Renal Replacement Therapy Flashcards
AEIOU: Indications for Renal Placement Therapy
A: __ with a pH of:
E: electrolyte abnormalities with a potassium of ___ or hypo/hyper___
I: ingestions such as toxic alcoholes like ___, or medications such as ___
O: overlaod: pulmonary edema
U: ____. Associated with conditions such as __, ___ and bleeding.
R- cases that are refractory to medical therapy
A: ACIDOSIS with a pH of: <7.1
E: electrolyte abnormalities with a potassium of >6.5 or hypo/HYPERCALCERMIA
I: ingestions such as toxic alcoholes like METHANOL, ETHYLENE GLYCOL, or medications such as LITHIUM, METFORMIN, VALPROIC ACID. ONES THAT STAY IN THE VASCULAR SOACE
O: overlaod: pulmonary edema
U: UREMIA. Associated with conditions such as PERICARDITIS, ENCEPHALOPATHY and bleeding.
R- cases that are refractory to medical therapy
non urgen uremia symptomsq
anorexia, nausea, fatigue, pruritis
for patients with CKD, these problems often start a bit more slowly. when is the ideal time to start renal reaplcement?
you can start a bit later; eariler dialysis initiation was not associated with improved outcomes. Often, they slowly develop the non-urgen symptoms. in AKI, earlier dialysis was also not associated with improved outcomes.
4 renal replacement therapy modalities
- transplant
- hemodialysis
- peritoneal dialysis
- conservative care
Dialysis is the diffusion of molecules in solution across a __ __ along an _ __ gradient
The goal is to restore the __ and __ compartments, as seen in normal kidney function in a fail safe manner
Dialysis is the diffusion of molecules in solution across a semipermeable membrane along an electrochemical concentration gradient
The goal is to restore the intracellular and extracellular compartments, as seen in normal kidney function in a fail safe manner
pros of AV FISTULA hemodialysis
reliable access
good long term patency
lower risk of infection and thrombosis
cons of AV FISTULA hemodialysis
- requires a surgical procedure
- takes 3 months to mature
- only 40% mature
- steal syndrome is a possibililte
- heart failure
- aneurysms with risk of rupture
pros of AV GRAFT hemodialysis
less time to mature
can be used in patients running out of vascular access options
cons of AV GRAFT hemodialysis
infection
thrombosis
venous hypertension
pseudoaneurysms
steal syndrome
most favorable hemodialysis method for CKD
AV fistula hemodialysis since it lasts a long time
Central Venous Catheter hemodialysis pros
can be used right away
can be inserted at bed side
cons of central line hemodialysis access
infection
catheter dysfunction
thrombosis
central vein stenosis
define steal syndrome
So much blood flowing through the fistula that less blood is flowing to the distal digits. May have ulceration, coldness in fingers etc.
seen in fistula and AV graft hemodialysis methods
outline the first second and third line places of types of hemodialysis
we basically use AV Graft when there’s not many options
when someone is on hemodialysis they must receive ___ medications. outline some of the meds used
ANTIGOAULATION THERAPY. helps prevent clotting of blood in the dialysis filter.
- heparin
- lower molevular weight heparin
- HITT
- citrate
- saline flush
type of dialysis favored for AKI
central venous catheter because it is fast
role of the dialyzer
the filter membrane. its meant to preserve albumin while removing the toxins.
made up of fine fibers for filtration
role of dialysate
the fluid. used for water purification. contains sodium, potassium, calcium, magnesium, bicarbonate, glucose. can be modified these to individualse the dialysis prescription.
CREATES CONCENTRATION GRADIENTS to influence the conservation or removal of specific electrolyes
we must optimize solute removal by using counter current flow. what is this?
blood runs in one direction, and the clean dialysate runs in the opposite direction. maintians a concntration gradient so that toxins run into the dialysate and the blood gets clean and goes back to the body
ultrafiltation role
- for fluid removal. uses transmembrane potential. written as target weight or liters of fluid to be removed
3 key safety monitors
pressure alarms; can indicate a clot and pressure buildup
air detectors; wanna make sure you aren’t exposing the patient to air ambolisms
blood leak alarm; you can have hemolysis if theres something wrong with the dialyzer fluid or something. gotta make sure its okay.
Types of Hemodialysis
dialysis disequilibrium syndrome is a hemodialysis complication. outline what this is
When a patient CKD is progressing and there’s a build up of toxin, those can be osmotically active substances. The cells of the brain also increase in osmolarity, to prevent fluid shift. When you provide someone with hemodialysis, we remove osmotically active substances in the blood quite quickly. This leaves the solutes in the brain at a higher concentration, and water from the now diluted blood will rush into the brain cells, causing cerebral edema.
This can manifest in headaches, nausea, vomiting, and seizures and decrease LOC
High risk for DDS for longer duration CKD. Should give some people lower efficiency dialysis to give the patients brains time to accommodate for the changes in osmolality.
Hemodialysis complications (VAHM DID acronym)
V; vascular injury
A: air embollism
H: hypotension: myocardial stunning or cerebral ischemia outcomes)
M: medication removal
D: dialysis disequilibrium syndrome
I: infeciton
D: dialyzer reactions– basically like an anaphylaxis
in peritoneal dialysis, the highly vascular peritoneum membrane is the insertion access point. what types of catheters are used?
straight or cuff coil catheters, swan neck of the TW catheter. dependent on body habitus
catheter goes through muscles and subQ tissue to enter the peritoenal membrane. Cuffs are places the reduce the translocation of the line and reduce infection. ideal position is lower in the pelvis for adequate draining. these catheters are radio opaque to look for localization.
with peritoneal dialysis, the peritoenal playes the role of the __.
glomerulus. it’s highly vascular and has a high flow rate. it also has holes and pores of different sizes
the osmotic gradient of peritoneal dialysis is created by _____
glucose. the higher concentration causes more fluid removal.
Icodextrin sugar can also be used– it’s non absorbable so it can be useful, especially if we need to remove a large volume
two main contents of peritoneal dialysalte
- glucose to create osotic gradient for fluid removal
- electrolytes needed for solute clearance and normalization of serum electrolytes
Types of Peritoneal Dialysis
Peritoneal Dialysis Complications
(CHIME acronym)
catheter dysfunction
infection
hyperglycemia
membrane failure
encapsulating peritoneal sclerosis
which electrolyte is not in peritoneal dialysate? Why?
potassium is not given. there is a high chance of hyperkalemia because it is absorbed really quikcly. if needed, they can take it orally
What’s the better option, hemodialysis or peritoneal dialysis?
outline groups that may not benefit from dialysis
frail elderly living in nursing home
comorbid conditions with high risk of mortality– ex/ malignancy
surprise question: would I be surprised if this patient died in the next year?
note; people on dialysis of a shortened lifetime and lower survival probability. Transplant is the best option.
