Chronic Kidney Disease 2

Question 1

What are 4 drug properties that predict removal by dialysis?

Answer 1

molecular weight
protein binding
volume of distribution
clearance (renal vs non-renal)

Question 2

Why is molecular weight of a drug important with dialysis?

Answer 2

hemodialysis dialyzers can remove drugs with MW up to 20,000daltons
a small drug can be removed by dialysis

Question 3

how does protein binding affect drugs and dialysis?

Answer 3

Drugs that are small (less than 20,000daltons) but bind tightly to large proteins won’t be removed.
Small drugs that don’t bind tightly to protein will probably be removed

Question 4

what is volume of distribution (Vd)?

Answer 4

the distribution of a drug throughout the body

Question 5

what does a large (Vd) mean? A small Vd?

Answer 5

large - distributed widely throughout tissues and fluids outside of the blood compartment
small - distribute primarily through blood compartment (0.2-0.3L/kg)

Question 6

how does Vd affect drugs and dialysis?

Answer 6

Drugs with a large Vd exhibit less dialyzability (less drug in blood available for dialyzer) and probably won’t be removed compared to drugs with a small Vd

Question 7

how does renal vs. non-renal clearance affect drugs and dialysis?

Answer 7

drugs that are excreted mainly by the kidneys (minimally metabolized by liver) are likely to be removed by dialysis compared to drugs that aren’t really excreted by kidneys

Question 8

How do you interpret the Dialysis of Drugs handbook?

Answer 8

For hemidialysis (high permeability) and peritoneal dialysis
U = unlikely to be removed
Yes = will be removed

Question 9

What are 4 different types of dialysis access?

Answer 9

AV fistula
Dialysis catheter (Central)
Peritoneal dialysis
Automated peritoneal dialysis

Question 10

What is an AV fistula?

Answer 10

arterio-venous fistula
a connection between an artery and a vein, typically in the lower or upper arm
two needles are put into the arm, one takes blood to the dialysis machine, and one gives filtered blood back to body

Question 11

what is a central dialysis catheter?

Answer 11

catheter inserted into the RA of the heart

Question 12

what is a pro and con to central dialysis catheter?

Answer 12

pro: blood is diluted much more quickly by the heart
con: most prone to infection so it’s the least preferred option

Question 13

what is peritoneal dialysis?

Answer 13

catheter inserted into the peritoneal cavity

two bags are attached, one containing dialysate and one with effluent coming out

Question 14

what is the function of dialysate?

Answer 14

draw fluids and toxins out of the bloodstream and supplies electrolytes and other chemicals to the bloodstream

Question 15

what is automated peritoneal dialysis (APD)?

Answer 15

peritoneal dialysis run throughout the night

Question 16

What are the 3 renal replacement therapy options for patients?

Answer 16

hemodialysis
peritoneal dialysis
kidney transplant

Question 17

what are the different options for hemodialysis? which is the best option for fluid abusers?

Answer 17

3x/week at dialysis centre for 4 hours
6x/week nocturnal (6-8hrs every night at home)
short hour daily (2hrs, 5 days a week) - best for fluid abusers

Question 18

what are the different options for peritoneal dialysis?

Answer 18

continuous ambulatory peritoneal dialysis (CAPD) - done manually, patient hand bads with 4-5 exchanges daily and one long dwell at night
APD - patient hooks up machine at night and exchange occurs

Question 19

where is the transplanted kidney usually placed?

Answer 19

close to bladder

Question 20

how long are patients usually waiting for a kidney?

Answer 20

1-3 years or more

Question 21

what are the top 3 causes of end-stage kidney disease?

Answer 21

1) diabetes
2) hypertension
3) glomerulonephritis