Renal replacement therapy Flashcards
1
Q
Describe the options for renal replacement therapy in AKI?
A
- Haemodialysis
- Haemofiltration
- Pertioneal dialysis is more rarely used
2
Q
Indications for renal replacement therapy in AKI?
A
- Fluid overload
- Metabolic acidosis
- Hyperkalaemia
- Uraemia
- Pericarditis, encephalopathy
3
Q
Complications of RRT?
A
- Procedural hypotension
- Bleeding risk from anticoagulation
- Altered nutrition and drug clearance
4
Q
Describe the use of RRT in CKD?
A
- RRT should be planned in advance in progressive CKD
- Around 1 year before it may be required
5
Q
Name the types of RRT?
A
- Haemodialysis
- Haemofiltration
- Peritoneal dialysis
- Kidney transplantation
6
Q
Describe Haemodialysis?
A
- Blood is passed over a semi-permeable membrane against dialysis fluid flowing in the opposite direction
- Diffusion of solutes occurs down a concentration gradient
- Access via arteriovenous fistula or central venous catheter
- Required 3 or more times a week
- Anticoagulation with heparin
7
Q
Problems with haemodialysis?
A
- Arteriovenous fistula
- Steal syndrome
- Infection
- Blockage
- Bleeding risk from anticoagulation
8
Q
Describe peritoneal dialysis?
A
- Mostly for CKD
- Uses peritoneum as a semi-permeable membrane
- Permanent catheter inserted into peritoneal cavity and fluid infused
- Waste diffuses from peritoneal capillaries into dialysis fluid
- Ultrafiltration achieved by adding osmotic agents (glucose) to the fluid
- Continuous process performed at home
9
Q
Problems with peritoneal dialysis?
A
- Bacterial peritonitis
- Damage to peritoneal membrane
- Encapsulating peritoneal sclerosis
10
Q
Describe haemofiltration?
A
- Water filtered from blood across porous semipermeable membrane
- Solutes removed via solvent drag
- Replaced by clean fluid after it exists the haemofilter
11
Q
Complications of RRT?
A
- Increased mortality
- CVD:
- hypertension, calcium/phosphate dysregulation, oxidative stress
- Protein-calorie malnutrition
- Renal bone disease
- Infection
- Uraemia causes granulocyte and T cell dysfunction
- Amyloid
- B2-microglobulin accumulates causing carpal tunnel and arthralgia
12
Q
What is the most common cause of end stage renal disease in developed countries?
A
Diabetic nephropathy
13
Q
What is survival on dialysis dependent on?
A
- Age
- Presence of complicatins
- eg DM
14
Q
What are the aims of renal replacement therapy?
A
- Replace excertory functions
- Maintain electrolyte and fluid balance
15
Q
Describe renal transplantation?
A
- Best chance of long term survival
- Graft rejection is major cause of transplant failure
- Match ABO group and MHC antigens
- Native kidneys are usually left in place
- Immunosuppressive therapy required to prevent rejection
