Renal Replacement Therapy

Question 1

What are the three types of renal replacement therapy?

Answer 1

• Periotenal Dialysis
• Haemodialysis
• Renal transplant

Question 2

What is Peritoneal Dialysis?

Answer 2

• A type of dialysis which uses the peritoneal membrane in a person’s abdomen as the dialysis membrane

Question 3

How does peritoneal dialysis work?

Answer 3

• Solutes (electrolyte, urea, creatinine) move from the patient’s blood across the peritoneal membrane down con. gradient into dialysis fluid
• High glucose con. in dialysis fluid creates osmotic gradient - removes water from patient

Question 4

What are the advantages of Peritoneal dialysis?

Answer 4

• Better QoL
• Designed on an individualised basis

Question 5

What are the disadvantages of PD?

Answer 5

• Pt must know how to manage technical aspect of dialysis
• Unsuitable in pt c stoma/previous surgery
• Risk of PD peritonitis
• Drainage problems, malposition, leaks, herniae, hydrothorax, encapsulating peritoneal sclerosis

Question 6

What are the contraindications for PD?

Answer 6

• Documented type II ultrafiltration failure.
• Severe inflammatory bowel disease.
• Acute active diverticulitis.
• Abdominal abscess.
• Active ischemic bowel disease.
• Severe active psychotic disorder.
• Marked intellectual disability

Question 7

What are the different types of PD?

Answer 7

• Automated PD
• Continuous Ambulatory PD
• Assisted Automated PD

Question 8

How does Haemodialysis work?

Answer 8

• Dialysis machine pumps blood from the patient, through disposable tubing, through dialyser and back into patient
• Waste solute, salt, excess fluid is removed from the blood as it passes through the dialyser

Question 9

What are the advantages of Haemodialysis?

Answer 9

• Efficient form of dialysis
• Unit based - plenty of support from staff

Question 10

What are the disadvantages of haemodialysis?

Answer 10

• Dialysis access needs to be secured
• Infection
• Haemodynamic instability
• Reactions to dialyser
• Haematomas
• Muscle cramps
• Anaemia
• AVF steal syndrome
• SVCO from central line

Question 11

What are the different types of haemodialysis?

Answer 11

• Home HD
• Nocturnal HD
• CRRT - mainly in ITU

Question 12

What are the indications for haemodialysis?

*remember AEIOU

Answer 12

• Acidosis
• Electrolyte imbalance (hyperkalaemia, hypercalcaemia)
• Intoxication (nephrotoxic drugs)
• Overload fluid
• Uraemic sx

Question 13

What are the contraindications to haemodialysis?

Answer 13

• Inability to secure vascular access
• needle phobia
• cardiac failure
• coagulopathy

Question 14

What are the examples of nephrotoxic drugs?

Answer 14

• Aspirin
• NSAIDs
• Lithium
• Aminoglycosides
• Penicillins, cephalosporins
• Tacrolimus
• Diuretics
• Statins
• Contrast dye

Question 15

What is the treatment of choice for pt c End Stage Renal Failure (ESRF)?

Answer 15

• Renal transplant

Question 16

What are the advantages of renal transplant?

Answer 16

• Near normal lifestyle
• Better mortality/morbidity

Question 17

What are the disadvantages of renal transplant?

Answer 17

• Strict criteria to meet suitability
• Compliance with lifelong medications
• Risk of rejection
• Risk of malignancies
• Risk of infection
• Long waiting times

Question 18

Which group of people will not benefit from RRT?

Answer 18

• >80
• WHO performance of 3

Question 19

If RRT is undesirable, what should be offered?

Answer 19

• Active Conservative Management

Question 20

What is Active Conservative Mx of ESRF?

Answer 20

• Sx control to enhance QoL
• Respect pt preferred place of care
• Advace care plan
• MDT approach
• Support system for pt and family