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CSR Exam > ESRD with PD > Flashcards

ESRD with PD Flashcards

1
Q

What is Continuous Ambulatory Peritoneal Dialysis (CAPD)?

A

Manual exchanges
Gravity infusion of dialysate into peritoneal cavity –> dwell –> drain
Repeated 4-5 times/day with typically longer dwells at night

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2
Q

What is Continuous Cyclic Peritoneal Dialysis (CCPD)?

A

Type of automated peritoneal dialysis
Machine assisted
Shorter dwell times, usually done at night
May include daytime manual dwells
Usually night exchanges with dry day

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3
Q

What is Tidal Peritoneal Dialysis (TPD)?

A

Type of automated peritoneal dialysis
Machine assisted
Optimize solute clearance by leaving portion of dialysis fluid in peritoneal cavity throughout dialysis session.
Primarily used with poor cath function, low drain alarms, and drain discomfort
High volumes can improve clearances but can be costly and inconvenient

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4
Q

What is cleared through diffusion in PD?

A

From blood to dialysate: uremic solutes, K+
From dialysate to blood: glucose, lactate or bicarb, calcium
Depends on concentration gradient and molecular weight of solute, membrane surface area, membrane resistance

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5
Q

What affects ultrafiltration in PD?

A

Concentration gradient for osmotic agent (dextrose, icodextrin, AA).
Peritoneal membrane surface area and characteristics (permeability).
Hydrostatic and oncotic pressure gradients

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6
Q

What are the characteristics of high transporters based on PET?

A

Rapid solute clearance
Poor UF
High risk of alb. loss
Preferred dialysis: nocturnal intermittent PD w/ dry day; CCPD and avoid long day dwells.

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7
Q

What are the characteristics of high-average transporters based on PET?

A

Good solute clearance
Good UF
High-average risk of alb. loss
Preferred dialysis: CCPD or CAPD standard dose

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8
Q

What are the characteristics of low-average transporters based on PET?

A

Adequate/slower solute clearance
Good UF
Low-avg. risk of alb. loss
Preferred dialysis: CCPD or CAPD standard dose

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9
Q

What are the characteristics of low transporters based on PET?

A

Slow/inadequate solute clearance
Excellent UF
Low risk of alb. loss
Preferred dialysis: CAPD or high-dose PD, avoid short dwells

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10
Q

What determines rate at which solutes are removed during PD?

A

Rate of equilibrium between dialysate and blood.

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11
Q

What are ways to improve adequacy in CAPD?

A

Increase exchange volume–may increase sense of fullness, cause back pain, abd. distension
Increase frequency or number of exchanges
Increase osmotic pressure of dialysis (ex: increase % of dextrose)–may damage peritoneum over time.

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12
Q

What are ways to improve adequacy in APD?

A

Add a daytime dwell to improve urea and creatinine clearance–long dwells may cause net fluid resorption
Increase dwell volumes on cycler
Increase time on cycler
Increase frequency of cycles to maximize concentration gradient
Increase osmotic strength of dialysate (ex: increase % dextrose)

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13
Q

What are the protein recommendations for PD?

A

1.0-1.2 g/kg BW
1.2-1.3 g/kg BW may be most optimal

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14
Q

What are the kcal recommendations for PD?

A

25-35 kcal/kg BW
Include kcal absorbed from dextrose in dialysate.

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15
Q

What is icodextrin?

A

High molecular weight, starch-based glucose polymer
Helps maintain osmotic gradient and minimize kcal load of PD.
Helps with glycemic control
Approx 25% (~150 kcal) absorbed in 8-hour dwell

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16
Q

What is the formula to estimate kcal absorption from PD solution?

A

(dialysate volume in L) x (g dextrose/L) x (3.4 kcal/g) x (% absorption)

17
Q

How much dextrose is estimated to be absorbed with APD (CCPD)?

A

40-50%

18
Q

How much dextrose is estimated to be absorbed with CAPD?

A

60-70%

19
Q

What are interventions for weight gain, hypertriglyceridemia, and hyperglycemia with PD?

A

Increase exercise as tolerated and allowed
Limit Na and fluid to minimize hypertonic exchanges
Use solutions with alternate non-glucose osmotic agents (icodextrin, AA)
Modify energy intake
Modify intake of sugars and fats, esp. sat fat

20
Q

What are interventions for fullness, abnormal GI function, constipation, and satiety with PD?

A

Eat small frequent meals and snacks
Limit fluid with meals but allow adequate total fluids
Eat while draining or when peritoneum is empty
Increase dietary fiber
Limit use of hypertonic exchanges
Use more frequent, smaller volume exchanges
Treat gastroparesis with appropriate meds

21
Q

What are interventions for protein losses, malnutrition, and wasting with PD?

A

Eat protein foods first and limit fluids at meals.
Eat small frequent portions of protein and easy to eat proteins
Avoid peritonitis
Use nutrient-tailored supplements
Use AA PD fluids if available
Use renal-specific water-soluble MVI/nutritional vitamin D
Identify, avoid, or treat sources of inflammation

22
Q

What are interventions for hypokalemia with PD?

A

Increase intake of high potassium fruits and veggies
Supplement if unable to increase PO intake.

23
Q

What are interventions for hyperkalemia with PD?

A

Limit high K+ foods
Maintain normal bowel function
Evaluate for s/s of GI bleed and hyperglycemia
Ensure adequate dialysis

24
Q

What are interventions for hypotension or hypotensive symptoms with PD?

A

Adjust PD fluids for less UF
Consult MD regarding antihypertensive meds.
Adjust salt and fluid intake if overrestricted.

25
Q

What are interventions for hypertension with PD?

A

Reduce sodium and fluid intake
Perform dialysis exchanges as prescribed
Evaluate antihypertensive meds

26
Q

What are the sodium recommendations for ESRD on PD?

A

Limit intake to 2300 mg/day or less
Clearance is higher in CAPD than APD

27
Q

What are the fluid recommendations for ESRD on PD?

A

Dependent on UF and residual urine output
Typically 1-3L/day depending on UOP, UF capacity, cardiac status, and BP

28
Q

What are the potassium recommendations for ESRD on PD?

A

Adjust to maintain serum levels WNL.
Most tolerate 3000-4000 mg/day
Fecal excretion increased with CAPD

29
Q

What are the calcium recommendations for ESRD on PD?

A

Limit total elemental calcium to avoid hypercalcemia.
No more than 1500 mg/day from phos binders

30
Q

What are the phos recommendations for ESRD on PD?

A

Adjust to maintain serum levels WNL
Consider bioavailability of source

31
Q

What is peritonitis?

A

Infection of peritoneum
Either due to contamination during PD exchange or exit site infection
Increased protein losses by up to 50%

CSR Exam (14 decks)

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