Renal Replacement Therapy Flashcards
what is dialysis
blood filtering machine for ESRD- removes toxins (urea, K, Na) and infuses bicarbonate
2 types of dialysis are…
haemodialysis and peritoneal dialysis
how does haemodialysis (HD) remove water
via convection
what is important in terms o diet while on dialysis
fluid restriction, K+ restriction, phosphate restriciton
accesss sites for dialysis
fistula- arteriovenous, tunnelled venous catheter
peritoneal dialysis set-up
tenkoth catheter inserted into abdomen- uses lining of peritoneum as a semi-permeable memrbrane to diffuse accross
how is water removed by peritoneal dialysis
osmosis driven by high glucose concentration in dialysate fluid
2 types of peritoneal dialysis?
continuous ambulatory (4 x bags), automated peritoneal dialysis
when to start dialysis
resistant hyperkalameia, GFR <5, Ur >45, unresponsive acidosis
symptomatic- itch, fatigue, unresponsive fluid overload
why must dialysis be built up slowly
to avoid disequilibrium syndrome- cerebral oedema, seizures
survival on dialysis
5yr survival is low
principles of transplant rejection
HLA molecules on cell surface proteins expressed on cells activate immune system if non-self and cause rejection
what are the 3 types of rejection
hyper acute- due to +ve match, remove kidney !
acute- early, due to t/B cell activation, given immunosuppressants
chronic- immunological and vascular deterioration of transplant
suitability for transplant
pt should have reasonable life expectancy
no cadaveric transplant >6 months prior to starting dialysis
based on tissue typing and time on list
due to immunosuppression, what are some Rrisks the patient faces
skin cancer, infections
