Chapter 336 Dialysis

Question 1

criteria for initiating patients on maintenance dialysis include the presence of

Answer 1

1. uremic symptoms,
2. presence of hyperkalemia unresponsive to conservative measures,
3. persistent extracellular volume expansion despite diuretic therapy,
4. acidosis refractory to medical therapy,
   bleeding diathesis
5. a creatinine clearance or estimated glomerular filtration rate (GFR) below 10 mL/min per 1.73 m2

Question 2

three essential components to hemodialysis:

Answer 2

1. the dialyzer,
2. the composition and delivery of the dialysate
3. and the blood delivery system

Question 3

is a plastic chamber with the ability to perfuse blood and dialysate compartments simultaneously at very high flow rates.

Answer 3

The dialyzer

Question 4

created by the anastomosis of an artery to a vein results in arterialization of the vein.

Answer 4

native fistula

Question 5

in which the cephalic vein is anastomosed end-to-side to the radial artery

Answer 5

the Brescia-Cimino fistula,

Question 6

(i.e., the interposition of prosthetic material, usually polytetrafluoroethylene, between an artery and a vein) or a tunneled dialysis catheter.

Answer 6

arteriovenous graft

Question 7

The most important complication of arteriovenous grafts is

Answer 7

thrombosis of the graft and graft failure

Question 8

are often used when arteriovenous fistulas and grafts have failed or are not feasible due to anatomic considerations.

Answer 8

tunneled catheters

Question 9

Most tunneled catheters are placed in the

Answer 9

internal jugular veins;
the external jugular,
femoral veins
and subclavian veins

Question 10

Current targets include a urea reduction ratio (the fractional reduction in blood urea nitrogen per hemodialysis session) of ____ and a body water– indexed clearance × time product (KT/V) above ____

Answer 10

1. > 65–70%

2. 1.2 or 1.05

Question 11

is the most common acute complication of hemodialysis, particularly among patients with diabetes mellitus.

Answer 11

Hypotension

Question 12

management of hypotension during dialysis consists of

Answer 12

1. discontinuing ultrafiltration,
2. the administration of 100–250 mL of isotonic saline
3. or 10 mL of 23% saturated hypertonic saline,
4. or administration of salt-poor albumin.

Question 13

In peritoneal dialysis,______ of a dextrose-containing solution is infused into the peritoneal cavity and allowed to dwell for a set period of time, usually _____

Answer 13

1.5–3 L

2–4 h

Question 14

dialysate is manually infused into the peritoneal cavity and exchanged three to five times during the day. A nighttime dwell is frequently instilled at bedtime and remains in the peritoneal cavity through the night.

Answer 14

CAPD

Question 15

exchanges are performed in an automated fashion, usually at night; the patient is connected to an automated cycler that performs a series of exchange cycles while the patient sleeps.

Answer 15

CCPD

Question 16

major difference between the dialysate used for peritoneal dialysis rather than hemodialysis

Answer 16

is that the hypertonicity of peritoneal dialysis solutions drives solute and fluid removal, whereas solute removal in hemodialysis depends on concentration gradients, and fluid removal requires transmembrane pressure.

Question 17

is a formal evaluation of peritoneal membrane characteristics that measures the transfer rates of creatinine and glucose across the peritoneal membrane.

Answer 17

peritoneal equilibrium test

Question 18

major complications of peritoneal dialysis are

Answer 18

peritonitis, catheter- associated nonperitonitis infections,
weight gain and other metabolic disturbances,
and residual uremia (especially among patients with no residual kidney function).

Question 19

Peritonitis is usually defined by an elevated peritoneal fluid leukocyte count

Answer 19

100/μL, of which at least 50% are polymorphonuclear neutrophils

Question 20

The most common culprit organisms in peritonitis are

Answer 20

gram-positive cocci, including Staphylococcus, reflecting the origin from the skin.

Question 21

When first-degree relatives are donors, graft survival rates at 1 year are

Answer 21

5–7% greater than those for deceased-donor grafts