dialysis

Question 1

What is dialysis and what does it do?

Answer 1

• Method to remove toxins, excess fluids, excess potassium from blood/body.
• During dialysis machine pumps blood out of body, through artificial kidney (dialyzer) that filters out waste and then blood returned to body

Question 2

What is haemodialysis? Where is it done? How many treatments? Constraints? Access & risks?

Answer 2

• Fast method of dialysis where blood passed through semi-permeable artificial membrane to artificial kidney to be filtered.
• Usually done at dialysis centre (but can be done at home too).
• 3-4.5 h of treatment 3x a week (allows 4 treatment free days per week).
• Strict dietary constraints & salt/water intake restrictions.
• Access usually by arteriovenous fistula (operation under local anaesthetic) or tunnelled central venous line (risk of bactaraemia if infected)

Question 3

What is peritoneal dialysis? Where done? When? Constraints? Advantages? Infection risk?

Answer 3

• Cleansing fluid flows through tube into abdomen, peritoneum acts as filter removing waste products from blood.
• Done at home, generally overnight (saves travel time).
• 7 days a week but sometimes weekend off if needed.
• Lesser constraints for food and water intake.
• Can travel easily (machine pack wheelie suitcase, fluids delivered by company)
• infection risk due to catheter or peritonitis

Question 4

When is peritoneal dialysis preferred?

Answer 4

• When young, high functioning people with residual renal function.
• Depends on presence of residual renal function.
• Don’t do peritoneal if lots of abdominal surgery (uses peritoneum)

Question 5

When is haemodialysis preferred?

Answer 5

• Bed-bound, co-morbidities, no renal function.
• Residual renal function not as important.
• If lots of abdominal surgery.
• Need access, if bad heart failure sometimes cant tolerate it.

Question 6

What are factors to consider for a live kidney donor?

Answer 6

Age (over 18), comorbidities, family history kidney disease, financial stability, mental health history, future pregnancy (better after having kids), kidney match (blood type compatibility, HLA typing, serum crossmatch - worse for mothers)
-2 healthy kidneys (normal size ultrasound, normal GFR function, no blood or protein in urine)

Question 7

What happens during a kidney transplantation? What happens to native kidney?

Answer 7

• Connect donor and recipient arteries and veins, transplanted ureter to recipients urinary bladder.
• Native kidney usually left there unless infection/cancer/polycystic kidney disease

Question 8

What are post-transplant surgery recommendations?

Answer 8

• On immunosuppressive medications so higher risk of infections (no raw eggs, meat, undercooked fish, unpasteurised cheese),
• no food items interacting with tacrolimus immunosuppressants - seville oranges, marmalade from seville, earl grey tea, grapefruit).
• For cancer risk - sunscreen, cover up, regularly check skin/breasts.
• For CV disorders - measure/manage BP, active lifestyle. For diabetes active lifestyle, low salt/sugar diet, regular fluid intake.
• For psych disorders - mindful and seek help.
• Avoid alcohol (moderate), live vaccines, NSAIDS/herbal meds, recreational drugs, smoking. Do flu jabs, antibiotics (check pharmacist)