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Renal Exam 2 > Lect 6 > Flashcards

Lect 6 Flashcards

1
Q

hemodialysis

A

blood is removed from the body, filtered, then put back into the body

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2
Q

peritoneal dialysis

A

Used peritoneal layer/ membrane act as a membrane inside the body then empty out peritoneal cavity and replace more fluid

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3
Q

KDOQI recommendation for planning dialysis

A

Stage 4 CKD or CrCl less than 30 mL/min

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4
Q

when is dialysis access created?

A

GFR less than 25 mL/min
SCr >4
1 year prior to anticipated need for dialysis

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5
Q

when does KDOQI recommend evaluating for dialysis?

A

GFR or CrCl less than 15 mL/min/1.73 m2

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6
Q

when is dialysis access created?

A

GFR 4

1 year prior to anticipated need for dialysis

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7
Q

when does KDOQI recommend evaluating for dialysis?

A

GFR or CrCl

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8
Q

indications for dialysis

A

LOOK AT SLIDE

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9
Q

how do you evaluate uremia?

A

BUN

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10
Q

what are the basic principles of diffusion in hemodialysis?

A

molecular weight, conc gradient, memb resistance, blood and dialysate flow rates

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11
Q

what are the basic principles of ultrafiltration in hemodialysis?

A

transmembrane pressure (TMP), ultrafiltration coefficient (Kuf)

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12
Q

conventional or standard dialyzers

A

small pores limit clearance to small molecules (urea and creatinine)
low blood flow rates

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13
Q

high efficiency dialyzers

A

large surface area (so increase capacity to remove water, urea, small molecules)
high blood flow rates

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14
Q

high flux dialyzers

A

large pores increase removal of high mol-weight substances

high blood flow rates

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15
Q

high flux dialyzers

A

large pores increase removal of high mol-weight substances

high blood flow rates

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16
Q

what is the dialysate solution composed of?

A

purified water and electrolytes (glucose, Na, K, Ca) –> actual quantities specified by physician
similar to body fluids but lacking waste products

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17
Q

dialysis solution bases

A

added to neutralize acid (since normal metabolism prod acids that ESRD pts are unable to clear)

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18
Q

examples of dialysis solution bases

A
  1. acetate= converted by liver to bicarb; has more adverse effects
  2. bicarbonate= $$$, drug of choice in liver impairment and severe acidosis
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19
Q

what is the major challenge for success and long-term feasibility of HD?

A

vascular access

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20
Q

AV fistula

A

anastomosis of a vein and artery

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21
Q

advantages of AV fistula

A

longest survival, lowest complications, increased survival and decreased hospitalizations, most cost-effective

22
Q

disadvantages of AV fistula

A

takes 1-2 months to mature, diff to create in elderly or PVD pts

23
Q

AV synthetic graft

A

graft connects the artery and vein

24
Q

advantages of AV synthetic draft

A

easily implanted

longer survival than catheters

25
Q

disadvantages of AV synthetic graft

A

shorter survival than fistula
higher rates of complications than fistulas
2-3 weeks to endothelialize prior to use

26
Q

disadvantages of AV synthetic graft

A

shorter survival than fistula
higher rates of complications than fistulas
2-3 weeks to endothelialize prior to use

27
Q

venous catheters

A

femoral, subclavian, or internal jugular vein

least desirable access

28
Q

advantages of venous catheters

A

immediate use

easy to place and remove

29
Q

disadvantages of venous catheters

A

short survival
higher risk of infection
may not provide adequate blood flow

30
Q

urea reduction ratio

A

% of blood being cleared of urea

(predialysis BUN- postdialysis BUN) / predialysis BUN x 100

31
Q

what is an adequate urea reduction ratio?

A

> 60%

32
Q

Kt/V

A

unitless parameter

fraction of total body water cleared of urea

33
Q

what is an adequate urea reduction ratio?

A

> 60%

measure monthly and adjust dialysis

34
Q

Kt/V

A

unitless parameter
fraction of total body water cleared of urea
K= dialyzer clearance of urea
t= time
V= total volume of water in body (0.6 x weight in kg)

35
Q

how do you interpret Kt/V?

A

mortality increases as Kt/V decreases

Kt/V of 1.2 is approx = URR of 63%

36
Q

intermittent hemodialysis

A

PRN basis

most commonly: 3 sessions/week with 3-5 hours/session

37
Q

continuous hemodialysis

A

based on access

38
Q

hemodialysis pros and cons

A

LOOK AT SLIDE

39
Q

basic principles of diffusion in peritoneal dialysis

A

molecular weight
conc gradient
memb resistance

40
Q

basic principles of ultrafiltration in peritoneal dialysis

A

osmotic force (dextrose and icodextrin)

41
Q

what can you alter in peritoneal dialysis?

A

NOT BLOOD FLOW OR PERMEABILITY
dialysate volume
dwell time
exchanges per day

42
Q

what can you alter in peritoneal dialysis?

A

NOT BLOOD FLOW OR PERMEABILITY
dialysate volume
dwell time
exchanges per day

43
Q

continuous ambulatory peritoneal dialysis (CAPD)

A

manual dialysate exchanges
adv= independence
disadv= infection risk

44
Q

automated peritoneal dialysis (APD)

A

automatic cycler performs exchanges (throughout the night)
adv= fewer exchanges in daytime, sterility, convenience
disadv= machine in bedroom

45
Q

types of APD

A
  1. ) continuous cycling peritoneal dialysis (CCPD)
  2. ) tidal peritoneal dialysis
  3. ) nightly intermittent peritoneal dialysis
46
Q

continuous cycling peritoneal dialysis (CCPD)

A

APD with “wet” day (long daytime dwell)

47
Q

tidal peritoneal dialysis

A

initial partial fill, then drain, then replace

creates tidal flow

48
Q

nightly intermittent peritoneal dialysis

A

APD with “dry” day (no daytime dwell)

49
Q

intermittent peritoneal dialysis

A

normally reserved for acute pts
machine operator
high cost, high risk of infection

50
Q

PD pros and cons

A

LOOK AT SLIDE

Renal Exam 2 (10 decks)

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