21) Renal Replacement Therapy Flashcards
What is end-stage renal failure?
When death is likely without renal replacement therapy, eGFR<15 mls/min
List some symptoms of ESRD:
Tiredness- physically and mentally incapacitated Difficulty sleeping Difficulty concentrating Nausea and vomiting / reduced appetite Cramps Pruritus Increased infections
What causes uraemic symptoms in those with CKD?
Accumulation of waste products
Why may drug doses need altering for CKD patients?
Reduced metabolism and/or elimination of drug
Drug sensitivity may be increased, side effects more likely e.g. statins
How often is haemodialysis carried out?
4 hours, 3 times a week
Describe the process of haemodialysis:
Blood taken from the body, travels through a pump to increase the pressure, then filtered across a semi permeable membrane to remove waste products using a dialysis fluid
Anticoagulants stop blood clots in machine
What is required in order to gain vascular access?
Arteriovenous fistula
Why is an arteriovenous fistula needed?
Pressure of blood means it moves from artery to vein so vein becomes dilated with thicker walls and faster flow.
If this wasn’t in place, artery would collaspe
When can haemodialysis not be used?
Failed vascular access
Heart failure
Coagulopathy
What are some complications of haemodialysis?
Infection Thrombosis Bleeding Accumulate morbidity Steal syndrome - less arterial supply to peripheries due to fistula
List some advantages of haemodialysis:
Less responsibility
Days off of illness
Effective
Can do from home/at night (in some cases, need someone at home)
List some disadvantages of haemodialysis:
Travel time
‘Tied’ to dialysis times
Large restriction on food and fluids
CVS instability
Describe peritoneal dialysis:
Dialysate inserted into peritoneal space and waste products cross peritoneal membrane (semi permeable) into peritoneal space. Then drain out waste
How frequently does peritoneal dialysis need to be undertaken?
4-5 bags a day (30 mins)
Overnight
When can’t peritoneal dialysis be used?
Failure of peritoneal membrane (surgery, peritonitis)
Obese or large muscle mass
What complications arise from peritoneal dialysis?
Peritonitis Leaks (into hernias)
What are the advantages of peritoneal dialysis?
Can do at home
Less restrictions on fluid and food
Portable
Self-sufficient
What are the disadvantages of peritoneal dialysis?
Frequent
Responsibility
Peritonitis
No long term survivors
Where is a kidney transplanted to?
Iliac fossa, connected iliac vessels and bladder
What types of kidney donors are there?
Live
Deceased after brain death
Deceased after circulatory death
How are kidneys matched?
Tissue match (ABO and HLA)
Length of time on waiting list
Age (paeds take priority)
What are the advantages of kidney transplant?
Decreased mortality
Increased quality of life
Good long term
Allows mobility
What are the disadvantages of kidney transplant?
Limited donors Peri-operative risk Life long immunosuppression Infection risk Malignancy risk
What transplant medications are required?
Anti-rejection drugs
Steroids
Anti-bacterials/virals
Ranitidine
What are some consequences of transplant medications?
Hypertension
Inflammation
Diabetes
Osteoporosis
What are the 3 main causes of death in CKD?
Cardiac disease
Infection
Malignancy
