2 - HD and RRT (Shepler)

Question 1

What are the two main types of dialysis?

Answer 1

HD and PD

Question 2

What are the types of PD

Answer 2

continuous ambulatory PD
continuous cyclic PD
nocturnal intermittent PD
nocturnal tidal PD

Question 3

What are the types of continuous RRT used for AKIs?

Answer 3

continuous arteriovenous hemofiltration (CAVH)
continuous venovenous hemofiltration (CVVH)
continuous venovenous hemodiafiltration (CVVHD)

Question 4

What is ultrafiltrate?

Answer 4

waste products removed during continuous RRT

Question 5

What is an AV fistula?

Answer 5

surgically created anastamosis btw an artery and a vein, usually located in the forearm btw radial atery and cephalic vein used for HD access

Question 6

What is an AV graft?

Answer 6

alternate to a fistula, the graft is created by surgically connecting an artery and vein w a polytetrafluoroethylene tube

Question 7

**What are indications for RRT?

Answer 7

Acid/base balance
Electrolyte balance
Intoxiciation
Overload (fluid)
Uremia *****

Question 8

Describe hemodialysis as a therapy.

Answer 8

for ESRD pts

intermittent – 3-4 hrs MWF or TRS

Question 9

What are the goals of dialysis?

Answer 9

1. initiate when BUN>100 and SCr >10 (also S/Sx)

2. removal of “middle molecules”

Question 10

What are the “middle molecules”?

Answer 10

substances that when at high levels in the urine cause patients to feel sick

<65 Da: urea, Cr
500-5000 Da: beta2microglobulin, phospholipase A2

Question 11

What are the two types of vascular access for HD?

Answer 11

AV fistula

AV graft

Question 12

**Describe an AV fistula w respect to survival rate, times to maturity and risk of infx in comparison to an AV graft.

Answer 12

AV fistula: longest survival (~20 yr), 2-3 mo to mature, low risk of compx

graft: synthetic, shorter survival ,incr infx rates, 2-3 wks to mature

Question 13

**What are the PK chara of aminoglycosides and vancomyci in HD pts? What is an appropriate dosing regiment for each?

Answer 13

… don’t worry about this for now

Question 14

What are substances that are not removed by dialysis?

Answer 14

1. high Vd
2. high lipophilicity
3. large MW
4. highly protein bound

Question 15

What measures are used to gauge the effectiveness of a dialysis session?

Answer 15

1. Kt/V

2. Urea reduction ratio (URR)

Question 16

Describe Kt/V

Answer 16

measure of the total body water that is cleared of urea

K=clearnce of urea
t=time on dialysis
V=Vd of urea

goal=at least 1.4

increase time if <1.4

Question 17

Describe URR.

Answer 17

Urea reduction ratio.

measure of the reduction of BUN; goal >= 70% reduction

Question 18

What are common complications of HD?

Answer 18

hypoTN
pruritis
muscle cramps