Dialysis

Question 1

Definition of end-stage renal disease

Answer 1

Irreversible damage to a person’s kidneys so severely affecting their ability to remove or adjust blood wastes that, to maintain life, he or she must have either dialysis, or a kidney transplant

Question 2

Clinical features of advanced CKD

Answer 2

1. Until CKD stage 4 or 5 the patient may be asymtomatic
2. The syndrome of advanced CKD is called uraemia
3. Uraemic symptoms can involve almost every organ system but the earliest and cardinal symptom is malaise and fatigue

Question 3

When is renal replacement therapy (RRT) indicated

Answer 3

eGFR < 10 mls/min

Question 4

2 types of dialysis

Answer 4

Haemodialysis

Pertonieal dialysis

Question 5

2 types of peritoneal dialysis

Answer 5

Continuous Ambulatory Peritoneal Dialysis (CAPD)

Intermittent Peritoneal Dialysis (IPD)

Question 6

What is dialysis

Answer 6

A process whereby the solute composition of solution A, is altered by exposing it to solution B, through a SEMIPERMEABLE MEMBRANE.

Question 7

4 types of haemodialysis access

Answer 7

Arteriovenous fistula
AV prosthetic graft
Tunnelled venous catheter
Temporary venous catheter

Question 8

What is removed and added to the blood by the dialysate

Answer 8

Removed: Na+, K+,Creatinine and urea
Added: HCO3-, ?Ca2+?

Question 9

Restrictions for dialysis patients

Answer 9

Fluid restriction:
Dictated by residual urine output
Interdialytic weight gain

Dietary restriction:
Potassium, Sodium and Phosphate

Question 10

In peritoneal dialysis what is used as the semipermeable membrane

Answer 10

The peritoneum

Question 11

Peritoneal dialysis complications

Answer 11

Peritonitis
Exit site infections 
Encapsulating peritoneal sclerosis 
Abdominal wall Herniae
Ultrafiltration Failure

Question 12

How would one differentiate between causes of peritonitis

Answer 12

Gram +ve - Skin contaminant
Gram -ve - Bowel origin
Mixed - Complicated peritonitis eg perforation

Question 13

Clear sign of peritonitis

Answer 13

The fluid drained from the abdomen is cloudy

Question 14

Fluid balance of dialysis patients

Answer 14

Haemodialysis - Usually restricted to 500-800 ml/24 hours
intake allowed = urine output +insensible loss

Peritoneal Dialysis - Usually more liberal intake as continuous ultrafiltration is often achieved

Question 15

Drugs usually prescribed alongside dialysis

Answer 15

Erythropoeitin injections
Calcitriol
Phosphate binders with meals
?antihypertensives?

Question 16

Complications of haemodialysis

Answer 16

Clotting of vascular access
Hypotension and cramps
Cardiovasular problems
Heparin related problems
Allergic reactions to dialysers and tubing

Question 17

Summary of dialysis

Answer 17

1. Principles of dialysis are diffusion and ultra-filtration.
2. Indicated when eGFR less than 10 ml/m or patient symptomatic of uraemia.
3. Two main types: haemodialysis and peritoneal dialysis.
4. Patients on dialysis have increased morbidity and mortality and are faced with dietary and fluid restrictions