Lecture 24 Renal Replacement Therapy (Dialysis)

Question 1

What are the functions of the kidneys

Answer 1

• Excretion of nitrogenous waste products
• Maintenance of acid and electrolyte balance
• Control of blood pressure
• Drug metabolism and disposal
• Activation of vitamin D
• Production of erythropoietin

Question 2

What is the syndrome of advanced CKD

Answer 2

Uraemia

Question 3

When is renal replacement therapy indicated

Answer 3

eGFR <10ml/min

Question 4

Name types of renal replacement therapy

Answer 4

Renal transplant
Haemodialysis
peritoneal dialysis

Question 5

What are the 2 types of haemodialysis

Answer 5

Home

Satellite/Hospital

Question 6

What are the 2 types of peritoneal dialysis

Answer 6

o Continuous ambulatory peritoneal dialysis (CAPD)

o Intermittent peritoneal dialysis (IPD)

Question 7

What are the 2 principle steps of dialysis

Answer 7

Diffusion

Ultrafiltration

Question 8

What are the pre-requisites for dialysis

Answer 8

Semi-permeable membrane
Adequate blood exposure to the membrane
Dialysis access
Anticoagulation

Question 9

Name 2 types of permanent haemadialysis access

Answer 9

– Arteriovenous fistula

– AV prosthetic graft

Question 10

Name 2 types of temporary haemodialysis access

Answer 10

– Tunnelled venous catheter

– Temporary venous catheter

Question 11

Describe the fluid restrictions for dialysis patients

Answer 11

– Dictated by residual urine output

– Interdialytic weight gain

Question 12

What is the dietary restriction for dialysis patient

Answer 12

– Potassium
– Sodium
– Phosphate

Question 13

How does dialyzer in a dialysis machine work

Answer 13

Balanced solution that pulls waste from blood

Question 14

What time of the day is continuous ambulatory peritoneal dialysis used

Answer 14

Day

Question 15

What time of the day is automated peritoneal dialysis used

Answer 15

Night

Question 16

What is the most common osmotic agent for ultrafiltration

Answer 16

Glucose

Question 17

What are the complications of peritoneal dialysis

Answer 17

Exit site infections
Peritonitis
Gram positive- skin infections
Gram negative- bowel origin
Ultrafiltration failure
Encapsulating peritoneal sclerosis

Question 18

What is the fluid restriction for haemodialysis

Answer 18

500-800 ml/24 hours

o intake allowed = urine output +insensible loss

Question 19

What is the fluid restriction for peritoneal dialysis

Answer 19

More liberal due to continuous ultrafiltration

Question 20

What drugs are used to treat anaemia

Answer 20

– Erythropoietin injections

– IV iron supplements

Question 21

What drugs are used to treat renal bone disease

Answer 21

– Activated Vitamin D (eg calcitriol)

– Phosphate binders with meals (CaCo3)

Question 22

What are the drugs are given to dialysis patients

Answer 22

Heprain
Water soluble vitamins
Anti-hypertensives

Question 23

Name cardiovascular problems of haemodialysis

Answer 23

– Intra-dialytic hypotension and cramps

– Arrythmias

Question 24

Name coagulation complications of haemodialysis

Answer 24

Clotting of vascular access

heparin related problems

Question 25

Name infection complications of haemodialysis

Answer 25

– Exit site infection
– Tunnel infection
– Peritonitis

Question 26

Name Mechanical complications of haemodialysis

Answer 26

Tube malfunction

Abdominal wall hernia