Renal replacement therapy 1

Question 1

What 2 functions of the kidney does dialysis not replace?

Answer 1

erythropoietin production

activation of vitamin D

Question 2

Define ESRD

Answer 2

irreversible damage to the kidneys severely affecting the ability to remove or adjust blood waste that to maintain life the patient must have dialysis or a transplant

Question 3

What is the syndrome of advanced CKD called?symptoms of this

Answer 3

Uraemia

earliest and cardinal sign is malaise and fatigue

Question 4

RRT definition

Answer 4

the means by which life is sustained in patients suffering from ESRD

Question 5

When is RRT usually indicated?

Answer 5

GFR<10mls/min but is variable

Question 6

4 types of RRT

Answer 6

renal transplant
haemodialysis - satellite or hospital
Peritoneal dialysis - CAPD or IPD
conservative management - symptoms of urea

Question 7

Define dialysis

Answer 7

A process which solute composition of solution A is altered by exposing it to solution B over a semi permeable membrane

Question 8

2 principles of dialysis

Answer 8

diffusion

ultrafiltration - remove water

Question 9

4 pre requisites for dialysis

Answer 9

semi permeable membrane - artificial kidney or peritoneal membrane
adequate blood exposure - extra corpeal or mesenteric
dialysis access - vascular or peritoneal
anti coagulation for haemodialysis

Question 10

What type of dialysis requires anticoagulation?

Answer 10

hamodialysis

Question 11

Types of permanent dialysis access

Answer 11

AV fistula or AV prosthetic graft

Question 12

Types of temporary dialysis access

Answer 12

tunnelled/temporary venous catheter

Question 13

What is a dialysate?

Answer 13

fluid we produce for the other side of the concentration gradient which we expose to the blood

Question 14

What are the main electrolyte shifts in dialysis?

Answer 14

bicarbonate into blood (for metabolic acidosis)

remove urea and creatinine

Question 15

How do the blood and dialysate move in terms of eachother and why?

Answer 15

opposite directions

maintain and optimise concentration gradient

Question 16

Fluid restrictions in dialysis - how are these calculated?

Answer 16

interdialytic weight gain

indicated by residual urine output

Question 17

Dietary restrictions in dialysis

Answer 17

phosphate, potassium and sodium

Question 18

CV problems - HD complications

Answer 18

hypotension and cramps
arrhythmias
myocardial stunning and fibrosis

Question 19

Coagulation problems with HD

Answer 19

clotting of vascular access

heparin related problem eg hair loss, thrombocytopenia

Question 20

Other HD problems

Answer 20

allergic reactions to dialyser and tubing

Question 21

Explain the basics of PD

Answer 21

a balanced dialysis solution is instilled into the peritoneal cavity through a catheter using the peritoneal membrane and fluid drained out and fresh fluid instilled

Question 22

What is the most common osmotic agent for ultrafiltration of fluid in PD?

Answer 22

glucose

Question 23

What is important in deciding between CAPD or APD?

Answer 23

peritoneal membrane characteristics and personal choice

Question 24

PD complications

Answer 24

exit site infection
PD peritonitis - gram +ve = skin commensal
gram -ve = gut commensal and if mixed perhaps think a perforation
tunnel infection
ultrafiltration failure
technical eg tube, hernia

Question 25

4 indications for dialysis in ESRD

Answer 25

advanced uraemia GFR<5-10ml/min
severe acidosis - bicarb<10mmol/min
Treatment resistant hyperkalaemia
treatment resistant fluid overload

Question 26

Fluid restriction for HD and PD

Answer 26

HD : 500-800ml per day

PD - more flexible

Question 27

What drugs may be given along dialysis?

Answer 27

Erythropoietin injections and IV iron 
activated vit D - calcitriol 
phosphate binders with meals eg CaCo3 
heparin 
replace water soluble vitamins 
anti hypertensives?