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dialysis Flashcards

1
Q

CHEMICAL definition of dialysis

A

the separation of particles in a liquid on the basis of differences in their ability to pass through a membrane

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2
Q

MEDICAL definition of dialysis

A

the clinical purification of blood, as a substitute for the normal function of the kidney

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3
Q

national kidney foundation definition of dialysis

A

treatment that does some of the same things done by healthy kidneys. needed when your kidneys can no longer take care of your own body’s needs

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4
Q

2 different types of dialysis

A

hemodialysis (both traditional and CRRT)
peritoneal dialysis (continuous ambulatory or cyclic peritoneal dialysis)

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5
Q

indications for dialysis

A

AEIOU
Acidosis
Electrolyte imbalance
Intoxication
Output
Uremia

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6
Q

when to initiate dialysis in CKD patients

A

preparation: stage 4 CKD (GFR<30)— should plan access for AV fistula

and when GFR < 15 should begin renal replacement therapy

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7
Q

what is the “perfect” timing for starting dialysis

A

it is a compromise between extending dialysis free period as long as possible but avoiding complications by waiting too long

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8
Q

primary goal of hemodialysis

A

to restore intracellular and extracellular fluid environment that is characteristic of normal kidney function—-based upon diffusion of solutes across a semipermeable membrane down a concentration gradient

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9
Q

______ is transported INTO dialysate

A

urea from the blood

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10
Q

______ is transported FROM dialysate into the blood

A

bicarb

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11
Q

diffusion is movement of substances _______

A

down a concentration gradient

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12
Q

what is ultrafiltration

A

movement of water across the dialyzer membrane as a result of hydrostatic or osmotic pressure. primary purpose being removal of excess total body water

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13
Q

what is convection

A

solutes are dragged across the membrane with water transport– occurs if pores in dialyzer are large enough for solutes to pass

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14
Q

relationship between diffusion and convection

A

can be controlled separately and the dialysis prescription can be personalized to achieve degree of solute and fluid removal

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15
Q

apparatus required for hemodialysis

A

dialyzer
dialysis solution (aka dialysate)
tubing for transport of blood & dialysis solution
machine

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16
Q

what is the dialyzer

A

plastic chamber w/ ability to perfuse blood & dialysate compartment simultaneously at very high flow rates
(hollow fiber capillary dialyzer most common)

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17
Q

what is the dialysate

A

solution of pure water, electrolytes, and salts. purpose is to pull toxins from the blood via diffusion (high concentration of waste in the blood, low concentration in dialysate).

NOT A STERILE SOLUTION

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18
Q

different lines of the tubing in hemodialysis

A

arterial line: carries blood from patient to dialyzer

venous line: carries dialyzed blood back to the patient

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19
Q

______ is administered to prevent clotting in the dialyzer

A

anticoagulant such as heparin

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20
Q

how frequent is in-center hemodialysis, typically

A

3 weekly sessions, 3-5 hours long

21
Q

goals/adequacy measures of hemodialysis

A

achieve dry weight (normotensive, edema free)
Kt/V urea = 1.2

22
Q

what is Kt/V urea

A

fraction of the patient’s total body water that is cleared of urea during a dialysis session
K= urea clearance of the dialyzer
T= duration of the sessio
V urea= patient’s volume of urea distribution

23
Q

what is the preferred type of access for hemodialysis

A

arteriovenous fistula (AV fistula)

24
Q

what is AV fistula

A

access made by joining an artery & vein in the arm; large diameter; preferred for long term HD due to less infection and clotting; takes at least 1-2 months to mature

25
Q

what are other types of access for HD besides AV fistula

A

graft (man made tube to connect artery to vein, takes 2-3 weeks, shorter survival than fistula, higher rates of infection and thrombosis)

central venous catheter (temporary access, placed if disease progresses quickly and there isn’t time to place fistula/graft, short life span, prone to infection and thrombosis)

26
Q

what are the complications of dialysis

A

hypotension
HTN
cramps
chest and back pain
pruritis
fever & chills

vascular access: dysfunction, thrombosis
infection: leading cause of mortality, sepsis

27
Q

how is intradialytic hypotension managed?

A

Pharmacologic: oral midodrine 5 mg 2-3 times daily
Non-pharm: Trendelenburg position, decrease rate, give fluids, etc

28
Q

how is hypertension managed?

A

changes in timing of antihypertensives; carvedilol 6.25 mg BID

29
Q

how is pruritis managed?

A

acute: diphenhydramine or hydroxyzine
prevention: topical emollients & adequate hemodialysis

30
Q

how is access thrombosis managed?

A

flush, alteplase 2 mg/2mL per catheter port, replace catheter

31
Q

pros/cons of home hemodialysis?

A

short daily sessions 5-7x/week x 2 hrs
less fluid removed at each session, reduces symptoms
but need to have a responsible care partner to help

32
Q

what is continuous renal replacement therapy (CRRT)

A

renal replacement therapy applied for 24h/d in an ICU
more “physiologic”

33
Q

pros/cons of CRRT

A

pros: physiologic, minimizes hypotension in hemodynamically unstable patients, used in acute renal failure

cons: lack of fever if infected (blood flowing out and back in constantly cools body down), medication dosing changes

34
Q

classic indications for CRRT

A

hyperkalemia, severe metabolic acidosis, diuretic- resistant volume overload, oliguria or anuria, uremic complications, drug intoxications

35
Q

contraindications for CRRT

A

patient declines, inability to establish vascular access, lack of trained personnel

36
Q

what is a common error with medications in a patient on dialysis

A

dosing medications based on SCr and not realizing they are on dialysis— you can’t calculate CrCL on dialysis because it means nothing– their kidneys don’t work.

37
Q

what is peritoneal dialysis

A

dialysis treatment that uses the peritoneum and dialysate; the peritoneal cavity is filled w/ the dialysate and remains there for a “dwell time”— at the end of said dwell time, an exchange occurs

38
Q

advantages of peritoneal dialysis

A

hemodynamic stability
can do it at home (independent), convenient
suitable for the very old and very young
better preservation of residual renal function
less blood loss
no systemic heparin necessary

39
Q

disadvantages of peritoneal dialysis

A

protein loss thru peritoneum
reduced appetite
sense of abdominal fullness
predisposed to malnutrition
PERITONITIS RISK!!!!!!!

40
Q

what are different types of peritoneal dialysis

A

continuous cycler-assisted peritoneal dialysis (CCPD)- usually done at night, a machine does exchanges, takes ~9 hours; in the morning the abdomen is filled with dialysate that remains the entire day.

continuous ambulatory peritoneal dialysis: exchanges are done by hand throughout the day; gravity is used to fill the abdomen and drain it

41
Q

what is peritonitis

A

inflammation of the peritoneum usually due to bacterial or fungal infection (1 episode per 24 patient months)
is a major cause of catheter loss in PD

42
Q

clinical presentation of peritonitis

A

abdominal pain and cloudy effluent
fever, nausea, vomiting, chills
dialysate WBC>100 (50% pmns)

43
Q

organisms causing peritonitis

A

s. epidermidis (most common)
s. aureus
strep sp
eneterococcus sp
E. coli
pseudomonas
fungi

44
Q

treatment of peritonitis

A

gram + coverage w/ vanco or 1st gen ceph
gram - coverage w/ 3rd or 4th gen ceph or aminoglycoside
ex: ceftriaxone + vanco

45
Q

how is adequacy of PD determined

A

Kt/V weekly= 1.7

46
Q

what does residual renal function mean

A

some patients still make urine when on dialysis: improved survival, better solute removal, better BP control

47
Q

how to preserve residual renal function

A

avoid nephrotoxins, avoid hypotension, ACEi/ARBs may help, avoid excess fluid control

48
Q

protein restriction on dialysis?

A

protein restriction in CKD increases risk of malnutrition but is used to slow progression of CKD….
protein restriction only if GFR<25 NOT on dialysis

advanced nephrology (7 decks)

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