336 Dialysis in Treatment of Renal Failure

Question 1

In the US, the leading cause of ESRD

Answer 1

Diabetes mellitus

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Question 2

Major cause of death in ESRD patients

Answer 2

Cardiovascular diseases

p. 1825

Question 3

Accepted criteria for initiating maintenance dialysis

Answer 3

1. Uremic symptoms
2. Hyperkalemia unresponsive to conservative measures
3. Persistent extracellular volume expansion despite diuretic therapy
4. Acidosis refractory to medical therapy
5. Bleeding diathesis
6. Crea clearance or eGFR below 10ml/min per 1.73m2

p. 1822

Question 4

Principle of hemodialysis

Answer 4

Solute diffusion across a semipermeable membrane

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Question 5

3 essential components of hemodialysis

Answer 5

1. Dialyzer
2. Composition and delivery of dialysate
3. Blood delivery system

p. 1822

Question 6

Used to counterbalance urea-related osmolar gradients in patients who frequently develop hypotensionduring dialysis

Answer 6

“sodium modeling”

dialysate Na concentration is gradually lowered fr 145-155mmol/L to isotonic concentrations (136-140mmol/L)

p. 1822

Question 7

Composition of blood delivery system

Answer 7

1. Extracorporeal circuit
2. Dialysis access

p. 1823

Question 8

Most important complications of arteriovenous grafts

Answer 8

1. Thrombosis

2. Graft failure

Question 9

Determines the efficiency of dialysis

Answer 9

1. Blood and dialysate flow through dialyzer

2. Dialyzer characteristics

Question 10

Goals of dialysis

Answer 10

1. Urea reduction ratio of >65-70%
2. Body water indexed clearance x time product (KT/V) above 1.2 or 1.05
3. Between 9 and 12 h of dialysis are required each week usually divided into 3 equal sessions

Question 11

The most common acute complication of hemodialysis among pt with DM

Answer 11

Hypotension

Question 12

Management of hypotension during dialysis

Answer 12

1. Discontinuing ultrafiltration

2. Administration of 100-250ml of isotonic saline OR 10ml of 23% saturated hypertonic saline OR salt-poor albumin

Question 13

Causes of dialysis-associated cramps

Answer 13

1. Changes in muscle perfusion due to excessively rapid volume removal
2. Targeted removal below the patient’s estimated dry weight

Question 14

Dialyzer Reaction Type A

Answer 14

1. Occurs within first few minutes
2. Attributed to IgE-mediated intermediate hypersensitivity reaction to ethylene oxide used in sterilization of new dialyzers
3. Treatment: Discontinue; Steroids or epinephrine if symptoms are severe

Question 15

Dialyzer Reaction Type B

Answer 15

1. Nonspecific (chest and back pain)
2. Occur several minutes into dialysis run
3. Result from complement activation and cytokine release
4. Resolve over time with continued dialysis

Question 16

Peritoneal dialysis process

Answer 16

1. 1.5-3L of dextrose-containing solution infused into peritoneal cavity and allowed to dwell for usually 2-4 hours
2. combination of convective clearance through ultrafiltration and diffusive clearance down a concentration gradient

Question 17

Factors affecting rate of peritoneal solute transport

Answer 17

1. Infection (Peritonitis)
2. Drugs
3. Physical factors (Position, Exercise)

Question 18

Dialysates of peritoneal dialysis vs hemodialysis

Answer 18

Peritoneal dialysis : Hypertonicity of solution drives solute and fluid removal

Hemodialysis: Depends on concentration gradients; fluid removal requires transmembrane pressure

Question 19

Major complications of peritoneal dialysis

Answer 19

1. Peritonitis
2. Catheter-associated nonperitonitis infection
3. Weight gain, other metabolic disturbance
4. Residual uremia

Question 20

Definition of peritonitis

Answer 20

Elevated peritoneal fluid leukocyte count (100/uL of which at least 50% are PMN)

Question 21

Clinical presentation of peritonitis

Answer 21

Pain
Cloudy dialysate
Fever

Question 22

Most common organism in peritonitis

Answer 22

Gram (+) cocci (Staphylococcus)

Question 23

Treatment to peritonitis due to hydrophilic gram negative rods (Pseudomonas sp.) or yeast

Answer 23

1. Antimicrobial therapy

2. Catheter removal

Question 24

Metabolic complications in peritoneal dialysis

Answer 24

1. Hypoproteinemia
2. Hyperglycemia
3. Weight gain
4. Hypertriglyceridemia