Renal Replacement Therapy Flashcards
When is renal replacement therapy indicated?
Medically resistant hyperkalaemia Medically resistant pulmonary oedema Medically resistant acidosis Uraemic pericarditis Uraemic encephalopathy Overdose of certain drugs
What symptoms are present with uraemia?
Anorexia Vomiting Itch Restless legs Weight loss Metallic taste
What are the options for renal replacement therapy?
Haemodialysis
Peritoneal dialysis
Renal transplant
Describe how harm-dialysis works?
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
What is the gold standard for access route for haemodialysis?
Arteriovenous fistula
Other than arteriovenous fistfula, what can be used as an access route for haemodialysis?
Artificial shunt between vein and artery in this unsuitable for fistula
Tunneled central venous catheter
Most patients receive haemodialysis in hospital. T/F?
True
What is the standard regimen for haemodilaysis?
4 hours 3 days a week
What home based regimens for haemodialysis are available?
6 hours 3 times a week
short daily dialysis
Daily overnight
What are the pros and cons of home haemodialysis compared to hospital?
Home haemodialysis gives greater flexibility and empowerment but requires a career, space and capital investment
What are the complications of haemodialysis?
Crash - acute hypotension Access problems Cramps Fatigue Hypokalaemia Blood loss Dialysis disequilbirium Air embolism
Describe how peritoneal dialysis works
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
What type of dialysis can be used in acute kidney injury?
Haemodialysis
Peritoneal dialysis is too gradual a treatment for AKI
What are the contra-indications to peritoneal dialysis?
Grossly obese
Intra-abdominal adhesions
Frail
Not home suitable
What are the potential complications of peritoneal dialysis?
Peritonitis Development or worsening of diabetes Hernia Diaphragmatic leak Disloadged catheter Peritoneal membrane failure Hypoalbuminuaemia Encapsulatign peritoneal sclerosis
What are the two types of peritoneal dialysis?
Automated peritoneal dialysis
Continuous ambulatory peritoneal dialysis
Conservative care is an alternative to renal replacement therapy. What is meant by conservative care?
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
What. factors effect the choice of modality for renal replacement therapy?
LIfestyle Frailty Vascular access Time Carers Concurrent medical problems
What aspects of kidney function cannot be done by dialysis?
EPO production
Vitamin D activation
Renin production
What are the advantages of renal transplant over dialysis?
Better life expectancy
Live more independently
Improves fertility
What are the disadvantages of renal transplant compared to dialysis?
Requires life long immuosupression which increases risk of infection and malignancy
Increased cardiovascular risk
risk of post-transplant diabetes
