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Renal and urology > Renal replacement therapy > Flashcards

Renal replacement therapy Flashcards

1
Q

What does dialysis do to the blood?

A

Removes toxins: urea, potassium, sodium

Allows infusion of bicarbonate

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2
Q

How does dialysis achieve removal of toxins and infusion of bicarbonate?

A

Diffusion via a semi-permeable membrane

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3
Q

How does haemodialysis get rid of water?

A

Convection/filtration:

The movement of water (and all solutes dissolved in it) across a semipermeable membrane in response to a pressure gradient

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4
Q

What is the minimum weekly amount of dialysis given to patients?

A

4 hours 3x weekly

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5
Q

What substances must patients reduce intake of when on dialysis and how is this achieved?

A

Fluid: if anuric 1litre per day (including food based fluid)

Salt: low salt diet to reduce thirst and help with fluid balance

Potassium: low potassium diet (bananas, chocolate, potatoes, avocado)

Phosphate: low phosphate diet and phosphate binders with meals (6-12 pills per day)

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6
Q

Why must patients restict intake of certain substances while on dialysis?

A

Kidneys normally excrete these things: on dialysis with kidneys not working, it is difficult ot remove them from the system

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7
Q

What is the gold standard method of creating vascular access for dialysis?

A

Creating an arteriovenous fistula

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8
Q

What are the benefits of creating an arteriovenous fistula for vascular access?

A

Good blood flow

Reduced likelihood of infection

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9
Q

What are the disadvantages of creating an arteriovenous fistula for vascular access?

A

Requires surgery

Requires maturation of about 6 weeks before can be used

Can limit blood flow to distal arm “steal”

Can block

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10
Q

How is a tunneled venous catheter used to get vascular access for dialysis?

A

A catheter inserted into a large vein: jugular, subclavian or femoral

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11
Q

What are the advantages of using a tunneled venous catheter for vascular dialysis access?

A

Usually easy to insert

Can be used immediately

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12
Q

What are the disadvantages of using a tunneled venous catheter for dialysis access?

A

High risk of infection

Can cause damage to veins making placing replacements difficult

Become blocked

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13
Q

What are the complications of an untreated infection from a tunneled venous catheter?

A

Endocarditis

Discitis

Death

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14
Q

What investigations should be done when infected tunneled venous catheter suspected?

A

Blood Cultures

FBC and CRP

Exit site swab

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15
Q

What is the treatment for an infected tunneled venous catheter?

A

Antibiotics: vancomycin

Line removal or exchange

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16
Q

What are some of the complications of haemodialysis?

A

Fluid overload

Blood leaks

Loss of vascular access

Hypokalaemia and cardiac arrest

Intradialytic hypotension

17
Q

Why does interdialytic hypotension occur as a complication of haemodialysis?

A

Removing large volumes of H20 three times per week rather than continuously with normal kidneys leads to underfilling of the intravascular space and low BP

18
Q

How does peritoneal dialysis work?

A

Solute removal by diffusion of solutes across the peritoneal membrane

Water removal by osmosis (water moving to equalise a concentration gradient) driven by high glucose concentration in dialysate fluid

19
Q

What is involved in continuous peritoneal dialysis (CAPD)?

A

Four bag exchanges per day

Fluid drained then fresh fluid instilled

½ hour per exchange

20
Q

What is involved in automated peritoneal dialysis?

A

1 bag of fluid stays in all day

Overnight machine drains in and out fluid for 9-10 hours per night

21
Q

What are the complications of intraperitoneal dialysis?

A

Infection

Membrane failure

Hernias

22
Q

What kinds of infection might occur with intraperitoneal dialysis?

A

Peritonitis

Exit site infection

23
Q

What are the causal organisms of infection with intraperitoneal dialysis?

A

Contamination: staphylococci, streptococci, diptheroids

Gut bacteria translocation: E. Coli, klebsiella

24
Q

What is the treatment for intraperitoneal dialysis infection?

A

Culture PD fluid

Intraperitoneal antibiotics

May need catheter removed

25
Q

What is membrane failure associated with intraperitoneal dialysis?

A

Inability to remove enough water so the patient becomes fluid overloaded

26
Q

How is membrane failure associated with intraperitoneal dialysis managed?

A

Requires switch to haemodialysis

27
Q

What blood results might indicate a patient needs to be started on dialysis?

A

Resistant hyperkalaemia

GFR <5

Urea >45

Unresponsive acidosis

28
Q

Is there any difference in mortality if dialysis started earlier?

A

No

29
Q

How long is the first session of haemodialysis?

A

2 hours

Renal and urology (11 decks)

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