Renal Replacement Therapy - Dialysis Flashcards
What are the functions of the kidneys?
Excretion of nitrogenous waste products Maintenance of acid and electrolyte balance Control of blood pressure Activation of vitamin D Production of erythropoietin Drug metabolism and disposal
What are the clinical features of advanced chronic kidney disease?
Patent may be asymptomatic until stage 4 or 5
Earliest and cardinal symptom is malaise and fatigue
What value of eGFR is an indication that renal replacement therapy is needed?
Less than 10ml/min
What are the different types of renal replacement therapy?
Haemodialysis
Peritoneal dialysis
Renal transplant
What is dialysis?
Process whereby the solute composition of a solution is altered by exposing it to a second solution through a semipermeable membrane
What are the ways to gain access fro haemodialysis?
Arteriovenous fistula
AV prosthetic graft
Tunnelled venous catheter
Temporary venous catheter
What are the restrictions for dialysis patients?
Fluid restriction Dietary restriction (K, Na, phosphate)
What is the process of peritoneal dialysis?
Balanced dialysis solution instilled into peritoneal cavity via a catheter using the mesothelium as a dialysis membrane
After a dwell time the fluid is drained out and fresh dialysate is instilled
What are the complication of peritoneal dialysis?
PD peritonitis
Exit site infection
Ultrafiltration failure
Encapsulating peritoneal sclerosis
What are the indications for starting dialysis in end stage renal disease?
Advanced uraemia, usually eGFR <10
Severe acidosis (bicarbonate <10mmol/L)
Hyperkalaemia (K>6mmol/L)
Fluid and salt retention not controlled with diuretics
What are the drugs usually prescribed to a dialysis patient?
Erythropoietin injections Iron supplements Water soluble vitamins Phosphate binders with meals One alpha vit D or calcitrol
What are the complications of haemodialysis?
Clotting of vascular access Hypotension and cramps Cardiovascular problems Heparin related problems Allergic reactions to dialyses and tubing Catastrophic dialysis accidents (rare)
