Lecture 24 Renal Replacement Therapy (Dialysis) Flashcards
What are the functions of the kidneys
- 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
What is the syndrome of advanced CKD
Uraemia
When is renal replacement therapy indicated
eGFR <10ml/min
Name types of renal replacement therapy
Renal transplant
Haemodialysis
peritoneal dialysis
What are the 2 types of haemodialysis
Home
Satellite/Hospital
What are the 2 types of peritoneal dialysis
o Continuous ambulatory peritoneal dialysis (CAPD)
o Intermittent peritoneal dialysis (IPD)
What are the 2 principle steps of dialysis
Diffusion
Ultrafiltration
What are the pre-requisites for dialysis
Semi-permeable membrane
Adequate blood exposure to the membrane
Dialysis access
Anticoagulation
Name 2 types of permanent haemadialysis access
– Arteriovenous fistula
– AV prosthetic graft
Name 2 types of temporary haemodialysis access
– Tunnelled venous catheter
– Temporary venous catheter
Describe the fluid restrictions for dialysis patients
– Dictated by residual urine output
– Interdialytic weight gain
What is the dietary restriction for dialysis patient
– Potassium
– Sodium
– Phosphate
How does dialyzer in a dialysis machine work
Balanced solution that pulls waste from blood
What time of the day is continuous ambulatory peritoneal dialysis used
Day
What time of the day is automated peritoneal dialysis used
Night
What is the most common osmotic agent for ultrafiltration
Glucose
What are the complications of peritoneal dialysis
Exit site infections Peritonitis Gram positive- skin infections Gram negative- bowel origin Ultrafiltration failure Encapsulating peritoneal sclerosis
What is the fluid restriction for haemodialysis
500-800 ml/24 hours
o intake allowed = urine output +insensible loss
What is the fluid restriction for peritoneal dialysis
More liberal due to continuous ultrafiltration
What drugs are used to treat anaemia
– Erythropoietin injections
– IV iron supplements
What drugs are used to treat renal bone disease
– Activated Vitamin D (eg calcitriol)
– Phosphate binders with meals (CaCo3)
What are the drugs are given to dialysis patients
Heprain
Water soluble vitamins
Anti-hypertensives
Name cardiovascular problems of haemodialysis
– Intra-dialytic hypotension and cramps
– Arrythmias
Name coagulation complications of haemodialysis
Clotting of vascular access
heparin related problems
Name infection complications of haemodialysis
– Exit site infection
– Tunnel infection
– Peritonitis
Name Mechanical complications of haemodialysis
Tube malfunction
Abdominal wall hernia
