RRT Flashcards
what eGFR to start predialysis counselling
30
what eGFR to consider transplant
<=15
types of transplant donor
living or deceased
CIs to transplant (4)
high BMI heart problems warfarin/DOACs cancer poor compliance with appointments/meds
what risk important risk is there after transplant and why?
MALIGNANT MELANOMA due to immunosuppressants. must wear sunscrean (prescribed) and cover in the sun
(can also get other Ca bc of immunosuppressants)
what scan is needed before going on transplant list
myocardial perfusion scan (myoview) - identifies areas of myocardium where ischaemia is inducible under stress
average lif expectancy after starting dialysis
4 yr
how much fluid goes into peritoneal cavity in peritoneal dialysis
2-2.5 L (fluid is prescribed)
how many times a day do pts need to dialyse in PD
3-4, each 30 mins. can also use automatic machine that does it at night
other things to know about PD
a home, tube always in situ, machine is portable
risk in PD
PERITONITIS!!!
must have v clean room for it, great handwashing. if tube touches bed with cap off need to have IV abx
CIs PD
weight previous abdo surgery stomas ostomies social - unclean house
symptoms which mean dialysis should be considered
fluid overload incl SOB sx vomiting itching fatigue ALL OF THESE ARE V COMMON Sx - remember them!!
electrolyte imbalances which mean pt may need to start on dialysis
urea
ca
k
dietary restrictions in both types of dialysis
PD - fewer restrictions and can pee so can drink more fluid (benefit to many pts)
HD - 1L fluid, watch K, phosphate (and salt!)
average wait for transplant
3.5 yr
how long between making fistula and using it
1 year
how long for haemo
3.5 hr 3 times a week
what line is an alternative to a fistula
tunnel line (not as god bc infection risk). uideally they are temporary
which dialysis slows down kidney decline
pd
do pts pass urine in dialysis
PD - yes, HD, no
sx after dialysis
cramps, BP drops, hungry, sweaty, fatigue, dizzy, headache, fluid overload, tremor, confused
what can HD cause
heart failure?
if don’t want transplant or dialysis
conservative care (resond to sx tha concern pt) there is actually no evidence that >74 yo are better to have idlaysis than conservative care
food with K in
rhubarb banana tomatoes (including tinned!!! no curry or spag bowl!!) mushrooms jacket potatoes beer
food with phoshate in
dairy
eggs
shellfish
what does dialysis remove
fluid ca urea k cr phosphate
why must phosphate be managed
low -> bone problems, high -> cardiac problems. if kidney failure, phosphate is not excreted -? HYPERphosphataemia
how to manage hyperphosphataemia
dialysis
phosphate binders
diet
nb phos and ca don’t cause acute problems
just chronic ones
what does peritoneal fluid contain
dextrose
electrolytes (mg cl k na ca)
lactate
bicarb
sx peritonitis (EMERGENCY!!)
cloudy fluid
abdo pain + tenderness
gnerally unwell
increased temp
abx for peritonitis
vancomycin
why is fistula/tunnel line important
IT IS THEIR LIFELINE (don’t use for general access unless it is an emergency)
where does a tunnel line sit
R atrium
what weekly IM injection is needed in ESRD
erythropoetin
other drugs that pts might need
activated vit d IV irons (cannot give oral bc already constipated from low fibre diet)
acute reasons to dialyse (6)
- refractory hyperkalemia
- volume overload
- intractable acidosis
- uraemic encephalopathy
- pericarditis, or pleuritis;
- removal of certain toxins
complications HD
- hypovol -> hypotension, camps, nausea, headache, chest pain, fever, rigors
- infection at access point
complications PD
- peritonitis
- herniation of abdo wall
- infection at access point
sx transplant rejection
PAIN / Sx of kidney failure
transplant inmmunosuppressant
tacrolimus!! - calcineurin inhibitor
