Dialysis

Question 1

Does having chronic kidney disease increase cardiovascular risk?

Answer 1

yes

Question 2

what is dialysis

Answer 2

moving particles from a high conc area to low area

Question 3

what does dialysis remove?

Answer 3

urea, potassium, sodium

Question 4

what does dialysis allow the addition of?

Answer 4

bicarbonate

Question 5

how does haemodialysis work

Answer 5

Urea creatinine, potassium and other toxins leave dialyse and pure water, Na, HCO3 and K, glucose enter the dialysate

Question 6

how does haemodialys get rid of excess water

Answer 6

there is a negative pressure applied across the membrane - suck water and solutes that are dissolved out

Question 7

what is the minimum amount of dialysis time?

Answer 7

4hours, 3 times a week

Question 8

what does decreased dialysis do?

Answer 8

increase risk of death

Question 9

is increased dialysis beneficial yes or no

Answer 9

yes- better survival but QOL compromised

Question 10

What kind of diet should dialysis patient be on

Answer 10

low salt, potassium and phosphate diet

Question 11

what is the fluid restriction on dialysis

Answer 11

1 litre per day (including those taken with pills in the morning

Question 12

what is the gold standard dialysis access

Answer 12

fistula- artery and vein join to form an enlarged arteriovenous fistula

Question 13

what are pros and cons to fistula

Answer 13

pros- good blood flow, unlikely to get infection

cons-surgery, 6 weeks before it can be used, can limit blood flow to distal arm, it can block

Question 14

what can go wrong with dialysis

Answer 14

fluid overload, blood leaks, loss of vascular access, hypoklaemia and cardiac arrest

Question 15

how can a patinet develop intradialytic hypotension

Answer 15

large amounts of volume 3 times a week rather than continuous renewal leads to underselling of intravascular space and low BP

Question 16

how does peritoneal dialysis work?

Answer 16

solute removed by diffusion of solutes cross peritoneal membrane, water is removed by osmosis and driven by a high glucose concentration

Question 17

what are the 2 types of peritoneal dialysis

Answer 17

continuous or automated

Question 18

what is involved in continuous peritoneal dialysis

Answer 18

change the bag 4 times a day- fluid is drained and then fresh fluid instilled for 30 mins at a time

Question 19

what is automated peritoneal dialysis

Answer 19

1 fluid bag stays in all day, overnight machine drains in a nd out fluid for 9-10 hours per night

Question 20

what can go wrong with peritoneal dialysis

Answer 20

infection- peritonitis, membrane failure- insufficient in removing enough water, hernias may develop

Question 21

what are metabolic complications of ESKD

Answer 21

phosphate retention, raised PTH, hypocalcaemia, EPO deficiency and iron deficiency, sodium and water retention, accelerated cardiovascular disease

Question 22

when do you start dialysis

Answer 22

when GFR 45, unresponsive acidosis, hyperkalaemia, nausea, vomiting, loss of apetite1

Question 23

can PD occur at home?

Answer 23

yes- requires training