3: Dialysis Flashcards

1
Q

Which three process are involved in dialysis?

A

Diffusion

Convection

Adsorbption

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2
Q

What builds up in end stage kidney disease and needs to be removed by dialysis?

A

Toxins

urea, sodium, potassium

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3
Q

How is metabolic acidosis associated with end stage kidney disease corrected?

A

Sodium bicarbonate

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4
Q

What passes from the dialyte to the blood by diffusion to correct metabolic acidosis?

A

Sodium bicarbonate

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5
Q

Why does end stage kidney disease cause metabolic acidosis?

A

Kidneys can’t filter H+

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6
Q

How is the movement of water controlled in dialysis?

A

Convection / ultrafiltration

controlled by altering the pressure rather than the conc. gradients of electrolytes

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7
Q

How is the transport of plasma proteins controlled in dialysis?

A

Size of the pores in the dialyser

by absorption

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8
Q

Which processes control

a) electrolyte
b) water
c) plasma protein

transport in dialysis?

A

a) Diffusion (solute gradients)

b) Convection / ultrafiltration (pressure gradient)

c) Absorption (size of the pores)

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9
Q

How long do patients tend to be on haemodialysis for per week?

A

4 hours

3 times a week

minimum

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10
Q

What lifestyle restrictions are put on patients on dialysis?

A

Fluid restriction

Salt restriction

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11
Q

Which electrolyte imbalances are people with CKD at risk of?

A

Hypernatraemia (> fluid overload)

Hyperkalaemia (>arrythmia)

Hyperphosphataemia (bone disease)

so they’re all restricted

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12
Q

How is a patient hooked up to haemodialysis?

A

Fistula

artery and vein joined together (e.g radial artery & bacilic vein)

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13
Q

What are complications of using a fistula for dialysis?

A

Stenosis

Thrombosis

regularly reviewed

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14
Q

Fistulas are (planned / emergency) procedures for people with CKD.

A

planned operation

no good in emergency presentations

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15
Q

How is dialysis given to patients with emergency presentations of CKD / renal failure?

A

Tunneled venous catheter

internal jugular or femoral vein

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16
Q

What is a complication of using a tunneled venous catheter for dialysis?

A

Infection

17
Q

Which organism usually causes infections associated with tunneled venous catheters?

A

Staph aureus

18
Q

Which antibiotics are given for dialysis line infections?

A

IV vancomycin

19
Q

Apart from infection, what are possible complications of dialysis?

A

Hypotension - decrease in blood volume due to filtration

Haemorrhage from ruptured fistula

20
Q

How does peritoneal dialysis work?

A

Peritoneum has loads of capillaries

Fluid into peritoneal cavity, comes into close contact with capillaries

21
Q

How are

a) solutes
b) water

removed from the blood by peritoneal dialysis?

A

a) Diffusion (high > low)

b) Osmosis (dialysate has high glucose conc.)

22
Q

Why is glucose included in the dialyte in peritoneal dialysis?

A

Increases the osmolarity of the dialyte, encouraging osmosis FROM the peritoneal capillaries

The peritoneal capillaries contain glucose themselves and so have their own osmolarity which needs to be overcome

23
Q

How often are patients given continuous (bags) peritoneal dialysis for?

How long does each session take?

A

QDS

20-30 mins

24
Q

What types of peritoneal dialysis are given

a) throughout the day
b) at night?

A

a) Continuous

b) Automated

25
Q

Which bacteria can cause infection in patients on peritoneal dialysis?

A

Skin commensals (staph, strep)

Gut commensals (E. coli, klebsiella)

26
Q

What are GI complications of peritoneal dialysis?

A

Hernia

Peritonitis

27
Q

What are common causes of death in people on dialysis?

A

CVD - MI, stroke

Infection