Dialysis procedure other than hemodialysis (eg, peritoneal dialysis, hemofiltration, or other continuous renal replacement therapies) requiring repeated evaluations by a physician or other qualified health care professional, with or without substantial re
CPT4 code
Name of the Procedure:
Peritoneal Dialysis (PD), Hemofiltration (HF), Continuous Renal Replacement Therapy (CRRT)
Summary
This procedure involves filtering waste products and excess fluids from the blood when the kidneys can no longer perform these functions naturally. It does not require access to the bloodstream as hemodialysis does, but instead utilizes the peritoneal cavity or specialized filtration techniques to cleanse the blood.
Purpose
The procedure addresses kidney failure or severe kidney dysfunction by removing toxins and excess fluid from the body. The goal is to improve quality of life, prolong survival, and manage the symptoms of kidney failure.
Indications
- Chronic kidney disease
- Acute kidney injury
- Fluid overload
- Electrolyte imbalances
- Patients unable to undergo hemodialysis due to vascular access issues
Preparation
- Follow a specific diet to manage electrolytes and fluid balance.
- May require fasting or adjustment of medications as advised by the healthcare provider.
- Blood tests and imaging studies to assess overall health and plan the procedure.
Procedure Description
Peritoneal Dialysis (PD):
- A catheter is surgically placed into the abdomen.
- Dialysate fluid is infused through the catheter into the peritoneal cavity.
- Waste products and excess fluid are absorbed into the dialysate, which is then drained and replaced with fresh fluid.
Hemofiltration (HF):
- Blood is passed through a filter to remove waste products and excess water.
- Ultrafiltration and convection processes assist in cleansing the blood.
Continuous Renal Replacement Therapy (CRRT):
- Continuous blood purification process over 24 hours.
- Combines elements of hemodialysis and hemofiltration.
- Commonly used in critical care settings.
Tools include catheters, dialysis solutions, filtration devices, and dialysis machines. No sedation is typically required, but local anesthesia is used for catheter placement.
Duration
PD: Approximately 4-6 exchanges per day, with each exchange taking about 30-40 minutes. HF and CRRT: Continuous over several hours (CRRT can last 24 hours).
Setting
PD: Can be performed at home after training. HF and CRRT: Performed in a hospital or intensive care unit (ICU).
Personnel
- Nephrologist
- Nurses specialized in dialysis care
- Surgical team for catheter placement (for PD)
- Critical care team for CRRT
Risks and Complications
- Infection (peritonitis for PD)
- Catheter malfunction
- Electrolyte imbalances
- Fluid overload or dehydration
- Low blood pressure
Benefits
- Effective waste and fluid removal
- Can be adjusted to fit patient needs
- Generally less invasive and more continuous than hemodialysis
- Improved quality of life and symptom management
Recovery
- Patients can usually return to normal activities with some restrictions.
- Regular follow-up appointments.
- Ongoing training updates for home dialysis.
Alternatives
- Hemodialysis: Requires vascular access and frequent clinical visits.
- Kidney Transplant: Long-term solution but limited by donor availability and suitability.
- Conservative Management: Symptom control without dialysis, focuses on quality of life.
Patient Experience
- Initial discomfort from catheter placement.
- Mild to moderate discomfort during fluid exchanges.
- Patients typically experience less fatigue compared to hemodialysis.
- Pain management strategies include local anesthesia for catheter placement and analgesics for discomfort.