Renal replacement therapy Flashcards
When need to assess for RRT
1 year before RRT needed
Indications for dialyiss
Impact of symptoms of uraemia on daily living
Uncontrollable fluid load
eGFR 5-7 ml/min/1.73
Dialysis options
Peritnoeal - continious ambulatory or automated
Haemodialysis/haemodiafiltration
How long before plan haemodialysis ideally make fistula
6 months - allow possibility of failing
Use US to assess site
Poor outcomes irsk factors transplant
lack of social support
neurocognitive issues
non-adherence (medicines, diet, hospital appointments)
poor understanding of process and complexities of treatment
poorly controlled mental health conditions or severe mental illness
substance misuse or dependence.
Referral crtieria for CKD
5 yr risk of needing RRT >5%
ACR>70
ACR>30 + haematuria
Susteained decrease eGFR >35% or more + change category in 12 months
eGFR change >15 per year
Poorly controlled HPTN despite 4 drugs
Sus rare or genetic CKD
Sus renalartery stenosis
Which haemo dialysis mode is better
Haemodiafiltration = additional convection more effective than haemodialysis
When is continious therapy used
ITU/AKI - unstable patients
When is haemoperfusion used in RRT
Poisonning or toxicity
due to barbiturates, many antidepressants, ethchlorvynol, meprobamate, paraquat, glutethimide, metals such as lithium and barium, or toxic doses of aminoglycosides or cardiovascular drugs
CIs to peritoneal dialysis
Loss of peritoneal function
Adhesions that limit dialysate flow
Recent abdominal wounds
Abdominal fistulas
Abdominal wall defects that prevent effective dialysis or increase infection risk (eg, irreparable inguinal or diaphragmatic hernia, bladder extrophy)
Patient’s condition not amenable to dialysis
Relative CIs for peritoneal dialysis
Abdominal wall infection
Frequent episodes of diverticulitis
Inability to tolerate large volumes of peritoneal dialysate
Inflammatory bowel disease
Ischemic colitis
Morbid obesity
Peritoneal leaks
Severe undernutrition
Indications for dialysis
Renal insufficiency with uncontrollable:
Fluid overload
Hyperkalemia
Hypercalcemia
Metabolic acidosis
Pericarditis
Uramic symptoms
GFR 5-7
Intermittent haemodialysis theoretical eGFR
150-200 during
0 in between
Overall <10
Peritoneal dialysis theroitcal eGFR
5-10
Continious veno venous haemofiltration theroitcal eGFR
15-25
