RRT - Dialysis

Question 1

What are the functions of the kidney?

Answer 1

Excrete nitrogenous waste
Acid/electrolyte balance
Blood pressure
Drug metabolism/disposal
Activate vitamin D
Produce EPO

Question 2

What are the clinical features of advanced CKD?

Answer 2

Asymptomatic til stage 4/5
Uraemia
Earliest - malaise and fatigue

Question 3

When is renal replacement therapy typically indicated?

Answer 3

eGFR <10ml/min

Question 4

What is dialysis?

Answer 4

The process by which solute composition of A is altered by exposure to solution B through a semipermeable membrane

Question 5

What are the prerequisites for dialysis?

Answer 5

Semipermeable membrane
Adequate blood exposure
Access
Anticoagulation

Question 6

What are the permanent forms of haemodialysis access?

Answer 6

Arterio-venous fistula

AV prosthetic graft

Question 7

What are the temporary forms of haemodialysis access?

Answer 7

Tunnelled venous catheter

Temporary venous catheter

Question 8

Which are the primary substances removed into the dialysate?

Answer 8

Creatinine

Urea

Question 9

Which are the primary substances added into the blood from the dialysate?

Answer 9

Bicarbonate

Question 10

What are the restrictions in place for dialysis patients?

Answer 10

Fluid - residual urine output, interdialytic weight gain
Diet:
- Potassum
- Sodium
- Phosphate

Question 11

What drug is used as an anticoagulant in haemodialysis?

Answer 11

Heparin

Question 12

What is peritoneal dialysis?

Answer 12

Balanced dialysis solution instilled into the peritoneal cavity via a catheter, using the peritoneal mesothelium as a dialysis membrane

Question 13

What are the types of peritoneal dialysis?

Answer 13

Continuous Ambulatory Peritoneal Dialysis (CAPD)
Automated peritoneal dialysis (APD)
Hybrid

Question 14

What is the contents of peritoneal dialysis fluid?

Answer 14

Balanced electrolytes

Glucose as osmotic agent

Question 15

CAPD takes place in when?

Answer 15

During the day

Question 16

APD takes place when?

Answer 16

At night

Question 17

What complications are associated with peritoneal dialysis?

Answer 17

Exit site infection
PD peritonitis
Ultrafiltration failure
Encapsulating peritoneal sclerosis

Question 18

PD peritonitis with gram -ve bacteria suggests what?

Answer 18

Bowel origin

Question 19

PD peritonitis with gram +ve bacteria suggests what?

Answer 19

Skin contaminant

Question 20

PD peritonitis with gram mixed bacteria suggests what?

Answer 20

Complicated peritonitis

Question 21

What are the indications for dialysis in ERSD?

Answer 21

Advanced Uraemia (GFR 5-10)
Severe acidosis (HCO3 <10)
Rx resistant Hyperkalemia
Rx resistant fluid overload

Question 22

What is the fluid balance in haemodialysis?

Answer 22

Restrict to 500-800ml/24hrs

Question 23

What is the fluid balance in peritoneal dialysis?

Answer 23

Usually more liberal as ultrafiltration is often achieved

Question 24

What drugs are used to treat anaemia in dialysis?

Answer 24

Erythropoietin injections

IV iron supplements

Question 25

What drugs are used to treat renal bone disease in dialysis?

Answer 25

Activated vitamin D

Phosphate binders with meals

Question 26

What medications are given with dialysis?

Answer 26

Heparin
Water soluble vitamins
antihypertensives

Question 27

What complications are associated with haemodialysis?

Answer 27

Intra-dialytic hypertension
Arrhythmia 
Clotting of vascular access
Heparin problems
Allergy

Question 28

What complications are associated with peritoneal dialysis?

Answer 28

Exit site infection
Tunnel infection
Peritonitis 
Tube malfunction
Abdominal wall herniae
Ultrafiltration issues