Dialysis lecture Flashcards
Patients are that in center dialysis for 4 hours a day 3 times a week. Tinier pts might not more time on dialysis machine
Bigger pts might need more time on dialysis machine
Monthly kt/V is a test that is done to see how well a pt is being dialyzed and that is a predictor to know if a pt is receiving good clearance to see if dialysis treatments are working.If they are not getting good clearances we might have to increase their time
Causes of End Stage Renal Diseases (ESRD) diabetes and ______________?
high blood pressure
Focal Segmental Glomerulosclerosis (FSGS) and polycystic kidney can cause End stage renal disease as well
Indications of ESRD (End stage renal disease)
Presence of severe symptoms secondary to ESRD: Persistent anorexia, ___________, and vomiting typically accompanied
by _____________, fatigue, declining serum albumin concentrations
Uncontrolled hypertension or CHF
Neurologic deficits or pruritus
Planning for treatment modality typically begins at CKD stage 4 although conversations about dialysis can
typically begin sooner
nausea
weight loss
Does everyone “get dialysis”?
Treatment options include:
Conservative Care
Transplant
HD
PD
Conservative Care
For many patients with CKD, dialysis and transplant
improves quality and longevity of life
For some patients with advanced age and or other
serious health problems it may not improve the quality of
life
Choosing not to pursue RRT may be a viable option for
some patients IF:
The burdens of dialysis outweigh the benefits
Patients still continue to meet with nephrologist, work on
management of symptoms
Kidney Transplantation
Two types:
_______________-
Can be from a family member or other willing person
Must be a match in both blood type and crossmatch
Can enter into a donor swap program
Living donation
Deceased donation
Placed on a ___________list
Organs are in _________ supply
Average waiting time is between 5-7 years
Strict criteria in terms of both receiving and donating a kidney, not
everyone is eligible
waiting list
short supply
Kidney Transplantation
Medications you may see used by Kidney Transplant
patients
Corticosteroids: Prednisone
Calcineurin Inhibitors: Tacrolimus, Cyclosporine
Antimetabolites: Mycophenolate mofetil, Azathioprine
mTOR inhibitors: Sirolimus, Everolimus
Belatacept
Basiliximab
Alemtuzumab
Goals of Treatment: prevent graft _________, reduce
morbidity, and prevent complications
Transplant recipients are typically maintained on an immunosuppression regimen that includes 1-3 drugs
prevent graft rejection
What is dialysis?
* Process by which waste, salt, and extra water is removed
to prevent them from building up in the body
* Enables your body to keep a safe level of certain
chemicals in your blood, such as potassium sodium and
bicarbonate
* Assists with blood pressure control
Morbidity and Mortality of Dialysis
Lower life expectancy than normal population (20-25% shorter)
Cardiovascular complications are the most common cause of death followed by infections
__________________: reserved for pts end stage diseases that doing dialysis would not necessarily prolong their life because they COPD, heart failure, cancer,etc; pt is just signing their death sentence if pts are on conservative care
Conservative care
Goals of HD
Achieve a desired dry weight without overcorrecting
Achieve adequate removal of wastes
Specific amount of dialysis is calculated for each patient based on a calculation, important to avoid under dialysis
HD dose is measured based on urea removal
HD
Most common type of RRT
for ESRD
Perfusion of blood and
physiologic solution on
opposite sides of a
semipermeable membrane
Substances move from
blood to dialysate by
passive diffusion due to
ultrafiltration
Amount of solute and fluid
removed depends on
patient needs
HD Procedure
Blood transferred from patient to dialyzer via mechanical
pump
Anticoagulated blood passes through dialyzer on one side of semipermeable membrane and returns to patient
Dialysate solution pumps through dialyzer countercurrent to the flow of the blood on the opposite side of the membrane
Result of HD: removal of metabolic waste and water
Generally, 3 times per week for 4-5 hours per session – M/W/F or Tu/Th/Sa. Longer sessions of dialysis leave patient feeling better
HD options
In center hemodialysis
In center nocturnal hemodialysis
Home hemodialysis
With a deceased donation is it from a drug user they have to test this kidney for other risks, is the kidney from a pt with HIV…with a deceased donation there are a lot of risks with it
