Renal

Question 1

What are the three forms of dialysis?

Answer 1

Peritoneal dialysis, continual renal replacement therapy and haemodialysis

Peritoneal: dialysate placed in the peritoneal cavity, peritoneal membrane serves as filtration surface

- Continuous ambulatory peritoneal dialysis
- Automated peritoneal dialysis (sleeping)
- Tidal peritoneal dialysis

Continuous renal replacement therapy:
- Dual lumen catheter with filter in jugular, subclavian or femoral vein

Haemodialysis: extracorporal blood filtration

- Central venous catheter (vena cava, internal jugular or femoral vein)
- AV fistula
- AV graft (used anatomical variation or arterial disease e.g. DM doesn't allow for fistula)

Question 2

What are the benefits and complications of peritoneal dialysis?

Answer 2

• Better tolerated if cardiovascular compromise (steady-state treatment)
• Can be done at home
• Bacterial peritonitis
• Local infection at catheter site
• Constipation
• Pleural effusion
• Sclerosing peritonitis

Question 3

What are the benefits and complications of haemodialysis?

Answer 3

• More effective than PD
• Actual time during dialysis is faster
• Lower rates of infection
• Hypotension
• Anaphylactic reaction to ethylene oxide (sterilises machines)
• Haemolytic reactions
• Air embolus
• “Hard water syndrome” (nausea, hypertension, headache, confusion, memory loss, seizures)
• Clotting/bleeding from anticoagulation

Question 4

What are the benefits and complications of continual renal replacement therapy?

Answer 4

• Continuous therapy
• Same mortality rates as haemodialysis
• Line related complications
  
  • Pneumothorax/Haemothorax
  • Arterial puncture/haematoma
  • Thoracic duct injury
• Circuit related complications
  
  • Air embolism
  • Clotting/bleeding if anticoagulated
  • DIC, anaemia, hypotension

Question 5

What are the main causes of death in patients with dialysis?

Answer 5

Cardiovascular disease and sepsis (staph aureus)