Dialysis Flashcards
what is dialysis
mimics the glomerulus ultra-filtration by removing fluid by hydrostatic pressure or osmotic gradient
mimics the proximal/distal tubule for reabsorption and conservation of wanted molecules
when is dialysis indicated
end stage
eGFR average is 7ml/min
unmanageable by other interventions
severe symptoms
what are the severe symptoms of end stage CKD
fatigue
N&V
itchy
drowsy
bone pain
inability to urinate
weight loss
what are the two types of dialysis
haemodialysis and peritoneal dialysis
what is haemodialysis
artificial kidney - uses a filter and semi permeable membrane to clean blood and return to the body
what is peritoneal dialysis
Patients own peritoneum acts to mimic the glomerular basement membrane - rich in blood supply and creates an empty space
- Dialysate fluid runs into cavity by gravity
- Fluid then drained out under gravity when full and new bag is put in
4 exchanges a day everyday - can be done at home
what access is required for haemodialysis
arteriovenous fistula is gold standard
- joined artery and vein to form large vessels
what access is required for peritoneal dialysis
Tenckhoff catheter through abdominal wall and sits in cavity
what are the two types of peritoneal dialysis
continuous ambulatory peritoneal
- 4 x a day every day at home
automated peritoneal dialysis
- carried out by a machine overnight
- reduced infection risk and improved adequacy
what is the adequacy of haemodialysis
work up to 3-5hr sessions to prevent disequilibrium syndrome
x 3 week
tolerance - may cause dizziness/hypotension
what are the symptoms of disequilibrium syndrome
headaches
N&V
convulsions in large urea removal
what are the advantages to peritoneal dialysis
- reduced anaemia risk less blood lost
- less aggressive
- better for cardiac stability
- can be done at home
- dietary and fluid restriction not as strict
what are the disadvantages of peritoneal dialysis
- peritonitis risk
- membrane can become fibrosed
- hypoglycaemia risk
- requires a lot of equipment
- less clearance of smaller molecules
what are the diet and fluid requirements for dialysis patients
healthy diet
low potassium
low phosphate
high protein in CAPD
urine output + 500ml/750ml in HD/PD
what medication considerations need to be made in dialysis
fluid management - stop diuretics
acid/base balance - stop bicarbonate
hypertension - monitor - likely to reduce post dialysis
renal bone disease - remain on treatment
erythropoietin - increased blood loss risk so continue
