Renal Replacement Therapy

Question 1

When is renal replacement therapy indicated?

Answer 1

Medically resistant hyperkalaemia
Medically resistant pulmonary oedema
Medically resistant acidosis
Uraemic pericarditis
Uraemic encephalopathy
Overdose of certain drugs

Question 2

What symptoms are present with uraemia?

Answer 2

Anorexia
Vomiting 
Itch
Restless legs
Weight loss
Metallic taste

Question 3

What are the options for renal replacement therapy?

Answer 3

Haemodialysis
Peritoneal dialysis
Renal transplant

Question 4

Describe how harm-dialysis works?

Answer 4

Blood from the patient is passed through the dialysis machine where diffusion removes solutes and filtration (via hydrostatic pressure) removes fluid. This is possible due to the counterflow of a dialysate through the dialysis machine. The dialysate is then discarded and blood returns to the patient. This is a continuous loop

Question 5

What is the gold standard for access route for haemodialysis?

Answer 5

Arteriovenous fistula

Question 6

Other than arteriovenous fistfula, what can be used as an access route for haemodialysis?

Answer 6

Artificial shunt between vein and artery in this unsuitable for fistula
Tunneled central venous catheter

Question 7

Most patients receive haemodialysis in hospital. T/F?

Answer 7

True

Question 8

What is the standard regimen for haemodilaysis?

Answer 8

4 hours 3 days a week

Question 9

What home based regimens for haemodialysis are available?

Answer 9

6 hours 3 times a week
short daily dialysis
Daily overnight

Question 10

What are the pros and cons of home haemodialysis compared to hospital?

Answer 10

Home haemodialysis gives greater flexibility and empowerment but requires a career, space and capital investment

Question 11

What are the complications of haemodialysis?

Answer 11

Crash - acute hypotension
Access problems
Cramps
Fatigue
Hypokalaemia
Blood loss
Dialysis disequilbirium
Air embolism

Question 12

Describe how peritoneal dialysis works

Answer 12

Glucose rich fluid is pumped into the peritoneal space of the abdomen and blood is filtered by diffusion. Different concentrations fo dialysate are used to provide more or less ultrafiltration

Question 13

What type of dialysis can be used in acute kidney injury?

Answer 13

Haemodialysis

Peritoneal dialysis is too gradual a treatment for AKI

Question 14

What are the contra-indications to peritoneal dialysis?

Answer 14

Grossly obese
Intra-abdominal adhesions
Frail
Not home suitable

Question 15

What are the potential complications of peritoneal dialysis?

Answer 15

Peritonitis
Development or worsening of diabetes
Hernia
Diaphragmatic leak
Disloadged catheter
Peritoneal membrane failure
Hypoalbuminuaemia
Encapsulatign peritoneal sclerosis

Question 16

What are the two types of peritoneal dialysis?

Answer 16

Automated peritoneal dialysis

Continuous ambulatory peritoneal dialysis

Question 17

Conservative care is an alternative to renal replacement therapy. What is meant by conservative care?

Answer 17

Symptom based management rather than dialysis or transplant. Often used in frail and elderly patients in recognition that survival may be slightly better on renal replacement therapy but the quality of life may not

Question 18

What. factors effect the choice of modality for renal replacement therapy?

Answer 18

LIfestyle
Frailty
Vascular access
Time
Carers
Concurrent medical problems

Question 19

What aspects of kidney function cannot be done by dialysis?

Answer 19

EPO production
Vitamin D activation
Renin production

Question 20

What are the advantages of renal transplant over dialysis?

Answer 20

Better life expectancy
Live more independently
Improves fertility

Question 21

What are the disadvantages of renal transplant compared to dialysis?

Answer 21

Requires life long immuosupression which increases risk of infection and malignancy
Increased cardiovascular risk
risk of post-transplant diabetes