RRT - Dialysis Flashcards
What are the functions of the kidney?
Excrete nitrogenous waste Acid/electrolyte balance Blood pressure Drug metabolism/disposal Activate vitamin D Produce EPO
What are the clinical features of advanced CKD?
Asymptomatic til stage 4/5
Uraemia
Earliest - malaise and fatigue
When is renal replacement therapy typically indicated?
eGFR <10ml/min
What is dialysis?
The process by which solute composition of A is altered by exposure to solution B through a semipermeable membrane
What are the prerequisites for dialysis?
Semipermeable membrane
Adequate blood exposure
Access
Anticoagulation
What are the permanent forms of haemodialysis access?
Arterio-venous fistula
AV prosthetic graft
What are the temporary forms of haemodialysis access?
Tunnelled venous catheter
Temporary venous catheter
Which are the primary substances removed into the dialysate?
Creatinine
Urea
Which are the primary substances added into the blood from the dialysate?
Bicarbonate
What are the restrictions in place for dialysis patients?
Fluid - residual urine output, interdialytic weight gain Diet: - Potassum - Sodium - Phosphate
What drug is used as an anticoagulant in haemodialysis?
Heparin
What is peritoneal dialysis?
Balanced dialysis solution instilled into the peritoneal cavity via a catheter, using the peritoneal mesothelium as a dialysis membrane
What are the types of peritoneal dialysis?
Continuous Ambulatory Peritoneal Dialysis (CAPD)
Automated peritoneal dialysis (APD)
Hybrid
What is the contents of peritoneal dialysis fluid?
Balanced electrolytes
Glucose as osmotic agent
CAPD takes place in when?
During the day
APD takes place when?
At night
What complications are associated with peritoneal dialysis?
Exit site infection
PD peritonitis
Ultrafiltration failure
Encapsulating peritoneal sclerosis
PD peritonitis with gram -ve bacteria suggests what?
Bowel origin
PD peritonitis with gram +ve bacteria suggests what?
Skin contaminant
PD peritonitis with gram mixed bacteria suggests what?
Complicated peritonitis
What are the indications for dialysis in ERSD?
Advanced Uraemia (GFR 5-10)
Severe acidosis (HCO3 <10)
Rx resistant Hyperkalemia
Rx resistant fluid overload
What is the fluid balance in haemodialysis?
Restrict to 500-800ml/24hrs
What is the fluid balance in peritoneal dialysis?
Usually more liberal as ultrafiltration is often achieved
What drugs are used to treat anaemia in dialysis?
Erythropoietin injections
IV iron supplements
What drugs are used to treat renal bone disease in dialysis?
Activated vitamin D
Phosphate binders with meals
What medications are given with dialysis?
Heparin
Water soluble vitamins
antihypertensives
What complications are associated with haemodialysis?
Intra-dialytic hypertension Arrhythmia Clotting of vascular access Heparin problems Allergy
What complications are associated with peritoneal dialysis?
Exit site infection Tunnel infection Peritonitis Tube malfunction Abdominal wall herniae Ultrafiltration issues
