CKD 2

Question 0

What is the length of hemodialysis, days per week?

Answer 0

12 (4 hours x 3 days a week)

Question 1

What are some symptoms of CKD?

Answer 1

• swollen feet and lower limbs
• little urination
• feeling tired and weak
• dry and itchy skin

Question 2

What factors predict drug removal?

Answer 2

1. molecular weight (size of drug)
2. protein binding (drugs that bind with proteins won’t be filtered because of large size)
3. Volume of distribution (small vd is blood, large vd is more than blood…small vd is more likely to be filtered)
4. Clearance (higher the excretion by kidney, the more filtration)

Question 3

Is creatinine clearance calculating necessary for dialysis patients?

Answer 3

No, all dialysis patients are considered to have a CrCl of <10ml/min

Question 4

Where is hemodialysis access?

Answer 4

• the AV fistula
• it creates a direct connection between an artery and vein
• done in lower arm
• a dialysis graft
• bad cause you can get clots in the tube
• more prone to infections
• dialysis catheter
• goes into right atrium of the heart
• least preferred option
• quickest way to start dialysis (if patient waited too long)
• most prone to infections

Question 5

What happens if a CKD patient doesn’t get dialysis?

Answer 5

• they will eventually die from kidney disease and hypercholemia

Question 6

What are the 3 different types of renal replacement therapy?

Answer 6

1. hemodialysis
   - 3x/week
   - 6x nocturnally
   - short term (2 hours, 5-6x/week)
2. Peritoneal dialysis
   - CAPD, patient hangs bag with 4-5 exchanges/day
   - APD, patient hooked up to machine at night and machine does exchanges (7 night a week)
3. kidney transplant

Question 7

Describe electrolyte removal by dialysis.

Answer 7

Depending on what electrolyte is out of balance, we can fix the levels by using diffusion.

ex. If pt is low on certain electrolytes, we will increase the concentration in the dialysate bath

Question 8

What is ultrafiltration?

How is it done/regulated?

Answer 8

• it is patient fluid removal
• done by controlling the pressure on the dialysate bath
• this controls how much fluid leaves the patient

Question 9

How is osmosis utilized in dialysis?

Answer 9

• dialysate baths with higher concentrations of Na+ are used
• where Na+ goes, water follows
• this will draw fluid out of the patient