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PHARM 343 > Dialysis > Flashcards

Dialysis Flashcards

1
Q

Indication for Renal Replacement

A

To treat acute or chronic loss in kidney function
- Remove waste and replenish lost fluids, move body fluid composition to normal

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2
Q

Kinds of Renal Replacement

A

Kidney Transplant

Dialysis
- Hemodialysis
- Peritoneal Dialysis

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3
Q

What is Dialysis

A

Remove excess fluids and waste products from the blood in place of the kidneys
- Not a cure, just treats the symptoms

Relies on the principles of diffusion, ultrafiltration, convection

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4
Q

Diffusion

A

Concentration gradient
- High to Low

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5
Q

Ultrafiltration

A

Fluid Pressure Gradient
- High to Low

Excess volume of fluid is cleared from the body using a pressure gradient between the blood and dialysate

Volume based

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6
Q

Convection

A

Fluid Pressure Gradient
- High to Low

Larger solutes are dissolved in fluid and are cleared from the body

Size based

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7
Q

Hemodialysis

A

Relies on Diffusion and Ultrafiltration

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8
Q

Peritoneal Dialysis

A

Relies on Diffusion, Ultrafiltration, and Convection

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9
Q

Concept of Dialysis

A

Blood runs parallel to a Dialysate, separated by a semipermeable membrane
- Fluid and solute move from the blood into the Dialysate

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10
Q

Dialysis
- What affects the rate of movement of solute

A
  • Concentration gradient
  • Permeability of membrane
  • Surface area of membrane
  • Length of time the blood is in contact with the membrane
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11
Q

Indication for Dialysis
- AKI

A

A: Acid Base Disturbances
E: Electrolyte Imbalances
I: Intoxication
O: Fluid Overload
U: Uremia

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12
Q

Indication for Dialysis
- CKD

A

Based on clinical status, initiate if one of the following is present
- Signs of kidney failure (acid-base, pruritus, serositis)
- Anuria
- Inability to control volume status or BP
- Deterioration in nutritional status
- Cognitive impairment

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13
Q

Dialysis
- Planning

A

Greater than 10% risk of Kidney Failure should be started on Dialysis Planning
OR
If patient is in CKD stage 4

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14
Q

Hemodialysis
- Components

A
  1. Dialyzer
  2. Dialysate
  3. Vascular Access
  4. Dialysis Machine
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15
Q

Hemodialysis
- Concept

A

Dialysis machine pumps blood into a dialyzer where it runs parallel to a dialysate
- Dialyzer contains the semipermeable membrane and acts as the kidneys
- Blood and Dialyzer are ran in a counter-current to increase concentration gradient

  • Substances removed through diffusion
  • Excess Water in plasma is removed through ultrafiltration

Patient requires heparin (anticoagulant) to prevent clotting

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16
Q

Hemodialysis
- Dialyzer with larger pores
- Dialyzer that is more permeable to water transport

A

Larger pores allow movement of more solutes

More permeable will result in greater ultrafiltration of water

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17
Q

Hemodialysis
- Diasylate

A

Cleansing liquid that contains electrolytes, purified water, dextrose
- Can add low amounts of potassium to treat hypokalemia
- Can add bicarbonate to treat metabolic acidosis

18
Q

Vascular Access

A

Temporary Access
- Insertion of a venous catheter in large vein, not used for ongoing dialysis

Advanced Planning: Permeant Access
- Arteriovenous Fistula
- Arteriovenous Graft

19
Q

Arteriovenous Fistula

A

Surgically connecting the radial artery to cephalic vein
- Takes 1-2 months of maturation before dialysis can be done

Preferred method
- Longest survival times
- Lowest rate of complications

20
Q

Arteriovenous Graft

A

Insertion of a graft to connect branchial artery and basilic vein
- Takes 2-3 weeks of healing before dialysis can be done

Not preferred
- Shorter survival times
- Higher rate of complications

21
Q

Function of a Dialysis Machine

A
  • Measures dry weight (weight after removal of excess fluids) and BP
  • Controls rate of blood flow and dialysate
  • Controls ultrafiltration
22
Q

Hemodialysis
- Complications

A
  • Hypotension (20-30%)
  • Hypertension (5-15%)
  • Nausea/Vomiting
  • Cramping
  • Infection at access sites
  • Worsening of Anemia
  • AV Fistula/Graft/Catheter thrombosis
23
Q

Hemodialysis
- Advantages

A

High solute clearance, allows for intermittent treatment
- 3x a week

Easier to detect under adequacy

Low rate of technique failure

24
Q

Hemodialysis
- Disadvantages

A

Decline of residual kidney function

Takes a while for patient to adjust, will experience muscle cramps, disequilibrium, hypotension

Risk of infection

Incenter dialysis removes independence from patient

25
Q

Peritoneal Dialysis
- Concept

A

Utilizes the highly vascularized abdominal viscera as a semipermeable membrane
- Dialysate is inserted through a catheter into the peritoneal cavity

  • Solutes are removed from blood through the peritoneal membrane through diffusion and ultrafiltration
  • Excess water is removed by ultrafiltraiton
26
Q

Peritoneal Dialysis
- Contraindications

A

Absolute:
- Peritoneal adhesions from previous surgery

Relative:
- Ostomy
- Physical/Mental disability (Treatment requires independence and self monitoring)
- IBD
- Lack of care giver or inadequate home living conditions

27
Q

Peritoneal Dialysate
- Components

A
  • Uses lactate instead of bicarbonate
  • Uses dextrose as osmotic agent
    –> Changing concentration of dextrose will affect the amount of fluid removed
  • Electrolyte and Serum concentrations are similar
28
Q

Peritoneal Dialysate
- Exchange

A

One cycle of
- Filling: Dialysate enters peritoneal cavity
- Dwelling: Solution remains in peritoneal
- Draining: Effluent fluid is removed from peritoneal cavity

29
Q

Peritoneal Dialysate
- Administration

A

Has to be done at minimum daily

30
Q

Peritoneal Dialysate
- Complications

A
  • Peritonitis
  • Exit site infection at catheter
  • Absorption of glucose (hypertriglyceridemia or weight gain)
  • Loss of albumin
31
Q

Peritoneal Dialysate
- Advantages

A
  • Hemodynamic stable due to slow ultrafiltration rate
  • Higher clearance of larger solutes
  • Preserves kidney function
  • Sense of independence
32
Q

Peritoneal Dialysate
- Disadvantages

A
  • Protein and amino acid loss leading to malnutrition
  • Glucose absorption
  • Risk of peritonitis
  • Hard to determine adequacy
33
Q

Dialysis and Mortality

A

Mortality rates are still high even with dialysis

Dialysis vs Health Individuals
- Dialysis patients all have lower life expectancy

34
Q

Dialysis and Cause of death

A

Most likely cause of death is Cardiovascular Related

Second most likely is infection

35
Q

High vs Low Dialyzability

A

High = Lots of drug is removed

Low = Less of drug is removed

36
Q

Factors affecting Dialyzability

A
  • Molecular Weight
  • Degree of protein binding
  • Volume of distribution
  • Water solubility
  • Dialysis membrane
  • Blood/Dialysate flow rate
37
Q

Drug Dosing in Dialysis
- Renally Cleared Drugs

A

Need to have dose adjusted
- Kidneys not working, will not clear drugs like normal

38
Q

Drug Dosing in Dialysis
- Highly Dialyzed Drugs

A

Need to have dose adjusted
- Adjust dose timings

39
Q

Drug Dosing in Dialysis
- Unaffected by Renal Impairment Drugs

A

If more than 50% of drug is cleared by non-renal routes then no dose change is needed

40
Q

Drug Dosing in Dialysis
- Toxic/Excreted in Active Form

A

Need to change dose or frequency to prevent accumulation

41
Q

Hemodialysis vs Perinoteal

A

Hemodialysis
- Blood leaves the body and is fed into a dialysate, clean blood then enters back into the body

Peritoneal
- Blood does not leave the body, dialysate leaves body with waste

PHARM 343 (20 decks)

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