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renal system > Dialysis > Flashcards

Dialysis Flashcards

1
Q

What are the functions of the kidneys?

A
  • 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
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2
Q

What functions of the kidneys cannot be replaced by dialysis?

A
  • Activation of vitamin D

- Production of erythropoietin

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3
Q

End stage renal disease (ESRD)

A

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

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4
Q

When may a patent with CKD be asymptomatic?

A

-Until CKD stage 4 or 5 the patient may be asymptomatic

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5
Q

What is the syndrome of advanced CKD called?

A

Uraemia

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6
Q

How do uraemic symptoms manifest?

A

Uraemic symptoms can involve almost every organ system but the earliest and cardinal symptom is malaise and fatigue

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7
Q

What is renal replacement therapy?

A

The means by which life is sustained in patients suffering from end-stage renal disease.

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8
Q

When is renal replacement therapy usually indicated?

A

Usually indicated when eGFR <10ml/min

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9
Q

What types of renal replacement therapy are there?

A
  • Renal transplant
  • Haemodialysis
  • Peritoneal dialysis
  • Conservative kidney management
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10
Q

How can haemodialysis be delivered?

A
  • Home haemodialysis

- Satellite/hospital haemodialysis

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11
Q

How can peritoneal dialysis be administered?

A
  • Continuous ambulatory peritoneal dialysis (CAPD)

- Intermittent peritoneal dialysis (IPD)

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12
Q

Dialysis

A

Dialysis is a process whereby the solute composition of a solution, A, is altered by exposing solution A to a second solution, B, through a semipermeable membrane.

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13
Q

What are the principles of dialysis?

A
  • Diffusion

- Ultrafiltration

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14
Q

What are the pre-requisites for dialysis?

A
  • Semipermeable membrane (artificial kidney in haemodialysis or peritoneal membrane)
  • Adequate blood exposure to the membrane (extracorporeal blood in haemodialysis, mesenteric circulation in PD)
  • Dialysis Access vascular in haemodialysis, peritoneal in PD
  • Anticoagulation in haemodialysis
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15
Q

What types of access are there for haemodialysis?

A

Permanent

  • AV fistula
  • AV prosthetic graft

Temporary

  • Tunnelled venous catheter
  • Temporary venous catheter
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16
Q

What is the name of the solution used in dialysis?

A

Dialysate

17
Q

How is maximum efficiency of the removal of waste products achieved?

A
  • Blood and dialysate run in opposite directions
  • This means that the concentration difference is maintained at either side.
  • This means waste will continue to filter into the dialysate maximising removal from the blood
18
Q

What intake restrictions are there for dialysis patients?

A
  • Fluid restriction dictated by residual urine output checked by interdialytic weight gain
  • Dietary restriction of potassium, sodium and phosphate
19
Q

How is clotting prevented in the dialysis machine?

A

Heparin pump

20
Q

What is involved in the process of peritoneal dialysis?

A
  • A balanced dialysis solution is instilled into the peritoneal cavity via a tunnelled, cuffed catheter, using the peritoneal mesothelium as a dialysis membrane
  • After a dwell time the fluid is drained out and fresh dialysate is instilled
21
Q

What does the dialysate used in peritoneal dialysis contain?

A
  • The dialysate contains a balanced concentration of electrolytes
  • Glucose is the most common osmotic agent for ultrafiltration of fluid
22
Q

Why do dwell times need to be adjusted in peritoneal dialysis?

A

The peritoneal transport characteristics can vary from high transporter to low transporter

23
Q

What are the possible complications of peritoneal dialysis?

A
  • Exit site infection
  • Tunnel infection
  • PD peritonitis
  • Technical
  • Ultrafiltration failure
  • Encapsulating peritoneal sclerosis
24
Q

What technical complications may there be in peritoneal dialysis?

A
  • Tube related problems

- Abdominal wall hernia

25
Q

Where can the bacteria come from in PD peritonitis?

A
  • Gram positive usually a skin contaminant
  • Gram negative usually bowel origin
  • Mixed: suspect complicated peritonitis e.g. perforation
26
Q

What are the indication for dialysis in ESRD?

A
  • 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
  • Nephrologist’s clinical judgment is important
27
Q

How is fluid balance maintained in haemodialysis patients?

A
  • Usually restricted to 500-800 ml/24 hours

- Intake allowed = urine output +insensible loss

28
Q

How is fluid balance maintained in peritoneal dialysis patients?

A
  • Usually more liberal intake as continuous ultrafiltration is often achieved
  • Less restriction on fluid intake
29
Q

What drugs are dialysis patients usually on?

A
  • Erythropoietin injections
  • IV iron supplements
  • Activated vitamin D
  • Phosphate binders
  • heparin
  • Water soluble vitamins
  • Antihypertensives
30
Q

What are the possible complications of haemodialysis?

A

CV problems

  • Intra-dialytic hypotension and cramps
  • Arrhythmias

Coagulation

  • Clotting of vascular access
  • Heparin related problems

Other

  • Allergic reactions to dialysers and tubing
  • Catastrophic dialysis accidents (rare)
31
Q

What factors contribute to the choice of dialysis modality?

A
  • Patient choice (involves education and shared decision making)
  • Patient related factors
  • Perceptions of effectiveness
  • Cost and remuneration (not applicable in Scotland)
32
Q

What are the limitations of dialysis?

A
  • It is a woeful substitute for the kidneys
  • It is not right for everyone
  • Mortality rates
33
Q

What type of care is involved in conservative kidney management?

A

Supportive care

34
Q

What supportive care is available in conservative kidney management?

A
  • Priority for symptomatic management
  • Holistic multi-professional approach
  • Anticipatory care planning
  • Randomised control trial ongoing for dialysis versus CKM for older adults with co-morbidity

renal system (26 decks)

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