Renal support

Question 1

AKI

Answer 1

common reason for admission to ICU needing dialysis

Question 2

dialysis

Answer 2

peforming the filtration tasks of the kidneys artificially. remove excess fluid, solutes and waste products

Question 3

what are the indications for acute dialysis in pt with severe AKI (AEIOU)

Answer 3

A- acidosis (severe and unresponsive to tx)

E- electrolyte abnormalities (tx reisstant hyperkalaemia)

I- intoxication (overdose of certain meds)

O- oedema (severe and unresponsive pulmonary oedema)

U- ureamia symptoms i.e seizures, reduced consciousness.

Question 4

two options of dialysis in pt with renal failure

Answer 4

1. peritoneal dialys
   (rarely used in AKI, generally limited to CKD)
2. haemodialysis

Question 5

haemodialysis (what is it and how does it work?)

Answer 5

blood is filtered by a haemodiaylsis machine- taken out of the body through the dialysis machine and then pumped back into the body.

blood passes along a semi permeable membrane and solutes will filter out of the blood, across the membrane and into a fluid ‘dialysate’ (concentration gradient between pt blood and this dialysate fluid causes water and solutes to diffuse out of the blood and across the membrane)

Question 6

haemodiaysis continued

Answer 6

acces via a vascath (central venous catheter) which has 2 lumens (one to remove the blood and the other to put blood back in)

anticoagulate with citrate or heparin (prevent blood clotting)

Question 7

what are the two options for haemodialysis

Answer 7

CRRT: continuous renal replacement therapy
= continuously performing dialysis 24 hours a day. Most patients requiring haemodialysis in ICU will be on CRRT.

IHD: intermittent haemodialysis = running the machine and performing dialysis for set periods, for example, 3-12 hours, before taking a break from dialysis.