renal replacement therapy Flashcards
what is the mechanism for pertioneal dialysis?
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
what are the advantages of peitoneal dialysis?
- 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
what are the disadvantages of peritoneal dialysis?
- 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
what is automated PD?
- 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
what is the continuous ambulatory PD?
- 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.
what is assisted automated PD?
trained healthcare assistant visit the patients home to help with setting up APD
what is haemodialysis used for?
AKI and ESRF
temporary Vs permanent
how does haemodialysis work?
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
what are the advantages of haemodiaylsis?
- efficient form of dialysis
- unit based = plenty of staff support
what are the disadvantages/ complications of haemodialysis?
- 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
what is home HD?
offer training at home for more frequent HD
what is nocturnal HD?
overnight slow, long HD
what is CRRT?
continuous renal replacement therapy mainly used in acute setting
(ITY/HDU)
when is transplantation considered?
the treatment of choice for most patients with ESRF
Can be live related/non related or deceased donor
what are the advantages of transplantation?
- near normal lifestyle
- better mortality/morbidity
