Haemodialysis

Question 1

What is haemodialysis?

Answer 1

Haemodialysis is a renal replacement therapy that filters blood using an external dialyser to remove waste products and excess fluids.

Question 2

What are the main types of haemodialysis?

Answer 2

The two main types are conventional haemodialysis (sessions lasting about four hours, three times a week) and continuous haemodialysis used in critical care.

Question 3

What are the primary indications for initiating haemodialysis?

Answer 3

Indications include severe metabolic acidosis, refractory hyperkalaemia, toxin ingestion, refractory pulmonary oedema, and symptomatic uraemia.

Question 4

How does a dialyser work in haemodialysis?

Answer 4

A dialyser is an artificial kidney that uses a semipermeable membrane to filter waste products and excess electrolytes from the blood.

Question 5

What vascular access options are available for haemodialysis?

Answer 5

Options include arteriovenous fistulas, arteriovenous grafts, and central venous catheters, with fistulas preferred for long-term use.

Question 6

What are common complications associated with haemodialysis?

Answer 6

Complications include hypotension, muscle cramps, itching, sleep disturbances, and access-related issues like infection or thrombosis.

Question 7

How is fluid balance managed in patients undergoing haemodialysis?

Answer 7

Fluid balance is managed by restricting fluid intake and using ultrafiltration during dialysis to remove excess fluid.

Question 8

What dietary restrictions are typically recommended for haemodialysis patients?

Answer 8

Patients are advised to limit potassium, phosphorus, sodium, and fluids while ensuring adequate protein intake.

Question 9

How does haemodialysis differ from peritoneal dialysis?

Answer 9

Haemodialysis uses an external machine and dialyser, often in clinical settings, while peritoneal dialysis uses the patient’s peritoneum as a filter at home.

Question 10

What is the role of anticoagulation during haemodialysis?

Answer 10

Anticoagulation, usually with heparin, prevents clotting in the extracorporeal circuit during haemodialysis.

Question 11

How often do patients typically undergo haemodialysis sessions?

Answer 11

Patients typically undergo haemodialysis three times a week, with each session lasting about four hours.

Question 12

What is an arteriovenous (AV) fistula, and why is it preferred for haemodialysis access?

Answer 12

An AV fistula is a surgically created connection between an artery and a vein, offering lower risks of infection and thrombosis compared to other access types.

Question 13

What are the potential risks of using central venous catheters for haemodialysis access?

Answer 13

Risks include higher rates of infection, thrombosis, and central vein stenosis compared to AV fistulas or grafts.

Question 14

How does haemodialysis help manage hyperkalaemia in patients with kidney failure?

Answer 14

Haemodialysis removes excess potassium from the bloodstream, correcting hyperkalaemia.

Question 15

What is the significance of dialysis adequacy, and how is it measured?

Answer 15

Dialysis adequacy measures how effectively haemodialysis removes waste products, often assessed using Kt/V or urea reduction ratio.

Question 16

How can patients manage the common side effect of muscle cramps during haemodialysis?

Answer 16

Muscle cramps can be managed by adjusting ultrafiltration rates, ensuring hydration, and using medications like quinine or vitamin E if needed.

Question 17

What lifestyle modifications are recommended for patients on haemodialysis?

Answer 17

Recommendations include adhering to dietary restrictions, managing fluid intake, exercising regularly, and avoiding smoking and alcohol.

Question 18

How does haemodialysis impact medication management in patients?

Answer 18

Some medications are removed during dialysis, requiring dose adjustments or timing changes to maintain their effectiveness.

Question 19

What psychological support options are available for patients undergoing haemodialysis?

Answer 19

Support options include counselling, support groups, and access to mental health professionals experienced with chronic illness.

Question 20

How does haemodialysis affect a patient’s daily life and work schedule?

Answer 20

Haemodialysis requires significant time, impacting daily activities and work, but many patients can work with flexible scheduling and support.

Question 21

What is the role of the multidisciplinary team in managing patients on haemodialysis?

Answer 21

The team includes nephrologists, dialysis nurses, dietitians, social workers, and technicians working together for comprehensive care.

Question 22

How can patients prevent infections related to haemodialysis access sites?

Answer 22

Patients should maintain proper hand hygiene, clean and inspect access sites regularly, and follow aseptic techniques during dialysis.

Question 23

What are the signs and symptoms of dialysis disequilibrium syndrome?

Answer 23

Symptoms include headache, nausea, vomiting, restlessness, blurred vision, muscle twitching, seizures, or coma during or after dialysis.

Question 24

How is dialysis disequilibrium syndrome managed and prevented?

Answer 24

Management includes slowing or stopping dialysis, administering hypertonic saline or mannitol, and preventing it by starting dialysis with shorter sessions.

Question 25

What factors influence the choice between haemodialysis and peritoneal dialysis?

Answer 25

Factors include the patient’s medical condition, lifestyle, home environment, and personal preferences, discussed with the healthcare team.