Hemodialysis, Peritoneal Dialysis, and other Renal Replacement Therapies Flashcards
What is Renal Replacement Therapy (RRT)?
A catch-all term for dialysis
What are the 4 kinds of Peritoneal Dialysis?
1) Continuous Ambulatory Peritoneal Dialysis (CAPD)
2) Continuous Cyclic Peritoneal Dialysis (CCPD)
3) Nocturnal Intermittent Peritoneal Dialysis (NIPD)
4) Nocturnal Tidal Peritoneal Dialysis (NTPD)
What kinds of dialysis are used for Acute Kidney Injury or Very Sick Patients?
1) Continuous arteriovenous hemofiltration (CAVH)
2) Continuous venovenous hemofiltration (CVVH)
3) Continuous venovenous hemodiafiltration (CVVHD)
What is ultrafiltrate?
Waste products removed during continuous renal replacement therapy
Which electrolyte is not able to be balanced through renal replacement therapies (RRT)?
phosphorus
What are the indications for RRT?
A: Acid-Base Balance
E: Electrolyte Disturbances
I: Intoxication
O: Fluid Overload
U: Uremia
What are the goals of dialysis?
1) Initiate when BUN > 100 and SCr > 10
2) Remove “middle molecules” such as beta2microglobulin, uric acid, and creatinine
What is an AV fistula?
A patient’s artery is sewn to their vein which causes AI pressure to go into the vein making it swell up
-This vein is then used as an access port for dialysis
What are some additional considerations of creating an AV Fistula?
-Has the longest survival (lasts for up to 20 years)
-Has fewer complications
-Takes 1-2months to mature and be usable
What is an AV Graft?
Tubing connects a patient’s artery to their vein
-This tubing is used as the access port for dialysis
What are some additional considerations of creating an AV Graft?
-The graft is synthetic and therefore more likely to be rejected by the body
-Has a shorter survival time and a greater chance of infection
-*Takes 2-3 weeks to mature and then is usable
After a vascular access device is created, what are two important things that should NEVER be done to the access arm?
No needle sticks
No blood pressure cuffs
What substances ARE NOT REMOVED by hemodialysis?
1) High Vd (volume of distribution)
2) High lipophilicity
3) Large molecular weight
4) Highly protein bound
What are the complications of hemodialysis?
1) hypotension
2) pruritis (itching)
3) muscle cramps
What urea reduction ration (URR) (measure of the reduction of the BUN) tells us that hemodialysis was successful?
> or = 70%
(BUN is 30% or less)
What is peritoneal dialysis (PD)?
Uses the patient’s peritoneal membrane as a dialysis membrane
Who is peritoneal dialysis (PD) used in?
Pediatrics or ESRD patients already receiving PD
What are some considerations when using peritoneal dialysis (PD)?
**Not as effective as hemodialysis
**Residual renal function is preserved
-Is a continuous therapy
-Rarely used for acute renal failure (ARF) except in children
-Interrupts patient’s lives less than hemodialysis
What are the 4 types of peritoneal dialysis?
CAPD
CCPD
NIPD
TPD
Which type of peritoneal dialysis does NOT require a machine?
CAPD
Which types of peritoneal dialysis only use automatic cyclers at night?
NIPD and TPD
*TPD keeps fluid amounts at the same level all night long with short exchanges throughout the night
When are Continuous Renal Replacement Therapies (CRRT) used?
Used primarily for Acute Renal Failure
–used for patients who cannot tolerate regular hemodialysis sessions
**These therapies run at a much slower rate!
Which CRRT work through convection?
CAVH and CVVH
*these do not use any dialysate fluid but do use ultrafiltrate replacement fluid
Which of the CRRT works through diffusion?
CVVHD
*this uses dialysate fluid
