Hemodialysis, Peritoneal Dialysis, and other Renal Replacement Therapies

Question 1

What is Renal Replacement Therapy (RRT)?

Answer 1

A catch-all term for dialysis

Question 2

What are the 4 kinds of Peritoneal Dialysis?

Answer 2

1) Continuous Ambulatory Peritoneal Dialysis (CAPD)
2) Continuous Cyclic Peritoneal Dialysis (CCPD)
3) Nocturnal Intermittent Peritoneal Dialysis (NIPD)
4) Nocturnal Tidal Peritoneal Dialysis (NTPD)

Question 3

What kinds of dialysis are used for Acute Kidney Injury or Very Sick Patients?

Answer 3

1) Continuous arteriovenous hemofiltration (CAVH)
2) Continuous venovenous hemofiltration (CVVH)
3) Continuous venovenous hemodiafiltration (CVVHD)

Question 4

What is ultrafiltrate?

Answer 4

Waste products removed during continuous renal replacement therapy

Question 5

Which electrolyte is not able to be balanced through renal replacement therapies (RRT)?

Answer 5

phosphorus

Question 6

What are the indications for RRT?

Answer 6

A: Acid-Base Balance
E: Electrolyte Disturbances
I: Intoxication
O: Fluid Overload
U: Uremia

Question 7

What are the goals of dialysis?

Answer 7

1) Initiate when BUN > 100 and SCr > 10

2) Remove “middle molecules” such as beta2microglobulin, uric acid, and creatinine

Question 8

What is an AV fistula?

Answer 8

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

Question 9

What are some additional considerations of creating an AV Fistula?

Answer 9

-Has the longest survival (lasts for up to 20 years)
-Has fewer complications
-Takes 1-2months to mature and be usable

Question 10

What is an AV Graft?

Answer 10

Tubing connects a patient’s artery to their vein

-This tubing is used as the access port for dialysis

Question 11

What are some additional considerations of creating an AV Graft?

Answer 11

-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

Question 12

After a vascular access device is created, what are two important things that should NEVER be done to the access arm?

Answer 12

No needle sticks
No blood pressure cuffs

Question 13

What substances ARE NOT REMOVED by hemodialysis?

Answer 13

1) High Vd (volume of distribution)
2) High lipophilicity
3) Large molecular weight
4) Highly protein bound

Question 14

What are the complications of hemodialysis?

Answer 14

1) hypotension
2) pruritis (itching)
3) muscle cramps

Question 15

What urea reduction ration (URR) (measure of the reduction of the BUN) tells us that hemodialysis was successful?

Answer 15

> or = 70%
(BUN is 30% or less)

Question 16

What is peritoneal dialysis (PD)?

Answer 16

Uses the patient’s peritoneal membrane as a dialysis membrane

Question 17

Who is peritoneal dialysis (PD) used in?

Answer 17

Pediatrics or ESRD patients already receiving PD

Question 18

What are some considerations when using peritoneal dialysis (PD)?

Answer 18

**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

Question 19

What are the 4 types of peritoneal dialysis?

Answer 19

CAPD
CCPD
NIPD
TPD

Question 20

Which type of peritoneal dialysis does NOT require a machine?

Answer 20

CAPD

Question 21

Which types of peritoneal dialysis only use automatic cyclers at night?

Answer 21

NIPD and TPD

*TPD keeps fluid amounts at the same level all night long with short exchanges throughout the night

Question 22

When are Continuous Renal Replacement Therapies (CRRT) used?

Answer 22

Used primarily for Acute Renal Failure
–used for patients who cannot tolerate regular hemodialysis sessions

**These therapies run at a much slower rate!

Question 23

Which CRRT work through convection?

Answer 23

CAVH and CVVH

*these do not use any dialysate fluid but do use ultrafiltrate replacement fluid

Question 24

Which of the CRRT works through diffusion?

Answer 24

CVVHD

*this uses dialysate fluid

Question 25

Which of the CRRT is the most similar to dialysis?

Answer 25

CVVHDF

-Uses both dialysate and ultrafiltrate replacement fluid