Dialysis Flashcards
Does having chronic kidney disease increase cardiovascular risk?
yes
what is dialysis
moving particles from a high conc area to low area
what does dialysis remove?
urea, potassium, sodium
what does dialysis allow the addition of?
bicarbonate
how does haemodialysis work
Urea creatinine, potassium and other toxins leave dialyse and pure water, Na, HCO3 and K, glucose enter the dialysate
how does haemodialys get rid of excess water
there is a negative pressure applied across the membrane - suck water and solutes that are dissolved out
what is the minimum amount of dialysis time?
4hours, 3 times a week
what does decreased dialysis do?
increase risk of death
is increased dialysis beneficial yes or no
yes- better survival but QOL compromised
What kind of diet should dialysis patient be on
low salt, potassium and phosphate diet
what is the fluid restriction on dialysis
1 litre per day (including those taken with pills in the morning
what is the gold standard dialysis access
fistula- artery and vein join to form an enlarged arteriovenous fistula
what are pros and cons to fistula
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
what can go wrong with dialysis
fluid overload, blood leaks, loss of vascular access, hypoklaemia and cardiac arrest
how can a patinet develop intradialytic hypotension
large amounts of volume 3 times a week rather than continuous renewal leads to underselling of intravascular space and low BP
how does peritoneal dialysis work?
solute removed by diffusion of solutes cross peritoneal membrane, water is removed by osmosis and driven by a high glucose concentration
what are the 2 types of peritoneal dialysis
continuous or automated
what is involved in continuous peritoneal dialysis
change the bag 4 times a day- fluid is drained and then fresh fluid instilled for 30 mins at a time
what is automated peritoneal dialysis
1 fluid bag stays in all day, overnight machine drains in a nd out fluid for 9-10 hours per night
what can go wrong with peritoneal dialysis
infection- peritonitis, membrane failure- insufficient in removing enough water, hernias may develop
what are metabolic complications of ESKD
phosphate retention, raised PTH, hypocalcaemia, EPO deficiency and iron deficiency, sodium and water retention, accelerated cardiovascular disease
when do you start dialysis
when GFR 45, unresponsive acidosis, hyperkalaemia, nausea, vomiting, loss of apetite1
can PD occur at home?
yes- requires training
