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Renal > Dialysis > Flashcards

Dialysis Flashcards

1
Q

Functions of the kidneys and which dialysis can perform

A

Metabolic waste excretion

Endocrine functions

Drug metabolism

Control of solutes and fluid status

Blood pressure control

Acid Base balance

nothing other than a transplant is going to effectively replace all of these functions

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2
Q

Aims of dialysis

A

Aim of dialysis therapy = Homeostasis

  • Removal of nitrogenous waste products
  • Maintenance of normal electrolytes
  • Maintenance of normal extracellular volume
  • Correction of metabolic acidosis
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3
Q

When to dialyse

A

Acute

  • Hyperkalemia resistant to medical therapy
  • refractory pulmonary oedema
  • Metabolic acidosis
  • Uraemic complications (pericarditis)
  • Severe uraemic symptoms (uraemic encephalopathy)

Chronic

ESRF stage 5 - lots of symptoms

  • anorexia
  • vomitting
  • itch
  • restless legs
  • weight loss
  • metallic taste
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4
Q

What are the options for RRT

A
  • transplant (living or deceased)
  • Dialysis
    • Haemodialysiss
    • peritoneal dialysis
    • CVVH
  • Conservative care
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5
Q

What is haemodialysis?

A
  • patient is connected to the machine
  • removal of solutes e.g postassiumm, urea.
    • Movement of solutes by diffusion down a concentration gradient across a semi-permeable membrane in to dialysate
    • dialysate is flushed out and discarded
  • Removal of fluid: via ultrafiltration (oscmotic pressure)
    • movement of fluid via ultrafiltration down a pressure gradient so blood volume falls

Blood out - diffusion removes the solute - filtration removes fluid- dialysate discarded- blood in

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6
Q

Practicalites of HD

A
  • Hospital or home based – hospital much more common
  • Standard: 4h, 3 times a week
  • Multiple other options – mainly home based:
    • 6h 3 times a week
    • Short daily dialysis
    • Daily overnight
  • Home based treatment gives greater flexibility and empowerment but need carer, space and capital investment
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7
Q

Vascular acess in haemodialysis

A

Need to create an arteriovenous fistula

  • radiocephalic (wrist)
  • Brachiocephalic (elbow)

The artery is anastomosed onto the vein then arterialised and hypertrophys.

If fail

  • tunnled line - risk of infection
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8
Q

Haemodialysis complications

A
  • ‘Crash’ - Hypotension (fluid out of intravascular, means fluid needs to be brought in by extravascular fluid, too much fluid out quickly then hypotension)
  • Dialysis disequilibrium - urea levels drop too quickly
  • Cramps
  • Fatigue
  • Hypokalaemia
  • Air embolism
  • Blood loss
  • Access problems
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9
Q

Peritoneal dialysis treatment

A
  • Need intraperitoneal Tenchkoff catheter
  • Use the patients own peritoneal membrane - diiffusion of solutes
    • Infuse fluid into the patients periteneal cavity
    • Dilaysate is at low concentration of solute
    • Solutes from blood capillaries in the peritenum diffuse across the peritoneal membrane into the peritenum
  • Glucose as osmotic gradient - Fluid by osmosis
    • Add glucose to the dialysate
    • creates an osmotic gradient
    • enables fluid to move from the capillary intot he peritenum
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10
Q

Two types of periotenal dialysis

A
  • Continous abulatory peritenoeal dilayssi
    • Manual exchages by patient
    • 4 times a day
  • APD (automated peritoneal dialyssi)
    • machine performs automated exchanges whilst asleep
    • more exchanges overnight
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11
Q

Practilicalites of PD​

A
  • Home based therapy
  • Better with some residual renal function
  • Different glucose concentrations of dialysate to provide more or less ultrafiltration
  • Dialysate contains other electrolytes like in HD
  • Gradual treatment – no good for AKI
  • Simple procedure once taught
  • Maintain independence
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12
Q

Complications of PD

A
  • Infection - peritonitis
  • Glucose load – development or worsening control of diabetes
  • Mechanical – hernia, diaphragmatic leak, dislodged catheter
  • Peritoneal membrane failure
  • Hypoalbuminaemia
  • Encapsulating peritoneal sclerosis

Some patients not suitable:

  • •Grossly obese
  • •Intra-abdominal adhesions
  • •Frail
  • •Home not suitable
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13
Q

Modality choice considerations

A
  • Lifestyle
  • Frailty
  • Vascular access
  • Time – travel to and from hospital
  • Carer
  • Physical – concurrent medical problems e.g. disseminated malignancy, severe dementia, severe psychiatric disease
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14
Q

Problems not helped by dialysis

A
  • Anaemia – need erythropoesis supplementing agents and iron
  • Renal bone disease – need phosphate binders and vitamin D
  • Neuropathy
  • Endocrine disturbances

Remember – dialysis only gives around 10ml/min eGFR, not as good as a transplant

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15
Q

Prognosis of patients on haemodialysis

A
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Renal (12 decks)

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