renal replacement therapy Flashcards

1
Q

what is the mechanism for pertioneal dialysis?

A

reliant on the patients own peritoneal membrane acting as the dialysis membrane

solutes (electrolytes, urea, creatinine) move from the patients blood across the peritoneal membrane down the concentration gradient into the dialysate fluid

osmotic gradient is created by high concentration of glucose (occasionally amino acid or glucose polymer solutions are used) in dialysate fluid, which removes water from the patient

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2
Q

what are the advantages of peitoneal dialysis?

A
  • QoL improved
  • good first choice for patients starting dialysis, with some residual renal function
  • PD regimes are much more individualised for the patients than HD
  • home based therapy so saved time
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3
Q

what are the disadvantages of peritoneal dialysis?

A
  • patient needs to manage technical aspects of dialysis
  • unsuitable in patients with stoma/previous surgery
  • risk of infection (PD peritonitis)
  • complications e.g drainage issues, malposition, leaks, herniae, hydrothorax, long term use associated with encapsulating peritoneal sclerosis
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4
Q

what is automated PD?

A
  • carried out with an automated cycler machine performed at night
  • 10-12 L usually exchanged over 8-10 hours
  • lifestyle advantages, leaves the daytime free
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5
Q

what is the continuous ambulatory PD?

A
  • usually consisting of 4-5 dialysis exchanges per day of 2L each
  • exchanges are performed at regular intervals throughout the day, with a long overnight dwell.
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6
Q

what is assisted automated PD?

A

trained healthcare assistant visit the patients home to help with setting up APD

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7
Q

what is haemodialysis used for?

A

AKI and ESRF

temporary Vs permanent

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8
Q

how does haemodialysis work?

A

the dialysis machine pumps blood from the patient through disposable tubing, through the dialyser or artificial kidney and back to the patient

waste solute, salt and excess fluid is removed from the blood as it passes through the dialyser

blood is passed over semi permeable against dialysis fluid flowing in the opposite direction, diffusion occurring down a concentration gradient

waste is called the ultrafiltrate

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9
Q

what are the advantages of haemodiaylsis?

A
  • efficient form of dialysis

- unit based = plenty of staff support

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10
Q

what are the disadvantages/ complications of haemodialysis?

A
  • dialysis access needs to be secured
  • infection/bacteraemia
  • haemodynamic instability
  • reactions to dialysers
  • haematomas/ risk of bleeding
  • muscle cramps
  • anaemia due to clotted lines/haemolysis
  • AVF steal syndrome
  • SVCO from central lines
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11
Q

what is home HD?

A

offer training at home for more frequent HD

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12
Q

what is nocturnal HD?

A

overnight slow, long HD

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13
Q

what is CRRT?

A

continuous renal replacement therapy mainly used in acute setting

(ITY/HDU)

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14
Q

when is transplantation considered?

A

the treatment of choice for most patients with ESRF

Can be live related/non related or deceased donor

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15
Q

what are the advantages of transplantation?

A
  • near normal lifestyle

- better mortality/morbidity

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16
Q

what are the disadvantages of transplantation?

A
  • criteria to meet suitability to safely undergo operation
  • compliance with medication lifelong
  • risk of rejection
  • risk of malignancies over time
  • risk of infection (on immunosuppression)
  • long waiting times for cadaveric organ
17
Q

when is active conservative management considered?

A

if patient is >80 or WHO performance score of 3 or more, then RRT offers no survival benefit

make decision after discussing with patient and family, and discussing the benefits + risks of each mode of therapy

18
Q

what is the active conservative management of ESRF?

A
  • symptom control to enhance QoL
  • respect patients preferred place of care
  • advanced care plan
  • MDT approach
  • support system for patient and family
19
Q

what are the complications of RRT?

A
  • protein calorie malnutrition
  • renal bone disease
  • infection