When to start dialysis Flashcards
What are the implications of renal failure. (5)
Electrolyte imbalance. Acidosis. Fluid retention. Retention of waste products. Secretory failure.
What electrolytes are affected in renal failure. (2)
Potassium - hyperkalaemia.
Sodium - hyponatraemia.
What waste products are retained in renal failure. (3)
Small molecules (urea, creatinine, urate). Phosphate. Middle molecules (peptides, beta2-microglobulin).
What fails to be secreted in renal failure. (2)
Erythropoietin.
1.25 vitamin D
What are the symptoms of renal failure. (12)
Tiredness. Lethargy. Shortness of breath. Oedema. Pruritis. Nocturia. Feeling cold. Twitching. Poor appetite. Nausea. Loss of/nasty taste. Weight loss.
What are some consequences of renal failure (in other organs/systems) (2)
Anaemia - exacerbates the tiredness.
Renal bone disease - causes aches and pains, pruritis.
What occurs to patients with renal failure if there is no renal replacement treatment. (7)
In increasing severity: hyperkalaemia - arrythmias, cardiac arrest. Pulmonary oedema. Nausea, vomiting. Malnutrition/cachexia. Fits. Increasing coma. Death.
What are the two forms of renal replacement therapy.
Dialysis.
Transplantation.
Does renal replacement therapy provide a cure.
No.
What are the two forms of dialysis.
Haemodialysis.
Peritoneal dialysis.
Where is haemodialysis carried out.
Predominantly hospital based, but can be done at home.
Where is peritoneal dialysis carried out.
At home.
What are the aims of renal replacement treatments. (5)
Correct electrolyte and acid-base status. Remove waste products. Restore fluid balance. Improve symptoms. Maintain quality of life for patient.
When do you begin to consider dialysis for a patient with renal failure.
When eGFR
What are some different access points for renal replacement therapy. (3)
Fistula (HD).
PD catheter.
Transplant assessment.
What are the three situations in which you begin dialysis for a patient with renal failure.
eGFR
What are the benefits of dialysis. (3)
Improve ureamic symptoms.
Correct fluid balance.
Avoid life-threatening events.
What life threatening events are you trying to avoid with dialysis. (3)
Severe acidosis.
Severe hyperkalaemia.
Pulmonary oedema resistant to diuretics.
What are the benefits of correcting fluid balance in a patient with renal failure. (2)
Less shortness of breath and oedema.
What are the main ureamic symptoms in a patient with renal failure. (3)
Tiredness.
Nausea.
Pruritis.
What are the risks of starting a patient on dialysis. (2)
Dialysis-related complications.
Adverse effects on quality of life.
What are the dialysis related complications. (3)
Infection (HD and PD).
Hypotension, arrhythmias (HD).
Access related (HD and PD).
What are the adverse effects on quality of life for a patient undergoing dialysis. (3)
Work.
Family.
Travel.
What aspects of renal failure does dialysis not treat. (3)
Lack of erythropoietin. (ie the anemia).
Lack of 1.25 vitamin D.
Other diseases - comorbidities.
What does lack of 1.25 vitamin D cause. (2)
Hyperparathyroidism.
Renal bone disease.
What comorbidities are associated with renal failure. (3)
SLE.
Diabetes.
Vascular disease.
Where does HD take place.
In a hospital.
Where does PD take place.
At home.
How many times does a patient need HD.
3 times a week.
How many times does a patient need PD.
Daily and continuous.
How long does a HD session take.
4 hours (but also recovery time and travel time).
What is needed in order to do HD.
Vascular access.
How is vascular access achieved in HD. (2)
Catheter.
A-V fistula.
How does HD affect the patient’s quality of life. (3)
Done for you and does not invade your home.
Limits travel opportunities and work.
Loss of independence.
How does PD affect the patient’s quality of life. (4)
Maintains independence.
Easier to travel and work.
Avoids the swings of HD.
Less dietary and fluid restrictions.
What two things limit the ability to do PD.
Access to peritoneum.
Ability to do technique correctly.
What are the benefits of renal transplants for renal failure. (5)
Better renal replacement.
Improvement in metabolic disorders (anaemia, renal bone disease).
Costs less in the long term.
Quality of life (avoids disadvantages of HD/PD, much easier to travel, work, maintain independence.)
Prolongued survival.
What are the risks associated with renal transplantation for renal failure. (4)
Older and sicker patients not eligible.
Immunosuppression (increased infection, increased malignancy).
Not a cure (surgical complications, hospital visits - frequent at the start).
Often worse off if/when the transplant fails.
What are the risks caused by immunosuppression after a renal transplant surgery. (2)
Increased infections.
Increased malignancy.
