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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
What process occurs in peritoneal dialysis?
Ultrafilration
26
What are the two main types of peritoneal dialysis?
Continuous Ambulatory Peritoneal Dialysis (CAPD) Intermittent Peritoneal Dialysis (IPD)
27
What is CAPD?
It involves filling the abdomen with dialysate, allowing it to remain there for a prescribed period of time, then draining the fluid
28
What is the typical CAPD regimen?
Two litres of fluid being inserted into the peritoneum and changed four times daily
29
What is IPD?
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
30
How long does IPD take?
Eight to ten hours
31
What dialysis requires diasylate?
Both haemodialysis and peritoneal dialysis
32
What is the sodium concentration in diasylate? What effect does this have?
High, which is the same concentration as sodium within the blood This maintains sodium levels and results in no change.
33
What is the potassium concentration in diasylate? What effect does this have?
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
What is the calcium concentration in diasylate? What effect does this have?
High, which is the same concentration as calcium within the blood This maintains calcium levels and results in no change
35
What is the bicarbonate concentration in diasylate? What effect does this have?
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
What is the creatinine concentration in diasylate? What effect does this have?
None This means that most creatinine moves from the bloodstream into the dialysate to be filtered
37
What is the urea concentration in diasylate? What effect does this have?
None This means that most urea moves from the bloodstream into the dialysate to be filtered
38
What are the two markers of dialysis efficiency?
Creatinine Urea
39
What is the glucose concentration in diasylate? What effect does this have?
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
What are the four complications of peritoneal dialysis?
Bacterial Peritonitis Peritoneal Sclerosis Ultrafiltration Failure Weight Gain
41
What is bacterial peritonitis?
An infection of the peritoneum lining the abdomen
42
Why is bacterial peritonitis a complication of peritoneal dialysis?
This is due to the infusions of glucose solution into the peritoneum enabling bacterial growth
43
What organisms tend to cause bacterial peritoneal secondary to dialysis? Name an example
Coagulase negative staphylococcus Staphylococcus epidermis
44
What is a clinical sign of bacterial peritonitis?
The drained dialysis fluid will appear cloudy instead of clear This is due to the increased number of white cells
45
How do we treat bacterial peritonitis positive infections?
Vancomycin - until the causative agent is identified
46
How do we treat bacterial peritonitis negative infections?
Ciprofloxacin
47
When should we consider if the peritonitis is related to bowel perforation - instead of dialysis?
When the bacterial agent is mixed
48
What is peritoneal sclerosis?
It is thickening and scarring of the peritoneal membrane
49
What is the cause of peritoneal sclerosis?
Constant inflammation
50
What can peritoneal sclerosis lead to?
Bowel obstruction
51
What is ultrafiltration failure?
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
How do we avoid the complication of ultrafiltration failure?
We don’t keep patients on peritoneal dialysis for more than two to three years
53
Why is weight gain a complication of peritoneal dialysis?
When dextrose within the dialysate is absorbed by the patient When the patient intakes too much fluid
54
How do we avoid the complication of weight gain?
Fluid restriction
55
How do we determine a dialysis patient's fluid restriction?
Residual urine output The type of dialysis treatment
56
What is the fluid restriction of patients on haemodialysis?
500-800ml/ of fluid intake over a period of 24 hours.
57
What is the fluid restriction of patients on peritoneal dialysis?
These patients have a better urine output and therefore their fluid intake is less restricted
58
What is the fluid restriction for patients with a small urine output?
The smaller the urine output, the more severe and restrictive the fluid intake becomes
59
What is the fluid restriction for patients with a high urine output?
The greater the urine output, the less severe and restrictive the fluid intake becomes
60
How can we help patients who struggle to restrict their fluid intake?
We can remove any excess fluid during dialysis sessions
61
What is the maximum amount of fluid that should be removed per dialysis session?
3L
62
What are the five complications of haemodialysis?
Hypotension Anaemia Hyperkalaemia Renal Bone Disease Heart Failure
63
Why is hypotension a complication of haemodialysis?
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
How do we prevent hypotension in haemodialysis?
We should review the patient’s medications before treatment commences
65
Why is anaemia a complication of haemodialysis?
Iron is removed by haemodialysis Patients usually intake less iron due to diet restrictions Failing kidneys reduce the production of erythropoietin
66
How do we prevent anaemia in haemodialysis patients?
We prescribe patients weekly erythropoietin injections alongside IV iron supplements
67
Why is hyperkalaemia a complication of haemodialysis?
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
What potassium level results in arrhythmias?
> 6.5mmol/L
69
How do we prevent hyperkalaemia in haemodialysis patients?
Dialysis patients are advised to restrict their potassium intake
70
What is renal bone disease?
Renal bone disease occurs when damaged kidneys are no longer able to process vitamin D, which helps you absorb calcium
71
How do we prevent renal bone disease in haemodialysis patients?
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
Why is heart failure a complication of haemodialysis?
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
Why is dialysis treatment not usually long term?
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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