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Nephrology > Dialysis > Flashcards

Dialysis Flashcards

1
Q

Steps to prevent filter clotting?

A

Increase blood flow rate
Use pre-filter replacement fluid
Change catheter
Use CVVHD instead of CVVH
Use anticoagulation

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2
Q

What is the preferred temporary line site?

A

Right internal jugular

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3
Q

What is the most likely cause for hypotension with someone receiving citrate anticoagulation?

A

Hypocalcemia

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4
Q

Electrolyte abnormalities seen in citrate lock?

A

Increased total serum calcium
Decreased ionized calcium

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5
Q

Acid/base abnormalities with citrate anticoagulation?

A

Metabolic alkalosis: liver converts citrate to bicarbonate

Metabolic acidosis: accumulation of citric acid in setting of non functioning liver

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6
Q

What is the formula for Urea Reduction Ratio?

A

URR=
(Pre BUN - Post BUN) / Pre BUN

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7
Q

What is the formula for Filtration Fraction?

A

FF =
UF / (Blood flow rate * 1-HCT)

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8
Q

What is the Kt/V goal for patients on PD?

A

1.8+

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9
Q

What is the formula for creatinine clearance?

A

CrCl =
(UCr * V) / SCr

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10
Q

What are the risks for targeting a Hb > 9-11 in ESRD patients?

A

Thrombosis
Hypertension
Malignancy

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11
Q

What is the starting epoetin dose for ESRD patients with anemia?

A

50-100 units/kg three times weekly

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12
Q

What are the diagnostic criteria for PD associated peritonitis?

A

Abdominal pain/cloudy dialysate
Effluent WBC count > 100/uL
Positive fluid culture

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13
Q

What is the preferred treatment for PD associated peritonitis?

A

Vancomycin + Cefepime
(Intraperitoneal unless septic)

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14
Q

What is the most likely pathogen causing PD associated peritonitis?

A

Coagulate negative staphylococcus (S. epidermidis)

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15
Q

How do you assess PD related peritonitis response to treatment?

A

Repeat effluent cell count or culture 3-5 days into treatment

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16
Q

How can you prevent PD related peritonitis?

A

Systemic antibiotics prior to catheter insertion

Daily topical antibiotics to exit site

Antibiotic prophylaxis prior to dental work, colonoscopy, invasive gynecological procedure

Antifungal prophylaxis for those on prolonged antibiotics

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17
Q

When should you remove the PD catheter for those with peritonitis?

A

Fungal or mycobacterium infection

Abscess

No clinical improvement after 5 days

Culture negative peritonitis with persistent effluent cell count and symptoms

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18
Q

What are the following definitions for PD associated peritonitis:
Recurrent?
Relapsing?
Repeat?
Refractory?

A

Recurrent = < 4 weeks of completing treatment but different bug

Relapsing = < 4 weeks of completing treatment but with same bug

Repeat = > 4 week of completing treatment but with same bug

Refractory = treatment failure at 5 days

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19
Q

What are the symptoms and treatment for encapsulating peritoneal sclerosis?

A

Symptoms = constipation + hemoperitoneum

Treatment = tamoxifen

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20
Q

Next steps for hydrothorax in patient on PD?

A

Stop PD
Surgical patch

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21
Q

Next steps for hemoperitoneum in patient on PD?

A

Heparin flushes to prevent catheter clotting

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22
Q

Next step for suspected tunneled PD catheter infection?

A

Ultrasound to rule out abscess

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23
Q

What do the variables mean in Kt/V?

A

K = dialyzer clearance
t = time
V = volume of distribution of urea

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24
Q

What does dialyzer efficiency refer to?

A

How well small molecules are cleared (KoA)

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25
Q

What does dialyzer flux refer to?

A

How well large molecules are cleared (KUF)

26
Q

What are the sizes of small, middle, and large molecules as it relates to dialysis clearance?

A

Small < 500 Da
Middle 500-5000 Da
Large > 5000 Da

27
Q

What is the mechanism of clearance for:
CVVHD?
CVVHF?
CVVHDF?

A

CVVHD = diffusion
CVVHF = convection
CVVHDF = diffusion + convection

28
Q

Why is Kt/V superior to URR in determining dialysis adequacy?

A

Kt/V accounts for urea generated during HD and clearance of urea during ultrafiltration

29
Q

What is the Kt/V goal for patients on HD?

A

1.2+

30
Q

How to increase Kt/V for high transporter PD patient?

A

Increase number of exchanges

31
Q

How to increase Kt/V for low transporter PD patient?

A

Decreased number of exchanges

32
Q

Is CAPD or CCPD better for high and low transporters?

A

CCPD is better for high transporters
CAPD is better for low transporters

33
Q

Compare high and low transporters with regards to solute clearance and ultrafiltration?

A

High transporter: good at clearance, poor at UF
Low transporter: poor at clearance, good at UF

34
Q

What is the Kt/V goal for patient on home HD?

A

2.1+

35
Q

True or False: Eosinophilic PD-associated peritonitis is benign?

A

True

36
Q

How can you diagnose a PD associated hydrothorax?

A

Measure glucose concentration (or stain with iodine in event icodextrin was used)

37
Q

How do you formally diagnose beta 2 microglobulin amyloidosis?

A

Synovial tissue biopsy

38
Q

What is the formula for calculating ideal 3% NaCl infusion rate for treatment of hyponatremia?

A

Expected Na+ mEq change for every 1 liter of 3% NaCl = (512 - serum Na+) / (TBW + 1)

39
Q

What is the formula for calculating ideal post-filter 3% NaCl infusion rate to maintain hypernatremia?

A

3% infusion rate = [(target Na+ - 140) / (513 - 140)] * replacement fluid rate

40
Q

What is the formula for calculating ideal post-filter D5W infusion rate to prevent overcorrection of hyponatremia?

A

[(RFR * 140) / (RFR + X)] = goal serum Na+

41
Q

Contrast what a carbon tank and RO/DI systems remove in a dialysis unit?

A

Carbon tank: Cl-, chloramine
RO/DI: Fl-

42
Q

Surgical approach for steal syndrome?

A

DRIL

43
Q

“Port wine” colored blood in dialysis circuit is concerning for what?

A

Hemolysis (chloramine, bleach exposure)

44
Q

“Foam” in venous dialysis line is concerning for what?

A

Air embolism

45
Q

What is the typical timing of presentation, pathophysiology, and treatment for Type A dialyzer reaction?

A

First 10 minutes, ethylene oxide exposure, stop HD without returning blood

46
Q

What is the typical timing of presentation, pathophysiology, and treatment for Type B dialyzer reaction?

A

30-60 minutes, complement activation, no need to stop HD

47
Q

What is the formula for calculating recirculation %?

A

(Plasma urea - Arterial urea) / (Plasma urea - Venous urea)
> 10-15% is significant

48
Q

What is the treatment for severe ASA toxicity?

A

Hemodialysis

49
Q

Diagnosis of elevated triglyceride level in peritoneal effluent?

A

Chyloperitoneum (from trauma)

50
Q

What are the treatments for instillation pain and drain pain?

A

Instillation pain Tx = Neutral pH dialysate
Drain pain Tx = Tidal PD mode

51
Q

How do you calculate daily residual renal Kt/V?

A

(UUN * UV) / (BUN * TBW)

52
Q

How do you calculate daily peritoneal urea Kt/V?

A

(DU * EV) / (BUN * TBW)

53
Q

Which component of a dialysis unit’s water treatment facility removes endotoxins?

A

RO

54
Q

Which method to screen for latent TB is best in a ESKD patient?

A

IGRA

55
Q

Right shoulder pain in a PD patient is concerning for what?

A

Intraabdominal air

56
Q

Li2+ level and indication for hemodialysis?

A

4-5

57
Q

Difficult cannulation can be seen with AVF __________ stenosis

A

Arterial

58
Q

Increase CVVH venous line pressure can be seen during which 3 access issues?

A

Venous clot
Venous stenosis
Kinked tubing

59
Q

What lab is used to evaluate for carnitine deficiency in dialysis patient?

A

Acylcarnitine:free carnitine > 0.4

60
Q

What are the SSRIs of choice for ESRD patients?

A

Sertraline
Paroxetine
Fluoxetine

Nephrology (10 decks)

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