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ZA - Renal System > Renal Replacement Therapy - Dialysis > Flashcards

Renal Replacement Therapy - Dialysis Flashcards

1
Q

What is ESRD?

A

End stage renal disease = irreversible damage to a persons kidney’s so severe that to maintain life they must have either dialysis or a transplant

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2
Q

What stage will CKD patient start showing symptoms?

A

Until stage 4 or 5 patient may be asymptomatic

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3
Q

What is the syndrome of advanced CKD called?

A

Uraemia

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4
Q

What are uraemic symptoms?

A

Symptoms can involve almost any organ system

Earliest cardinal symptoms are malaise and fatigue

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5
Q

When is renal replacement therapy indicated?

A

When eGFR reaches <10 ml/min

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6
Q

What is eGFR?

A

Estimated GFR based on serum creatinine, age, sex and race.

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7
Q

Types of renal replacement therapy?

A

Transplants
Haemodialysis
Peritoneal dialysis
Conservative kidney management

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8
Q

What is dialysis?

A

a process where the solute composition of a solution, A, is altered by exposing solution A to a second solution, B, through a semipermeable membrane

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9
Q

Pre-requisites for dialysis?

A

A semi-permeable membrane
Adequate blood exposure to the membrane
Dialysis access
Anticoaglation

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10
Q

What is the semi-permeable membrane used in dialysis?

A

Artificial kidney in haemo

Peritoneal membrane in PD

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11
Q

Where is the blood needed for adequate blood exposure to the membrane taken from?

A

Haemo - extra-corporeal blood

PD - Mesenteric circulation

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12
Q

Where is dialysis access taken from?

A

Haemo - vascular

PD - peritoneum

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13
Q

When is anti-coagulation used?

A

haemodialysis only

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14
Q

Describe the types of vascular access taken in haemodialysis.

A

Permanent - Arteriovenous fistula or a AV prosthetic graft

Temporary - Tunnel venous catheter or a temporary venous catheter

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15
Q

What 2 things should you restrict from dialysis patients?

A

Fluids and diet

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16
Q

How is fluid restriction dictated?

A

By residual urine output and interdialytic weight gain

17
Q

what is restricted in the diet of a dialysis patient?

A

Potassium
Sodium
Phosphate

18
Q

Why is a patient on haemodialysis given heparin?

A

To prevent coagulation

19
Q

Give a brief explanation of how PD works?

A

Dialysis solution is inserted into peritoneal cavity and uses the peritoneal mesothelium as a dialysis membrane

20
Q

Types of PD?

A

CAPD - continuous ambulatory peritoneal dialysis

APD - Automated PD

Hybrid of both

21
Q

When is a CAPD or APD done usually?

A

CAPD - day

APD - night

22
Q

PD complications?

A

Exit site infection
PD peritonitis
Ultra-filtration failure
Encapsulating peritoneal sclerosis

23
Q

If PD peritonitis is caused by a skin containment then what type of bacteria causes it?

A

Gram pos

24
Q

If PD peritonitis is caused by bacteria of bowel origin then what type of bacteria causes it?

A

Gram neg

25
Q

If there is a mix of gram pos and neg then what would be the cause of PD peritonitis?

A

A suspected complicated peritonitis - example perforation

26
Q

What are the indications for dialysis in ESRD?

A

Advanced uraemia - GFR 5-10 ml/min

Severe acidosis - bicarb at <10 mmol/l

Treatment resistant hyperkalaemia - >6.5 mmol/l

Treatment resistant fluid overload

27
Q

REVISION - what is the mnemonic used for remembering indications for dialysis in AKI?

A

AEIOU

A - acidosis
E - electrolyte balance (K)
I - intoxication
O - overload
U - uraemia
28
Q

What is fluid overload? How is it treated?

A

Hypervolemia - treated via diuretics

29
Q

Explain fluid balance in a haemodialysis patient.

A

restricted to 500-800 ml/ day

The intake allowed is calculated by - urine output+ insensible loss

30
Q

What is fluid balance like in a PD patient?

A

Usually more liberal as continuous ultra-filtration is often achieved using this method

31
Q

What is used to treat dialysis related anaemia?

A

Erythropoitein injections

IV iron supplements

32
Q

What is used to treat dialysis related/renal bone disease?

A

Activated vitamin D - Calcitriol

Phosphate binders with meals

33
Q

Complications of haemoD?

A

CV issues - intra-dialytic hypotension. cramps, arrythmia’s

Coagulation - clotting of vascular access, heparin issues

Allergic reactions to fialysis

Dialysis accidents = death (rare)

34
Q

How is a dialysis modality chosen?

A

Patient choice via education and shared decision making
Perceptions of effectiveness
Cost

35
Q

Limitations of dialysis?

A

Not the best substitute for a kidney
BUT
Only one available to keep ESRD patients alive

36
Q

What is conservative kidney management?

A

Supportive care focusing on symptomatic management and anticipatory care planning

Involves a multi-professional approach

ZA - Renal System (27 decks)

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