The Clinical Kidney part 2

Question 1

indications or renal disease

Answer 1

AEIOU
Acidemia
Electrolytes
Intoxicants
Overload
Uremia

Question 2

modalities

Answer 2

Hemodialysis (HD or iHD)
Peritoneal dialysis (PD)
Continuous renal replacement therapy (CRRT)

Question 3

diffusion

Answer 3

Solute passes between two fluid compartments driven by concentration gradient

Question 4

convection

Answer 4

Water (and accompanying solute) passes between two compartments driven by hydrostatic pressure gradient

Question 5

hemodialysis

Answer 5

Blood and dialysate fluid pumped through dialyzer in countercurrent fashion

Access through AV fistula, AV graft, or central catheter

Question 6

peritoneal dialysis

Answer 6

Dialysate fluid instilled into the peritoneal space, allowed to dwell, and drained

Continuous ambulatory PD, intermittent PD, continuous cyclic PD

Uncommon

Question 7

advantages of peritoneal dialysis over hemodialysis

Answer 7

Less physiologically stressful

Does not require vascular access or anticoagulation

Flexible

Question 8

disadvantages of peritoneal dialysis over hemodialysis

Answer 8

Slower solute removal

Cannot adjust diffusion:convection

Complicated by peritonitis

Greater patient involvement

Question 9

Continuous venovenous hemofiltration (CVVH)

Answer 9

convection

Question 10

Continuous venovenous hemodialysis (CVVHD)

Answer 10

diffusion

Question 11

Continuous venovenous hemodiafiltration (CVVHDF)

Answer 11

convection + diffusion

Question 12

advantages of continuous renal replacement therapy CRRT

Answer 12

Less physiologically stressful

Greater fluid and solute removal per day

Greater clearance of inflammatory mediators

Consistent

Question 13

disadvantages of continuous renal replacement therapy CRRT

Answer 13

Slower fluid and solute removal

Continuous (hooked up to machine 24/7)

Question 14

pharmacokinetics in kidney dysfunction

Answer 14

Enteral bioavailability, protein binding, and clearance may be decreased
Volume of distribution may be increased

Question 15

without renal replacement therapy

Answer 15

Evaluate drug information recommendations when available
-Use CKD-EPI or MDRD when expected to be accurate (KDIGO recommendation)
-Use Cockcroft-Gault when expected to be accurate (historical FDA guidance)
(if creatinine is increasing or decreasing a lot, then its not accurate representation of persons renal function). calculate creatinine as floor or ceiling.
Adjust to body surface area when needed

Question 16

renal dose adjustments may not be needed when

Answer 16

there is less than 30% renal elimination

Question 17

Administer doses post-HD

Answer 17

or else hemodialysis will take the drug out of the system.

Question 18

Determine effluent flow rate for CRRT

Answer 18

rough estimate of creatinine clearance when comparing dosing regimen

Question 19

convection vs diffusion

Answer 19

convection tends to yield greater clearance of moderate to large size medications, but diffusion is limited to smaller sized medications