Renal Replacement Therapies

Question 1

What is an arteriovenous fistula?

Answer 1

Surgically created…?
Takes several weeks to months to mature.

Question 2

Arteriovenous fistula must be protected from…

Answer 2

COMPRESSION (to prevent thrombosis)

Question 3

What happens if a patient cannot have an arteriovenous fistula (unsuitable vessels)?

Answer 3

Central venous dialysis catheter

Question 4

What is a central venous dialysis catheter?

Question 5

What are the disadvantages of a central venous dialysis catheter?

Answer 5

Infection
Clotting
(due to introduction of foreign body - catheter - into the body)

Question 6

What is continuous renal replacement therapy (CRRT)

Answer 6

Gentler form of dialysis: occurs at a lower blood flow rate. Often used for patients in the ICU (very ill and hypotensive).

Question 7

What is peritoneal dialysis?

Question 9

How do you chose the dialysis modality for your patient? (4)

Answer 9

1. Technical feasibility
2. Degree of patient autonomy (cognitive impairment? dementia?)
3. Personal preference
4. Technique complications (e.g. peritoneal infection)

Question 11

Principles of dialysis: Movement of molecules and fluid occurs by… (3)

Answer 11

Diffusion
Ultrafiltration
Convection

Question 12

Diffusion

Question 13

Dialysis membranes that we chose are not permeable to…

Answer 13

…any molecules larger than albumin (we do not want to lose proteins, only exchange water and electrolytes).

Question 14

What is the renal replacement therapy of choice?

Answer 14

renal transplant

Question 15

What are the advantages and disadvantages of renal transplant?

Answer 15

Advantages:
- Better quality of life
- Lower mortality risk

Disadvantages:
- Risk of death still higher than general population
- Requires continuous immunosuppression

Question 16

What is the key to a successful solid organ transplantation?

Answer 16

Preventing organ rejection by immunosuppression

Question 17

What are 3 types of kidney donors (living related or unrelated)

Answer 17

1. Direct donation
2. Kidney paired exchange
3. Anonymous, non-directed donation

Question 18

What are the 2 types of deceased donors?

Answer 18

SCD: standard criteria donors
ECD: expanded criteria donors

Question 19

Which is more common in Canada:
a) deceased kidney donors
b) living kidney donors

Answer 19

It’s about 50/50.
The likelihood of having a living vs dead donor depends on the region in Canada.

Question 20

Which yields better survival rates:
a) kidney from living donor
b) kidney from deceased donor

Answer 20

a) kidney from living donor