renal replacement therapy

Question 1

what happens in haemodialysis?

Answer 1

Pumping blood through artificial kidney (dialyser) outside of body

Question 2

what is used in haemodialysis to prevent contact between blood and external surfaces activating the clotting cascade?

Answer 2

heparin - constantly infused through

Question 3

how time consuming is haemodialysis?

Answer 3

typically 4hours 3 times a week

Question 4

what are the 2 options for haemodialysis access and what’s better and why?

Answer 4

arteriovenous fistula (preferred)
tunnelled central venous catheter-less preferred because of risk of infections

Question 5

what is buttonholing?

Answer 5

placing dull needles into the exact same hole in the fistula every time for dialysis

Question 6

what are the complications of dialysis?

Answer 6

• Access-related: infection (including bacteraemia leading to endocarditis, discitis), venous
  stenosis, access failure
• Haemodynamic instability
• Nausea and vomiting
• headache
• cramps, particularly leg cramps
• Reactions to dialysis membranes

Question 7

what is a contraindication to peritoneal dialysis?

Answer 7

need a functional membrane -patients may not be suitable if they have had previous intra-abdominal pathology (eg previous peritonitis, surgery, adhesions)

Question 8

what are the 2 potential regimens of PD?

Answer 8

• continuous ambulatory peritoneal dialysis (CAPD): manual dialysate exchanges are typically performed 4x a day
• automated dialysis (APD) -machine does it overnight

Question 9

what does cloudy peritoneal fluid suggest?

Answer 9

peritonitis
intraperitoneal disease (peritonitis, cholecystitis, bowel ischaemia)
retroperitoneal disease (pancreatitis, renal cell carcinoma)
drugs -vancomycin, amphotericin B
allergic reactions (increased eosinophils)

Question 10

what are the causes of bloody peritoneal liquid?

Answer 10

coagulopathy
retrograde menstruation
ovulation
strenuous exercise
ovarian cyst rupture
adhesions
catheter associated trauma

Question 11

what are the causes of chylous peritoneal liquid?

Answer 11

high TGs
lymphatic obstruction
trauma
abdominal lymphomas
pancreatitis
drugs (CCBs)

Question 12

what are the complications of peritoneal dialysis?

Answer 12

-bacterial or fungal peritonitis
-catheter issues: infection, blockage, kinking, leaks, displacement-more likely if patient becomes constipated
-weight gain
-worsening glycaemic control in diabetic patients
-failure of peritoneal membrane -would have to switch to haemodialysis
-encapsulating peritoneal sclerosis