Renal Replacement Therapy - Dialysis Flashcards
What is ESRD?
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
What stage will CKD patient start showing symptoms?
Until stage 4 or 5 patient may be asymptomatic
What is the syndrome of advanced CKD called?
Uraemia
What are uraemic symptoms?
Symptoms can involve almost any organ system
Earliest cardinal symptoms are malaise and fatigue
When is renal replacement therapy indicated?
When eGFR reaches <10 ml/min
What is eGFR?
Estimated GFR based on serum creatinine, age, sex and race.
Types of renal replacement therapy?
Transplants
Haemodialysis
Peritoneal dialysis
Conservative kidney management
What is dialysis?
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
Pre-requisites for dialysis?
A semi-permeable membrane
Adequate blood exposure to the membrane
Dialysis access
Anticoaglation
What is the semi-permeable membrane used in dialysis?
Artificial kidney in haemo
Peritoneal membrane in PD
Where is the blood needed for adequate blood exposure to the membrane taken from?
Haemo - extra-corporeal blood
PD - Mesenteric circulation
Where is dialysis access taken from?
Haemo - vascular
PD - peritoneum
When is anti-coagulation used?
haemodialysis only
Describe the types of vascular access taken in haemodialysis.
Permanent - Arteriovenous fistula or a AV prosthetic graft
Temporary - Tunnel venous catheter or a temporary venous catheter
What 2 things should you restrict from dialysis patients?
Fluids and diet
How is fluid restriction dictated?
By residual urine output and interdialytic weight gain
what is restricted in the diet of a dialysis patient?
Potassium
Sodium
Phosphate
Why is a patient on haemodialysis given heparin?
To prevent coagulation
Give a brief explanation of how PD works?
Dialysis solution is inserted into peritoneal cavity and uses the peritoneal mesothelium as a dialysis membrane
Types of PD?
CAPD - continuous ambulatory peritoneal dialysis
APD - Automated PD
Hybrid of both
When is a CAPD or APD done usually?
CAPD - day
APD - night
PD complications?
Exit site infection
PD peritonitis
Ultra-filtration failure
Encapsulating peritoneal sclerosis
If PD peritonitis is caused by a skin containment then what type of bacteria causes it?
Gram pos
If PD peritonitis is caused by bacteria of bowel origin then what type of bacteria causes it?
Gram neg
