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Year Two - Urinary System > Dialysis > Flashcards

Dialysis Flashcards

1
Q

What is dialysis?

A

A method for performing the filtration tasks of the kidney artificially – specifically removing waste products, salts and fluid from the blood

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2
Q

What are the two processes that dialysis rely on?

A

Diffusion

Ultrafiltration

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3
Q

What eGFR indicates dialysis?

A

eGFR is less than 10ml/min

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4
Q

When is acute dialysis indicated?

A

It is indicated in patients with severe acute kidney injury, in which the following complications arise…

Acidosis, in which bicarbonate levels fall below 10mmol/l

Electrolyte Imbalance, such as hyperkalaemia, where K > 6.5mmol/l

Intoxication, which is the overdose of certain medications

Oedema, specifically pulmonary

Uraemia Symptoms, such as seizures or reduced consciousness

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5
Q

When is dialysis indicated?

A

It is indicated in end stage renal failure and advanced chronic kidney disease– specifically stage four (GFR <30) and stage five (GFR < 15)

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6
Q

What are the two types of dialysis?

A

Haemodialysis

Peritoneal dialysis

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7
Q

What is haemodialysis?

A

It involves a haemodialysis machine filtering waste products, salts and fluid from the blood

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8
Q

In which two locations can haemodialysis be conducted?

A

Home

Satellite clinics

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9
Q

What is a typical haemodialysis regime?

A

Four hours a day for three days a week

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10
Q

In what two ways can blood supply be accessed for haemodialysis?

A

Arteriovenous (AV) Fistula

Tunnelled Cuffed Catheter

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11
Q

What is an AV fistula?

A

An an artificial connection between an artery and a vein

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12
Q

Why is an AV fistula preferred for haemodialysis?

A

It bypasses the capillary system and allows blood to flow under high pressure from the artery directly into the vein

This provides a permanent, large, easy access blood vessel with high pressure arterial blood flow

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13
Q

How is an AV fistula created?

A

Surgery

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14
Q

Why is an AV fistula not used for acute dialysis?

A

A maturation period between 6 weeks to 8 weeks is required before it can be used

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15
Q

Where are AV fistula normally formed?

A

Forearm

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16
Q

What are the three types of AV fistulas?

A

Radio-Cephalic Fistula

Brachio-Cephalic Fistula

Brachio-Basilic Fistula

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17
Q

What four abnormalities do we look for when examining an AV fistula?

A

Skin Integrity

Aneurysms

Palpable Thrill

“Machinery Murmur”

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18
Q

How do we avoid the complications associated with AV fistulas?

A

We prescribe patients anticoagulant agents whilst receiving treatment

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19
Q

Is blood taken from the fistula?

A

We never take blood from a fistula

This is a lifeline for the patient, providing access to dialysis

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20
Q

What is a tunnelled cuffed catheter?

A

A tube inserted in to the subclavian or jugular vein with a tip that sits in the superior vena cava or right atrium

It has two lumens, one where blood exists the body and one where blood enter the body

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21
Q

What is the permanent blood access point for haemodialysis?

A

AV fistula

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22
Q

What is the temporary blood access point for haemodialysis?

A

Tunnelled cuffed catheter

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23
Q

In diabetic patients, what do we need to remember about haemodialysis treatment?

A

It can result in falsely low HbA1c readings

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24
Q

What is peritoneal dialysis? What catheter is used?

A

It involves a dialysis solution, containing dextrose, entering the abdomen via a Tenchkoff catheter

This results in ultrafiltration from the blood, across the peritoneal membrane, into the dialysis solution

After a period of time, the dialysis solution is replaced, removing the waste products that have filtered out of the blood

Tenchkoff catheter

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25
Q

What process occurs in peritoneal dialysis?

A

Ultrafilration

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26
Q

What are the two main types of peritoneal dialysis?

A

Continuous Ambulatory Peritoneal Dialysis (CAPD)

Intermittent Peritoneal Dialysis (IPD)

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27
Q

What is CAPD?

A

It involves filling the abdomen with dialysate, allowing it to remain there for a prescribed period of time, then draining the fluid

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28
Q

What is the typical CAPD regimen?

A

Two litres of fluid being inserted into the peritoneum and changed four times daily

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29
Q

What is IPD?

A

It involves a machine performing multiple exchanges overnight whilst the patient sleeps

The machine automatically fills the abdomen with dialysate, allows it to remain there for a prescribed period of time and then drains it to a sterile bag that the patient empties in the morning

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30
Q

How long does IPD take?

A

Eight to ten hours

31
Q

What dialysis requires diasylate?

A

Both haemodialysis and peritoneal dialysis

32
Q

What is the sodium concentration in diasylate? What effect does this have?

A

High, which is the same concentration as sodium within the blood

This maintains sodium levels and results in no change.

33
Q

What is the potassium concentration in diasylate? What effect does this have?

A

Low, which is a slightly lower concentration than potassium within the blood

This allows some potassium to move into the dialysate, preventing a rapid major drop in potassium – which could eventually result in arrythmias

34
Q

What is the calcium concentration in diasylate? What effect does this have?

A

High, which is the same concentration as calcium within the blood

This maintains calcium levels and results in no change

35
Q

What is the bicarbonate concentration in diasylate? What effect does this have?

A

High, which is a higher concentration than bicarbonate within the blood

This enables bicarbonate to move from the dialysate to move into the bloodstream, thus preventing acidosis

36
Q

What is the creatinine concentration in diasylate? What effect does this have?

A

None

This means that most creatinine moves from the bloodstream into the dialysate to be filtered

37
Q

What is the urea concentration in diasylate? What effect does this have?

A

None

This means that most urea moves from the bloodstream into the dialysate to be filtered

38
Q

What are the two markers of dialysis efficiency?

A

Creatinine

Urea

39
Q

What is the glucose concentration in diasylate? What effect does this have?

A

High, which is a higher concentration than glucose within the blood

This enables glucose to move from the dialysate to move into the bloodstream

40
Q

What are the four complications of peritoneal dialysis?

A

Bacterial Peritonitis

Peritoneal Sclerosis

Ultrafiltration Failure

Weight Gain

41
Q

What is bacterial peritonitis?

A

An infection of the peritoneum lining the abdomen

42
Q

Why is bacterial peritonitis a complication of peritoneal dialysis?

A

This is due to the infusions of glucose solution into the peritoneum enabling bacterial growth

43
Q

What organisms tend to cause bacterial peritoneal secondary to dialysis? Name an example

A

Coagulase negative staphylococcus

Staphylococcus epidermis

44
Q

What is a clinical sign of bacterial peritonitis?

A

The drained dialysis fluid will appear cloudy instead of clear

This is due to the increased number of white cells

45
Q

How do we treat bacterial peritonitis positive infections?

A

Vancomycin - until the causative agent is identified

46
Q

How do we treat bacterial peritonitis negative infections?

A

Ciprofloxacin

47
Q

When should we consider if the peritonitis is related to bowel perforation - instead of dialysis?

A

When the bacterial agent is mixed

48
Q

What is peritoneal sclerosis?

A

It is thickening and scarring of the peritoneal membrane

49
Q

What is the cause of peritoneal sclerosis?

A

Constant inflammation

50
Q

What can peritoneal sclerosis lead to?

A

Bowel obstruction

51
Q

What is ultrafiltration failure?

A

Ultrafiltration failure occurs when the patient starts to absorb the dextrose in the filtration solution

This reduces the filtration gradient making ultrafiltration less effective over time

52
Q

How do we avoid the complication of ultrafiltration failure?

A

We don’t keep patients on peritoneal dialysis for more than two to three years

53
Q

Why is weight gain a complication of peritoneal dialysis?

A

When dextrose within the dialysate is absorbed by the patient

When the patient intakes too much fluid

54
Q

How do we avoid the complication of weight gain?

A

Fluid restriction

55
Q

How do we determine a dialysis patient’s fluid restriction?

A

Residual urine output

The type of dialysis treatment

56
Q

What is the fluid restriction of patients on haemodialysis?

A

500-800ml/ of fluid intake over a period of 24 hours.

57
Q

What is the fluid restriction of patients on peritoneal dialysis?

A

These patients have a better urine output and therefore their fluid intake is less restricted

58
Q

What is the fluid restriction for patients with a small urine output?

A

The smaller the urine output, the more severe and restrictive the fluid intake becomes

59
Q

What is the fluid restriction for patients with a high urine output?

A

The greater the urine output, the less severe and restrictive the fluid intake becomes

60
Q

How can we help patients who struggle to restrict their fluid intake?

A

We can remove any excess fluid during dialysis sessions

61
Q

What is the maximum amount of fluid that should be removed per dialysis session?

A

3L

62
Q

What are the five complications of haemodialysis?

A

Hypotension

Anaemia

Hyperkalaemia

Renal Bone Disease

Heart Failure

63
Q

Why is hypotension a complication of haemodialysis?

A

In dialysis, the kidney function is improved and therefore patient’s blood pressure control becomes better

In cases where patients are on antihypertensives, hypotension may occur as a result

64
Q

How do we prevent hypotension in haemodialysis?

A

We should review the patient’s medications before treatment commences

65
Q

Why is anaemia a complication of haemodialysis?

A

Iron is removed by haemodialysis

Patients usually intake less iron due to diet restrictions

Failing kidneys reduce the production of erythropoietin

66
Q

How do we prevent anaemia in haemodialysis patients?

A

We prescribe patients weekly erythropoietin injections alongside IV iron supplements

67
Q

Why is hyperkalaemia a complication of haemodialysis?

A

Potassium is a mineral that is normally removed from the body by the kidneys

In cases where dialysis patients consume too much potassium, hyperkalaemia can occur

68
Q

What potassium level results in arrhythmias?

A

> 6.5mmol/L

69
Q

How do we prevent hyperkalaemia in haemodialysis patients?

A

Dialysis patients are advised to restrict their potassium intake

70
Q

What is renal bone disease?

A

Renal bone disease occurs when damaged kidneys are no longer able to process vitamin D, which helps you absorb calcium

71
Q

How do we prevent renal bone disease in haemodialysis patients?

A

We prescribe patients calcitriol, advise diet restrictions of phosphate and prescribe phosphate binders with meals – which prevents the absorption of phosphate from the diet

72
Q

Why is heart failure a complication of haemodialysis?

A

It occurs when AV-fistulas causes rapid return of blood to the heart

This increases the preload of the heart, which can lead to hypertrophy of heart muscle and thus heart failure

73
Q

Why is dialysis treatment not usually long term?

A

This is due to the additional complications associated with it and the fact that it does not reduce mortality rates

It instead should be thought of as a temporary measure to increase kidney function before a kidney transplant becomes available

Year Two - Urinary System (15 decks)

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