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
