Dialysis

Question 1

What are the functions of the kidneys?

Answer 1

Excretion of nitrogenous waste products
Maintenance of acid and electrolyte balance
Control of blood pressure
Drug metabolism and disposal
Activation of vitamin D
Production of erythropoietin

Question 2

When is Renal replacement therapy usually indicated?

Answer 2

Renal replacement therapy usually indicated when eGFR 10ml/min.

Question 3

What types of renal replacement therapy are there?

Answer 3

Renal transplant
Haemodialysis
Peritoneal dialysis (CAPD/IPD)
Conservative Kidney Management

Question 4

What pre-requisites are required for dialysis?

Answer 4

• Semipermeable membrane
• Adequate blood pressure to the membrane
• Dialysis Access
• Anticoagulation in haemodialysis

Question 5

What is used for permanent haemodialysis access?

Answer 5

Arteriovenous fistula

AV prosthetic graft

Question 6

What is used for temporary haemodialysis access?

Answer 6

Tunnelled venous catheter

Temporary venous catheter

Question 7

What restrictions are placed on dialysis patients?

Answer 7

Fluid restriction

• Dictated by residual urine output
• Interdialytic weight gain

Dietary restriction

• Potassium
• Sodium
• Phosphate

Question 8

What are the three types of peritoneal dialysis?

Answer 8

Continuous Ambulatory Peritoneal Dialysis (CAPD),
Automated Peritoneal Dialysis (APD)
Hybrid

Question 9

What are some complications of peritoneal dialysis?

Answer 9

Exit site infection

PD peritonitis
Gram positive – skin contaminant
Gram negative – bowel origin
Mixed – suspect complicated peritonitis eg perforation

Ultrafiltration failure

Encapsulating peritoneal sclerosis

Question 10

What are the indications for dialysis in end stage renal disease?

Answer 10

Advanced uraemia, (GFR 5-10 ml/min)
Severe acidosis (bicarbonate <10 mmol/l)
Treatment resistant hyperkalaemia (K >6.5 mmol/l)
Treatment resistant fluid overload

Question 11

How much is fluid intake usually restricted to in haemodialysis patients?

Answer 11

Up to 800mls in 24 hours

Question 12

List some dialysis related drugs

Answer 12

Anaemia
-Erythropoietin injections
-IV iron supplements 
Renal Bone Disease
-Activated Vitamin D (eg calcitriol)
-Phosphate binders with meals (CaCo3)
Heparin
Water soluble vitamins 
? antihypertensives

Question 13

What are complications of haemodialysis?

Answer 13

Cardiovasular problems

• Intra-dialytic hypotension and cramps
• Arrythmias

Coagulation

• Clotting of vascular access
• Heparin related problems

Other

• Allergic reactions to dialysers and tubing
• Catastrophic dialysis accidents (rare)