monitor for any signs of infection or complications.
• Follow specific instructions for catheter care and fluid management.
• Regular follow-up appointments with the healthcare team.
• Recovery time varies, maintain hygiene and adhere to dietary and fluid restrictions as advised.

Alternatives

• Hemodialysis.
• Kidney transplant.
• Conservative management including diet and medications.
• Each alternative has its pros and cons, and the best choice depends on the individual patient’s condition and circumstances.

Patient Experience

• Initial adjustment period, particularly for peritoneal dialysis.
• Possible discomfort or anxiety associated with catheter placement.
• Sensation during fluid exchanges (for peritoneal dialysis).
• Continuous monitoring in the ICU for CRRT.
• Pain management strategies will be used to ensure patient comfort.