Renal Failure CBM

Question 1

List 3 indications for acute dialysis?

Answer 1

• Acidosis (not responsive to medical management).
• Electrolyte imbalances (such as hyperkalaemia not responsive to medical management).
• Ingestion of dialysable substances (such as ethylene glycol or lithium).
• Volume overload (not responsive to medical management).
• Uraemia complications (notably pericarditis or encephalopathy).

Question 2

Is GFR <10 an indication for dialysis? When would you consider starting dialysis in a chronic setting?

Answer 2

Low GFR on its own is not an indication for dialysis.

Dialysis can be considered for individuals with progressive kidney disease who are at endstage (usually eGFR <10 ml/minute) and have developed complications of renal failure such asdifficult-to-control volume status or uraemic symptoms.

Question 3

List four categories of etiology for renal failure associated symptoms ? At what level of GFR would you expect to see these sympotms?

Answer 3

1. Volume/fluid accumulation - any stage
2. Hyperparathyroidism/low phosphate - e.g. pruritis. eGFR<60
3. Anemia - eGFR <30
4. Accumulation of ‘uremic toxins’ - note: these are the unmeasured by-products of metabolism that lead to the clinical syndrome of uraemia. It is not due to elevation in the levels
   of urea (azotaemia). This generally occurs when eGFR is 5–10 ml/minute but can, on occasion, occur outside this range.

Question 4

In end stage renal disease, stopping which medication might slow the progression of renal dysfunciton? In which population might this be inappropriate?

Answer 4

ACEI or ARB - allows renal autoregulation to resume. Not appropriate in patients with concurrent cardiovascular disease.

Question 5

List 3 of the most common symptoms seen at end of life in a patient dying of renal failure.

Answer 5

• pain (42%)
• agitation (30%)
• myoclonus (28%)
• dyspnoea (25%)
• nausea (13%)

Question 6

List goals of reduced dose dialysis in those with life limiting disease or in the elderly:

Answer 6

Examples of short-term measures of dialysis adequacy include:
◆ Control of fluid balance (stable weight/oedema/blood pressure).
◆ Control of electrolytes (stable serum potassium).
◆ Control of acid/base balance in the body.
◆ Avoidance of uraemic encephalopathy.