Case 3 - Renal replacement therapy Flashcards
1
Q
3 types of RRT
A
- Haemodialysis
- Peritoneal dialysis
- Transplantation
2
Q
What are the 3 types of peritoneal dialysis?
A
- Automated PD- automated cycler machine at night, 10-12L exchanged over 8-10hrs
- Continious ambulatory PD - 4-5 dialysis exchanges per day, regular intervals with a long overnight swell
- Assisted automated PD - HCA visits pts home to help with setting up
3
Q
What is peritoneal dialysis?
A
- Home based therapy
- Uses patients peritoneal membrane as dialysis membrane
- Solutes move from patients blood across peritoneal membrane down conc gradient to dialysate fluid
4
Q
How is osmotic gradient created in peritoneal dialysis?
A
- High concentration of glucose (ocassionally amino acids or glucose polymer solutions are used) in dialysate fluid - removes water from patient
5
Q
What moves across from blood into dialysate fluid in peritoneal dialysis?
A
- Urea
- Electrolytes
- Creatinine
6
Q
Advantages of peritoneal dialysis
A
- Quality of life good
- Excellent first choice when starting dialysis - esp when have residual renal function
- Regimes are much more individualised than HD
7
Q
Disadvantages of PD
A
- Need to be able to manage technical aspects of dialysis
- Unsuitable if have stoma/pervious surgery
- Risk of infection eg PD peritonitis
8
Q
Complications of PD
A
- Drainge problems
- Malposition
- Leaks
- Herniae
- Hydrothorax (pleural effusion)
- Long term use –> encapsulating peritoneal sclerosis
9
Q
When is haemodialysis used?
A
- AKI
- ESRF
So can be temporary or permanent
10
Q
How does haemodialysis work?
A
- Dialysis machine pumps blood from patient through disposable tubing
- Through dialyser/artifical kidney
- Back to patient
- Waste solute, salt and excess fluid is removed from blood as it passes through dialyser
11
Q
Advantages of haemodialysis
A
- Efficient
- Unit based - support from staff
12
Q
Disadvantages of haemodialysis
A
- Access needs to be secured for dialysis
*
13
Q
Complications of haemodialysis
A
- Infection/bacteraemia
- Haemodynamic instability
- Reactions to dialysers
- Haematomas/risk of bleeding
- Muscle cramps
- Anaemia due to clotted lines/haemolysis
- AVF steal syndrome
- SVCO from central lines
14
Q
3 types of haemodialyssi
A
- Home HD - offer training at home for more frequent dialysis
- Nocturnal - overnight slow and long
- CRRT - continious renal replacement therapy mainly used in acute setting eg ITU/HDU
15
Q
Who is renal transplant used for?
A
Treatment of choice for most patients with ESRF
