Renal Dialysis Flashcards
what is RRT
renal replacement therapy (dialysis or transplant)
what is end-stage renal disease
irreversible kidney damage so severely affecting ability to remove waste or adjust blood that they need dialysis or transplant
the syndrome of advanced chronic kidney disease
uraemia
earliest cardinal symptoms of uraemia
malaise and fatigue
what stage of CKD can it remain asymptomatic till
stage 4 or 5
what eGFR would indicate RRT
<10ml.min
4 types of RRT
transplant, haemodialysis, peritoneal dialysis and conservative kidney management
signs of uraemia
hyperpigmentation pallor hypertension postural hypotension peripheral oedema LV hypertrophy PVD pleural effusion peripheral neuropathy restless legs syndrome
symptoms of uraemia
anorexia nausea vomiting fatigue weakness pruritus lethargy dyspnoea insomnia cramps nocturia polyuria headace
what is CKD
chronic kidney disease –> proteinuria or haematuria and/or reduction in GFR for more than 3 months
most common causes of CKD
diabetes and hypertension
why is fatigue a symptom of CKD
because anaemia is present from the lack of erythropoietin produced once GFR<50ml/min
oedema in CKD is caused by
salt and water retention as GFR declines
pruritis, nausea and vomiting in CKD is thought to be caused by
accumulation of toxins
what key toxin is not excreted in CKD
urea
principle of haemodialysis
blood is pumped through a solute (dialysate) and a semipermeable membrane. The content is filtered by diffusion (solute concentration) and by ultrafiltration (pressure altering water content)
what is constantly infused throughout haemodialysis
heparin (anticoagulant)
what vascular structure is required for haemodialysis
an arteriovenous fistula
4 things needed for dialysis
- a semipermeable membrane
- adequate blood exposure to membrane
- dialysis access
- anticoagulation (only haemo)
what is the semipermeable membrane in peritoneal dialysis
the peritoneum
restrictions in dialysis
reduced fluid intake (usually <1L/day) and dietary restriction of potassium sodium and phosphate
what is the blood supply in PD
mesentric circulation
principle of peritoneal dialysis
a dialysate is instilled through a catheter into the peritoneal cavity. The peritoneum acts as the membrane and after a time the fluid is drain out and replaced with new dialysate
3 types of PD
continuous ambulatory, automated or a hybrid
what is the most commonly used osmotic agent of PD
glucose
which part of dialysis, diffusion or ultrafiltration, is glucose responsible for
ultrafiltration
what varies in timing between CAPD and APD
CAPD is throughout the daytime
APD is through night
complications of PD
infection of skin or peritoneum
encapsulating peritoneal sclerosis (extensive thickening and fibrosis of peritoneum creating a fibrous cocoon for bowel)
if there is PD peritonitis with a gram positive microorganism, where is it’s origin
skin
if there is PD peritonitis with a gram negative microorganism, where is it’s origin
bowel
indications for dialysis
GFR 5-10ml/min
severe acidosis
treatment resistant hyperkalaemia
treatment resistant fluid overload
which dialysis type is allowed more fluid intake
PD - fluid balance is more continuous
main indication for dialysis
symptoms or uraemia or eGFR<10ml/min
in haemodialysis urea and creatinine are moved into/removed from the blood
removed from the blood
electrolyte movement in dialysis
not neccessarily removed or kept in, more just that they are brought to the right conc in blood
