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CDM 1 Exam 3 > Renal: ESRD > Flashcards

Renal: ESRD Flashcards

1
Q

Most common treatment used for ESRD?

A

Hemodialysis

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2
Q

Primary cause of ESRD?

A

DM

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3
Q

Overall mortality rate of dialysis?

A

13%, decreasing since 1988

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4
Q

Dialysis life expectancy is…

A

20-25% of a healthy individual

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5
Q

1 killer of patients on dialysis is…

A

ASCVD

infections 2nd most common cause

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6
Q

When do you start dialysis?

A

planning once eGFR or ClCr <30ml/min

benefits and risks of actual start should be eval when eGFR or ClCr <15 ml/min (when to start within next short period of time)

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7
Q

Criteria for starting dialysis

A

1 = pts clinical status (Persistent anorexia, N/V, weight-loss, fatigue, low serum albumin lvls, neurologic deficits or itching

  1. concomitant diseases (uncontrolled HTN/CHF)
  2. Adv/Disadvantages of HD and PD
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8
Q

How often is and how long is each HD session

A

3/week for about 3-5hrs

larger pts will require long treatment time

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9
Q

What is Dialysate solution?

A

Purified water and electrolytes

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10
Q

What is important to add with HD?

A

Add heparin to prevent clotting of blood running through the lines

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11
Q

Two options for access in Hemodialysis

A

Arterial venus fistula

Synthetic AV graft

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12
Q

Arterial Venus Fistula

A

Take artery and connect with vein

takes like 6 months before you can use it

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13
Q

Primary Artery used for AV fistula

A

usually radial or cephalic in forearm

start closer in wrist, if issue can move farther back up

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14
Q

Central venous catheters

A

are temporary and have a high rate of infection

placed in femoral, subclavian or internal jugular vein

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15
Q

Pro/Con of Native AV fistula

A

Pro:

  1. longest access survival
  2. lowest rate of complications
  3. inc survival = decrease hospitalizations
  4. most cost-effective

Con:

  1. require 1-2 months to mature before use
  2. difficult to rate in some pt…(elderly, PVD, anyone with Vascular disease)
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16
Q

Pro/Con of Synthetic AV graft

A

Pro:
1. 2-3 wks to mature

Con:

  1. shorter survival vs fistula
  2. increased infections/thrombosis
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17
Q

Pro/Con of Central Venous Catheter

A

Pro:

  1. used immediately
  2. pts like small kids, severe PVD, morbidly obese

Con:

  1. short life span
  2. most infections/thrombosis
  3. mayn’t provide adequate blood flow for dialysis
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18
Q

Diffusion

A

movement of substances along a conc gradient

Rate depends on conc difference between blood and dialystate, solute characteristics, dialyzer membrane comp and flow rates

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19
Q

Ultrafiltration

A

movement of water across dialyzer membrane due to hydrostatic or osmotic pressure

primary means for removal of excess body water

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20
Q

Convection

A

dissolved solutes “dragged” across membrane with fluid transport (during ultrafiltration)

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21
Q

HD membranes: conventional/standard

A

small pores

limit clearance to smaller molecules

22
Q

HD membranes: High efficiency

A

large surface area

can remove water/urea/other small molecules

23
Q

HD membranes: High Flux

A

Large pores

capable of removing high-molecular-weight substances

drugs like vancomycin

24
Q

Shorter treatment times occur with which membranes?

A

High efficiency and High flux due to increased clearance

25
Q

Flow rates required for High efficiency/flux membranes

A

> 400 mL/min blood flow
500 mL/min dialysate flow

can increase risk of hypotension and muscle cramps

26
Q

Pro/Con of HD

A

Pro:

  1. higher solute clearance = intermittent sessions
  2. Technique failure rate low
  3. closer pt monitoring

Con:

  1. Multiple visits/wk to HD center
  2. SE = Hypotension, muscle cramp, disequilibrium
  3. Infections
  4. Vascular thrombosis
27
Q

Complications during HD

A

Hypotension

Muscle cramps

28
Q

Point of Air detector in HD?

A

To prevent embolism if air is in the lines

29
Q

can you still urinate on dialysis?

A

Yes they can

you want to maintain any kidney functions they have as it can improve their outcomes

30
Q

What causes Hypotension in HD

A

taking out too much fluid too fast

more common in DM and elderly

31
Q

What causes muscle cramps in HD

A

excessive ultrafiltration = decreased plasma volume and decrease muscle filtration

pulls volume out of tissues into vasculature

32
Q

Acute Hypotension during Dialysis treatment

A
  1. Trendelenburg postion
  2. decrease ultrafiltration rate
  3. 100-200ml bolus normal saline
  4. 10-20 ml hypertonic saline bolus
33
Q

Prevention of Hypotension during Dialysis treatment

A

Midodrine = 1st choice

2.5-10mg 30min prior to start

34
Q

Acute Muscle Cramp during Dialysis treatment

A
  1. 100-200ml normal saline bolus

2. 10-20ml hypertonic saline bolus

35
Q

Prevention of Muscle cramp during Dialysis treatment

A
  1. Vit E 400IU daily = 1st choice (well tolerated, cheap, easy)
  2. Quinine
36
Q

What to do if thrombosis occurs during HD?

A

give alteplase/reteplase

37
Q

How to treat infections from HD

A
  1. remove catheter

2. give ABX depending on infection based on what it is

38
Q

Who gets Peritoneal Dialysis

A
  1. Hemodynamically unstable
  2. Sig residual kidney function
  3. Pts who desire to maintain sig degree of self care as long as they can be trained
39
Q

PD vs HD

A
  1. PD is much less efficient
  2. No easy method to regulate blood flow
  3. No countercurrent of flow

PD session will be much longer than HD session

40
Q

Pros/Cons of Peritoneal Dialysis

A

Pro:

  1. More hemodynamic stability vs HD
  2. Better preservation of residual renal function
  3. Can admin some drugs IP
  4. Freedom from HD machine
  5. Less blood loss/iron deficiency

Con:

  1. Peritonitis
  2. Catheter malfunction
  3. Infection
  4. Inadequate dialysis and ultrafiltration
  5. High rate of tech failure
41
Q

How to treat PD Peritonitis

A

give ABX intraperitoneally

42
Q

Prophylaxis of Peritonitis in PD pts

A

Test for Staph aureus in nose = increase risk

Can give mupirocin intranasal BID/5 days/month
Place daily on exit port

43
Q

Continuous Renal Replacement Therapies

A

Used in acute renal failure by toxic substance

44
Q

CVVH primary clearance is through…

A

convection

45
Q

CVVHD primary clearance is through….

A

Diffusion

46
Q

CVVHDF primary clearance is through….

A

Convection and diffusion

47
Q

Pros/Cons of CRRT vs IHD

A

Pro:

  1. Less BP issues
  2. increase solute removal/day
  3. improved survival
  4. faster ARF resolution

Cons:

  1. increase thrombosis
  2. Special equip
  3. intensive RN care & $$$, pharmacy care
  4. Little known about drug dosing in CRRTs
  5. ?? nutrition requirement changes
48
Q

Drug dosing in Dialysis

A
  1. If drug dialyzable, schedule admin after dialysis to avoid supplemental dosing
  2. if in doubt, drug drug levels. need pre/post dialysis levels
49
Q

Efficiency of drug removal determined by….

A
  1. Membrane characteristics
  2. Dialysis characteristics (Blood flow, duration of dialysis, Dialysate flow rate & composition)
  3. Drug characteristics (MW, water solubility, protein binding = most important, Volume of Distribution = the higher it is, the lower removed by dialysis)
50
Q

Small MW of drug influenced by….

A

Diffusion

51
Q

Large MW of drug influenced by….

A

Convection

52
Q

Volume of Distribution effect on dialysis drug removal

A

The higher the volume of distribution = the less is removed by dialysis

CDM 1 Exam 3 (10 decks)

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