Renal Replacement Therapy

Question 1

Indications for RRT?

Answer 1

eGFR <10ml/min

Question 2

Types of RRT?

Answer 2

Renal transplant, haemodialysis, peritoneal dialysis, conservative kidney management

Question 3

What is dialysis?

Answer 3

Process whereby the solute composition of a solution, A, is altered by exposing solution A to a second solution, B, through a semipermeable membrane

Question 4

What are the main principles of dialysis?

Answer 4

Diffusion and ultrafiltration

Question 5

Pre-requisites for dialysis?

Answer 5

Semipermeable membrane (arterifical kidney in HD or peritoneal membrane)
Adequate blood exposure to membrane (extracorporeal blood in HD, mesenteric circulation in PD)
Dialysis Access (vascular in HD, peritoneal in PD)
Anticoagulation (HD)

Question 6

Permanent haemodialysis access?

Answer 6

Arteriovenous fistula, AV prosthetic graft

Question 7

Temporary haemodialysis access?

Answer 7

Tunnelled venous catheter, temporary venous catheters

Question 8

Restrictions for dialysis patients?

Answer 8

Fluid restriction:
Dictated by residual urine output, interdialytic weight gain
Dietary restriction:
Potassium, sodium, phosphate

Question 9

What is peritoneal dialysis

Answer 9

A balanced dialysis solution is instilled into the peritoneal cavity via a tunnelled, cuffed catheter, using the peritoneal mesothelium as a dialysis membrane.
After a dwell time the fluid is drained out and fresh dialysate is instilled

Question 10

what are the types of peritoneal dialysis?

Answer 10

Continuous Ambulatory Peritoneal Dialysis (CAPD)
Automated Peritoneal Dialysis (APD)
Hybrid

Question 11

What is contained within peritoneal dialysis fluids?

Answer 11

The dialysate contains a balanced concentration of electrolytes,
Glucose (osmotic agent for ultrafiltration of fluid)

Question 12

What are some complications that can occur from peritoneal dialysis?

Answer 12

Exit site infection,
PD peritonitis,
Ultrafiltration failure,
Encapsulating peritoneal sclerosis

Question 13

what types of PD peritonitis can you get?

Answer 13

Gram positive- caused by skin contamination
gram negative- caused by bowel contamination
Mixed- suspected complcated peritonitis eg perforation

Question 14

Indications for dialysis in end-stage renal disease?

Answer 14

Advance uraemia (GFR 5-10ml/min), 
severe acidosis (bicarbonate <10mmol/l),
Treatment resistant hyperkalaemia (K>6.5mmol/l),
Treatment resistant fluid overload,
`

Question 15

What is the fluid restriction in HD patients?

Answer 15

500-800ml/ 24 hours

Intake allowed= urine output + insensible loss

Question 16

Drugs given with dialysis

Answer 16

Erythropoietin injections, IV iron supplements (for anaemia)
Calcitriol, phosphate binders with meals (for renal bone disease)
Heparin,
Water soluble vitaminn,
? Antihypertensives

Question 17

Complications of peritoneal haemodialysis

Answer 17

Cardio problems:
Intra-dialysic hypotension and cramps,
Arrhythmia

Coagulation:
Clotting of vascular access,
Heparin related problems

Other:
Allergic reactions to dialysers and tubing
catastrophic dialysis accidents

Question 18

Complications of peritoneal dialysis/

Answer 18

Infection- exit site infection, tunnel infection, peritonitis
Mechanical- tube malfunction, abdominal wall herniae
Ultrafiltration problems