When to start dialysis

Question 1

What are the implications of renal failure. (5)

Answer 1

Electrolyte imbalance. 
Acidosis. 
Fluid retention. 
Retention of waste products. 
Secretory failure.

Question 2

What electrolytes are affected in renal failure. (2)

Answer 2

Potassium - hyperkalaemia.

Sodium - hyponatraemia.

Question 3

What waste products are retained in renal failure. (3)

Answer 3

Small molecules (urea, creatinine, urate). 
Phosphate. 
Middle molecules (peptides, beta2-microglobulin).

Question 4

What fails to be secreted in renal failure. (2)

Answer 4

Erythropoietin.

1.25 vitamin D

Question 5

What are the symptoms of renal failure. (12)

Answer 5

Tiredness. 
Lethargy. 
Shortness of breath. 
Oedema. 
Pruritis. 
Nocturia. 
Feeling cold. 
Twitching. 
Poor appetite. 
Nausea.
Loss of/nasty taste. 
Weight loss.

Question 6

What are some consequences of renal failure (in other organs/systems) (2)

Answer 6

Anaemia - exacerbates the tiredness.

Renal bone disease - causes aches and pains, pruritis.

Question 7

What occurs to patients with renal failure if there is no renal replacement treatment. (7)

Answer 7

In increasing severity:
hyperkalaemia - arrythmias, cardiac arrest. 
Pulmonary oedema. 
Nausea, vomiting. 
Malnutrition/cachexia. 
Fits. 
Increasing coma. 
Death.

Question 8

What are the two forms of renal replacement therapy.

Answer 8

Dialysis.

Transplantation.

Question 9

Does renal replacement therapy provide a cure.

Answer 9

No.

Question 10

What are the two forms of dialysis.

Answer 10

Haemodialysis.

Peritoneal dialysis.

Question 11

Where is haemodialysis carried out.

Answer 11

Predominantly hospital based, but can be done at home.

Question 12

Where is peritoneal dialysis carried out.

Answer 12

At home.

Question 13

What are the aims of renal replacement treatments. (5)

Answer 13

Correct electrolyte and acid-base status. 
Remove waste products. 
Restore fluid balance. 
Improve symptoms. 
Maintain quality of life for patient.

Question 14

When do you begin to consider dialysis for a patient with renal failure.

Answer 14

When eGFR

Question 15

What are some different access points for renal replacement therapy. (3)

Answer 15

Fistula (HD).
PD catheter.
Transplant assessment.

Question 16

What are the three situations in which you begin dialysis for a patient with renal failure.

Answer 16

eGFR

Question 17

What are the benefits of dialysis. (3)

Answer 17

Improve ureamic symptoms.
Correct fluid balance.
Avoid life-threatening events.

Question 18

What life threatening events are you trying to avoid with dialysis. (3)

Answer 18

Severe acidosis.
Severe hyperkalaemia.
Pulmonary oedema resistant to diuretics.

Question 19

What are the benefits of correcting fluid balance in a patient with renal failure. (2)

Answer 19

Less shortness of breath and oedema.

Question 20

What are the main ureamic symptoms in a patient with renal failure. (3)

Answer 20

Tiredness.
Nausea.
Pruritis.

Question 21

What are the risks of starting a patient on dialysis. (2)

Answer 21

Dialysis-related complications.

Adverse effects on quality of life.

Question 22

What are the dialysis related complications. (3)

Answer 22

Infection (HD and PD).
Hypotension, arrhythmias (HD).
Access related (HD and PD).

Question 23

What are the adverse effects on quality of life for a patient undergoing dialysis. (3)

Answer 23

Work.
Family.
Travel.

Question 24

What aspects of renal failure does dialysis not treat. (3)

Answer 24

Lack of erythropoietin. (ie the anemia).
Lack of 1.25 vitamin D.
Other diseases - comorbidities.

Question 25

What does lack of 1.25 vitamin D cause. (2)

Answer 25

Hyperparathyroidism.

Renal bone disease.

Question 26

What comorbidities are associated with renal failure. (3)

Answer 26

SLE.
Diabetes.
Vascular disease.

Question 27

Where does HD take place.

Answer 27

In a hospital.

Question 28

Where does PD take place.

Answer 28

At home.

Question 29

How many times does a patient need HD.

Answer 29

3 times a week.

Question 30

How many times does a patient need PD.

Answer 30

Daily and continuous.

Question 31

How long does a HD session take.

Answer 31

4 hours (but also recovery time and travel time).

Question 32

What is needed in order to do HD.

Answer 32

Vascular access.

Question 33

How is vascular access achieved in HD. (2)

Answer 33

Catheter.

A-V fistula.

Question 34

How does HD affect the patient’s quality of life. (3)

Answer 34

Done for you and does not invade your home.
Limits travel opportunities and work.
Loss of independence.

Question 35

How does PD affect the patient’s quality of life. (4)

Answer 35

Maintains independence.
Easier to travel and work.
Avoids the swings of HD.
Less dietary and fluid restrictions.

Question 36

What two things limit the ability to do PD.

Answer 36

Access to peritoneum.

Ability to do technique correctly.

Question 37

What are the benefits of renal transplants for renal failure. (5)

Answer 37

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.

Question 38

What are the risks associated with renal transplantation for renal failure. (4)

Answer 38

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.

Question 39

What are the risks caused by immunosuppression after a renal transplant surgery. (2)

Answer 39

Increased infections.

Increased malignancy.