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Year 2 > Renal replacement therapy > Flashcards

Renal replacement therapy Flashcards

1
Q

Renal disease is associated with higher gastrointestinal risk. T/F

A

False - higher CVS risk

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2
Q

Describe the very basics of dialysis

A

Diffusion through a semi permeable membrane down a concentration gradient until equilibrium is reached

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3
Q

Dialysis allows the removal of four main toxins, name them

A

Potassium
Sodium
Urea
Creatinine

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4
Q

What is given to patients during dialysis? Why is this given?

A

Bicarbonate infusion

Patients become acidotic as hydrogen cannot be secreted into the urine

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5
Q

How fast does blood flow through a haemodialysis machine? How is this relevant?

A

300ml/min

You can’t get this amount of blood through simple IV access

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6
Q

Which type of vascular access is needed in haemodialysis?

A

Arterovenous fistula

Tunneled venous catheter

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7
Q

How is hypoglycaemia avoided in haemodialysis?

A

Glucose is given to patients during dialysis

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8
Q

Describe the haemodialysis circuit

A

Water in –>
Reverse osmosis machine (purifies) –>
Dialysis through semi-permeable membrane –>
Waste removed and disposed

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9
Q

How is waste removed in haemodialysis?

A

Convection/filtration - movement of water across semipermeable membrane in response to a pressure gradient (negative pressure created by vacuum)

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10
Q

What is the GFR of patients on haemodialysis?

A

10-20 (i.e shitty)

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11
Q

What is the minimum time and frequency of haemodialysis?

A

3 times a week for four hours

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12
Q

Why are patients not given haemodialysis for longer?

A

Quality of life would be greatly reduced

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13
Q

What restrictions does haemodialysis put on patients?

A

1 litre fluid intake if anuric
Low salt diet (reduce thirst)
Low potassium diet
Low phosphate diet +/- phosphate binders with meals

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14
Q

Which foods are rich in potassium?

A

Banana’s
Chocolate
Potatoes
Avocado

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15
Q

Which foods are high in salt?

A

Baked beans
Bread
Processed food

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16
Q

What type of patients suffer the most from dietary restrictions on haemodialysis?

A

Diabetics (super restricted diet)

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17
Q

Which foods are high in phosphate?

A

High protein foods (i.e meats)
Diet coke
Ready made meals

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18
Q

List some phosphate binders

A

Calcium
Aluminium
Magnesium
Lanthanum salts

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19
Q

Are AV fistulas likely to cause infection?

A

Nope

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20
Q

How long do AV fistulas take to mature?

A

6 weeks

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21
Q

At which sites can a tunnelled venous catheter be placed?

A

Jugular
Subclavian
Femoral

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22
Q

What is the major risk with tunnelled venous catheters?

A

Infection (usually staph. aureus)

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23
Q

Which types of infections tend to arise from tunnelled venous catheters?

A

Endocarditis

Discitis

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24
Q

How is tunnelled venous catheter infection treated?

A

Vancomycin

Removal of line +/- replacement

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25
Q

How are suspected tunnelled venous catheter infections treated?

A

Blood cultures
FBC
CRP
Exit site swab

26
Q

How do patients with tunnelled venous catheter infections present?

A

Rigors with dialysis

27
Q

What are the complications of haemodialysis?

A 
Fluid overload
Blood leaks
Loss of vascular access 
Hypokalaemia + cardiac arrest 
Intradialyic hypotension
28
Q

What should NOT be given to haemodialysis patients with fluid retention? What should be done?

A

Frusemide (cannot produce urine or pee) or any other diuretic

Dialysis

29
Q

Blood leaks from haemodialysis can cause what?

A

Massive haemorrhage and death

30
Q

How does intradialyic hypotension arise?

A

Too much fluid removed from intravascular space on dialysis (not continuously as in normal kidneys)

31
Q

Explain the basics of peritoneal dialysis

A

Solute diffuses down a concentration gradient through the peritoneal membrane

32
Q

How is water removed in peritoneal dialysis?

A

Osmosis occurs because of high glucose concentration in dialysis fluid

33
Q

What type of access is used in peritoneal dialysis?

A

Tenckhoff catheter

34
Q

Which type of dialysis is more efficient - haemo or peritoneal?

A

Haemodialysis

35
Q

Which two types of peritoneal dialysis are available?

A

Continous (CAPD)

Automated (APD)

36
Q

How frequent is CAPD?

A

4 bag exchanges per day

37
Q

How long does a bag exchange on peritoneal dialysis take?

A

30 minutes

38
Q

How frequent is APD?

A

1 bag of fluid stays in all day

39
Q

How long does APD take?

A

9-10 hours overnight

40
Q

Which type of dialysis can be taken on holiday?

A

Peritoneal dialysis

41
Q

What are the main complications of peritoneal dialysis?

A

Infection
Membrane failure
Hernia

42
Q

What types of infections occur in peritoneal dialysis?

A

Peritonitis

Exit site infection

43
Q

How does infection occur in peritoneal dialysis? Which bugs are typical?

A

Contamination (staph, strep, diptheroids)

Gut bacteria translocation (e.coli, klebsiella)

44
Q

How is infection treated with respect to peritoneal dialysis?

A 
Intraperitoneal antibiotics (vancomycin & gentamicin)
\+/- removal of catheter
45
Q

How is PD infection cultured?

A

Peritoneal fluid used

46
Q

When is PD catheter removed with respect to infection?

A

Staph aureus

Pseudomonas

47
Q

How does membrane failure present? What must be done?

A

Fluid overload

Switch to haemodialysis

48
Q

How do hernias occur with respect to PD dialysis? How are they treated?

A

Increased intra-abdominal pressure due to fluid

Repair + smaller fluid volumes

49
Q

Is survival better on haemodialysis or peritoneal dialysis?

A

Not much difference - PD tends to be better for younger patients and haemo tends to be better for older patients

50
Q

What metabolic complications can arise from end stage kidney disease?

A

Bone mineral metabolism abnormalities
Anaemia
Sodium & water retention
Accelerated CVS risk

51
Q

How might bone mineral metabolism abnormalities present biochemically in chronic kidney disease?

A

Phosphate retained
Low 1,25 vitamin D
Hypocalaemia
Raised PTH

52
Q

How might anaemia present biochemically in chronic kidney disease?

A

Erythropoetin deficiency

Iron deficiency

53
Q

Which two parameters will be taken into consideration with regard to the decision to begin dialysis?

A

Symptoms

Blood results

54
Q

What abnormalities of blood results would trigger the start of dialysis?

A

Resistant hyperkalaemia
GFR 45
Unresponsive acidosis

55
Q

Which symptoms might trigger the start of dialysis?

A 
Fatigue
Itch
Unresponsive fluid overload
Nausea 
Vomiting 
Loss of appetite
56
Q

How is haemodialysis started?

A

Gradually build up (start at 2 hours then move on to 4)

57
Q

What happens if you begin haemodialysis quickly?

A

Disequilibrium syndrome (cerebral oedema and seizures)

58
Q

How is PD started?

A

Begin with small volumes then build up to 2/2.5 litres

59
Q

Patients with short life expectancy +/- co-morbidities will still get dialysis. T/F

A

False - in most cases no (effect on QoL is too great)

60
Q

When might withdrawal from dialysis be indicated?

A

Patient decision based on medical or social reasons

61
Q

A young patient on dialysis will have the same life expectancy as an older patient. T/F

A

True - in most cases

Year 2 (72 decks)

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