Dialysis lecture

Question 1

HD Access

Access from which blood is obtained for dialysis

AV fistula à permanent

AV graft à permanent

Central venous catheter à short term

Question 2

AV Fistula (AVF)

Best option for HD patients

• Native: created by anastomosis of artery & vein
• Longest survival of all access types
• Lowest rate of complications (i.e. Infection, thrombosis)
• Increased patient survival; less hospitalizations
• Most cost-effective
• More feasible to create compared to graft
• Require 1-2 months for maturation
• Not always feasible in certain patients

Question 3

Criteria for receiving a kidney: obesity trying to pt’s BMI down, control blood pressure and diabetes in order to receive a kidney, if vascular system is poor, if your having a lot of cardiac issues then you won’t get a kidney

Question 4

Criteria for Donor of kidneys: if donor has high blood pressure they won’t take your kidney

Question 5

AV Graft

2nd best option for HD patients
* Synthetic; created between brachial artery & cephalic vein
* Require 2-3 weeks to endothelialize or mature
* Shorter graft survival
* Higher rate of infection and thrombosis

Question 6

Central Venous Catheter
* Worst option for HD patients
* Femoral, subclavian, or jugular vein
* Least desirable à short life span
* Can be used immediately
* Used in patients with poor access
* Easiest to insert and use
* Least-cost effective
* Highest risk of complication

Question 7

Complications During HD

__________very common

Answer 7

Hypotension

Question 8

Managing Intradialytic Hypotension

Acute management strategies
* Decrease ultrafiltration rate
* Administer fluids (Ie. 100-200mL NS)
* Prevention strategies
* Instruct on when to take anti-hypertensive meds
* Set accurate “dry-weight” goals
* Midodrine 2.5-10mg PO 30 minutes before HD
* Other therapies not as well studied

Question 9

HD and PD are two available RRT’s for ESRD patients
and they have varying advantages and disadvantages
* Transplant and Conservative care can be alternative
options if patient’s condition warrants
* AVF and AVG are two access methods of HD that have
less complications than central venous catheters
* It is crucial to understand the risk of specific drug
accumulation and dose appropriately when warranted

Question 10

Managing Intradialytic Hypotension

Management of hypertension with drugs in dialysis
patients:
12.4a Drugs that inhibit the renin-angiotensin system, such as ACE
inhibitors or angiotensin II-receptor blockers should be preferred because
they cause greater regression of LVH, reduce sympathetic nerve activity,
reduce pulse wave velocity, may improve endothelial function, and may
reduce oxidative stress. (C)
12.4b Antihypertensive drugs should be given preferentially at night,
because it may reduce the nocturnal surge of blood pressure and minimize
intradialytic hypotension, which may occur when drugs are taken the
morning before a dialysis session. (C)

Question 11

Prevention of Infections in HD
* Decrease duration of catheter use for access
* Use disinfection and sterile technique when accessing HD
access
* Exit site localized antimicrobials
* Manipulation of fistula, graft, and catheters should be
done by skilled practitioners
* Limit peripheral blood draws

Question 12

Peritoneal Dialysis

• Blood is cleansed in the body by using the peritoneum; a
  filter-like membrane located in the lower abdomen
• Solution is inserted into the abdomen where it is in
  contact with the peritoneum
• Excess fluid and waste products in the nearby blood
  vessels are filtered through the peritoneum and collect in
  the solution in the abdomen
• The solution is allowed to dwell for a period of time, then
  is drained out of the abdomen and replaced with fresh
  solution

Question 13

Types of PD

Continuous Ambulatory Peritoneal Dialysis (CAPD)
* Manual process usually done during the day
* Can be done in any clean location at home, work or while traveling
* Average 4 to 5 exchanges each day
* About 30-45 minutes for each exchange
* Continuous Cycling Peritoneal Dialysis
* A machine-controlled process usually done overnight while
sleeping, for about 9-10 hours
* Solution remains in the peritoneum during the day until you go to
bed and hook up to the machine
* Occasionally some patients require an additional exchange during
the day

Question 14

PD Advantages

Home/self care/independence
* Have residual renal function à better preserver
* Good option if individuals develop intradialytic
hypotension during HD
* Can administer drugs via intraperitoneal (IP) route
* Less blood loss and iron deficiency
* Higher clearance of larger solutes
* Can give erythropoeitin subQ vs. IV with less
requirements

Question 15

PD Disadvantages

Reduces appetite à abdominal fullness
* Higher risk of obesity (glucose load)
* Exit site infections and risk of peritonitis
* Inadequate ultrafiltration and dialysis
* At risk in obese patients
* Can fix by increasing volume and number of exchanges
* Very dependent on proper technique
* Mechanical problems can occur
* If IV iron needed, would need IV access
* Less efficient per unit time vs. HD
* Blood sugar control for diabetic patients

Question 16

How long do you have to take medication for kidney transplantation? Forever because immunosuppressants will help prevent your body attacking this kidney because your body knows this is foreign to your body

Question 17

Pt with a kidney transplant CAN’T receive any live vaccines

Question 18

(There is protein restriction as your kidney declines…when you get on dialysis the demand is greater on your body and you need more)