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CDM Exam 3 > ESRD > Flashcards

ESRD Flashcards

1
Q

Dialysis planning should begin once eGFR or Clcr

A

30 mL/min

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2
Q

Benefits and risks of actual start of dialysis should be evaluated when eGFR or Clcr is

A

15mL/min

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3
Q

Primary criterion

A

Pts clinical status

Persistent anorexia, N/V, weight loss, fatigue, low serum albumin levels, neurological deficits or pruritus

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4
Q

Hemodialysis duration

A

3x/wk for 3 to 5 hours per session

Larger patients require longer treatment times

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5
Q

Primary cause for ESRD

A

DM

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6
Q

HD system: external vascular circuit

A

Pt’s blood transferred in sterile polyethylene tubing to dialysis filter or membrane (dialyzer) via mechanical pump

Blood then passes through dialyzer on one side of semipermeable membrane and back to pt

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7
Q

Dialysate solution: purified water and electrolytes

A

Pumped through dialyzer countercurrent to blood flow on other side of semipermeable membrane

Systemic anticoagulation (with heparin) used to prevent clotting of HD circuit

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8
Q

Native Arterio-venous (AV) fistula

A

created by anastomosis of a vein and artery (ideally radial artery and cephalic vein in the forearm)

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9
Q

Synthetic AV grafts:

A

usually made of polytetrafluoroethylene

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10
Q

Central venous catheters

A

placed in femoral, subclavian, or internal jugular vein

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11
Q

Advantages of Native AV fistula

A 
Longest access survival
Lowest rate of complications
   --> infxn & thrombosis
Pts: increased survival & decreased hosp.
Most cost-effective
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12
Q

Disadvantages Native AV fistula

A

Require ≥1 to 2 months to mature before routine use

May be difficult to create in some pts: Elderly, PVD, anyone with vascular disease ( + DM)

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13
Q

Advantages of Synthetic AV graft

A

2-3 weeks to mature

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14
Q

disadvantages of Synthetic AV graft

A

Shorter survival vs. fistula

increased infections and thrombosis

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15
Q

Advantages of central venous catheter

A

Can be used immediately

Some pts: small kids, severe PVD, morbidly obese

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16
Q

Disadvantages of central venous catheter

A

Short life span
Most infections and thrombosis
May not provide adequate blood flow for dialysis

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17
Q

Diffusion

A

movement of substances along a concentration gradient

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18
Q

ultrafiltration

A

movement of water across dialyzer membrane due to hydrostatic or osmotic pressure

19
Q

Convection

A

dissolved solutes “dragged” across membrane with fluid transport (during ultrafiltration)

20
Q

Conventional or standard HD membrane

A

small pores

limit clearance to smaller molecules

21
Q

High efficiency HD membrane

A

large surface area

^ ability to remove water, urea, and other small molecules

22
Q

High Flux HD membrane

A

large pores

capable of removing high-molecular weight substances

23
Q

High efficiency + high flux

A

shorter treatment time
increased blood flow
increased rate of hypotension and muscle cramps

24
Q

HD advantages

A

Higher solute clearance = intermittent sessions
Technique failure rate low
Closer pt monitoring
In HD center

25
Q

HD disadvantages

A

Multiple visits/wk to HD center
SEs: Hypotension, muscle cramps, disequilibrium
Infections
Vascular thrombosis

26
Q

Complications during HD

A

Hypotension

  • taking out too much fluid too fast
  • more common in DM and elderly

Muscle Cramps

  • excessive ultrafiltration
  • plasma volume contraction
  • muscle perfusion
27
Q

HD hypotension acute treatment

A

Trendelenburg position
-feet above head, increases blood flow to the head

Hypertonic saline

Mannitol

28
Q

HD hypotension prevention

A

Midodrine

29
Q

HD Cramps

A

1st line saline, vitamin E

2nd line Quinine (no longer marketed)

30
Q

HD complications less common

A

Thrombosis and infection

31
Q

Peritoneal Dialysis candidates

A 
Hemodynamically unstable (e.g., hypotension on HD)
Significant residual kidney function
Pts who desire to maintain a significant degree of self-care as long as they can be trained
32
Q

PD

A

Instillation of dialysate into peritoneal cavity via a permanent peritoneal catheter
Peritoneal membrane acts as semipermeable membrane across which diffusion and ultrafiltration occur
Substances removed from blood across peritoneum via diffusion and ultrafiltration
Excess plasma water removed via ultrafiltration created by osmotic pressure generated by various dextrose or icodextrin concentrations

33
Q

Dialysate-filled compartment in PD

A

peritoneal cavity

34
Q

Peritoneal membrane

A

semipermeable membrane

35
Q

Blood compartment

A

vessels supplying and draining the abdominal viscera, musculature and mesentery

36
Q

Advantages of PD

A

More hemodynamic stability vs. HD
Due to slower filtration rate
Better for elderly?
Better preservation of residual renal function
Can administer some drugs IP
Freedom from HD machine
Less blood loss and iron deficiency vs. HD

37
Q

disadvantages of PD

A 
Peritonitis
Catheter malfunction
Infection
Inadequate dialysis and ultrafiltration
        Esp in large pts
High rate of technique failure
38
Q

PD complications

A

Peritonitis: common
increase risk of infection

Prophylaxis: Mupirocin daily at exit site

39
Q

Continuous Renal Replacement Therapies (CRRT)

A

Solute removal slower vs. HD, but more can be removed over 24 hr period

40
Q

Advantages of CRRT

A

Hemodynamically unstable pts
increased solute removal/day
Improved survival
Faster ARF resolution

41
Q

disadvantages of CRRT

A 
increased thrombosis
Special equipment
Intensive RN care
More \$\$$
increased pharmacy care
Little known about drug dosing in CRRTs
? Nutrition requirement chgs?
42
Q

Dialysis membrane characteristics

A

Surface area of dialyzer membrane

Membrane porosity

43
Q

Dialysis characteristics

A

Blood Flow

Duration of dialysis

Dialysis flow rate and composition

44
Q

Drug Characteristics

A

Molecular weight

Water solubility

protein binding (most important)

Volume of distribution

CDM Exam 3 (8 decks)

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