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Renal > 5.1: Dialysis > Flashcards

5.1: Dialysis Flashcards

1
Q

True or false:

Most patients with CKD die before they reach end stage kidney disease?

A

TRUE

Most patients with CKD die before they reach end stage kidney disease (As CVS risk is increased)

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2
Q

Two treatments for end stage renal disease?

A

Dialysis

Transplantation

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3
Q

What is dialysis based on?

A

Based on the principle of diffusion

Movement of solutes from an area of high concentration to an area of low concentrations through a semi-permeable membrane

Eventually there is an equilibrium

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4
Q

What does dialysis do?

A

Removes toxins from the blood that build up in end stage kidney disease

  • Urea
  • Potassium
  • Sodium

Also gives patients bicarbonate (if they have acidosis)

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5
Q

Describe how electrolytes move during dialysis?

A

Move across the semi-permeable membrane down a concentration gradient

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6
Q

How do you gain access for haemodialysis?

What is the blood flow per minute required?

A

300mls/min needed

AV Fistula

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7
Q

Describe what is happening in this picture?

A

Blood is being taken out of the body

Solutes pass out across the semi-permeable membrane

Blood passes back into the body

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8
Q

Describe the composition of Dialysate?

A

Pure Water

Sodium

Bicarbonate

Some potassium (to ensure we don’t remove all the potassium from the patient leading to stopping of the heart)

Glucose (Prevent hypo)

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9
Q

What happens to water before it enters the haemodialysis machine?

Why?

A

Water must be purified (a bit like a fish tank filtration system)

Prevents toxins entering the patients body and causing damage

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10
Q

How does haemodilaysis get rid of water?

A

Use of vacuum (negative pressure) to suck water across the membrane

This is called FILTRATION

This also removes some solutes dissolved in the water

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11
Q

How efficient is dialysis?

A

Not very

Longer treatment time equals better efficiency

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12
Q

Minimum time for dialysis in a week?

A

4 Hours

3 times a week

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13
Q

Describe the pros/cons for increasing and decreasing dialysis?

A

Decreased: 1% Increased risk of death for every 30mins less dialysis

However improved QoL (less time on it)

Increased: Potentially better survival

Decreased QoL

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14
Q

What restrictions are put on dialysis patients?

A
  • Fluid Restriction (1l per day if anuric)
  • Sodium Restriction (low salt diet)
  • Potassium Restriction (Low potassium diet - bananas, chocolate, potatoes)
  • Phosphate (Low Phosphate diet, phosphate binders)
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15
Q

Describe a fistula?

A

Joins and artery and a vein to make an enlarged thick walled vein called an Arteriovenous Fistula

This is where access for dialysis is gained

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16
Q

Pros and cons of fistula?

A

Pros;

  • Good blow flow
  • Unlikely to cause infections

Cons:

  • Takes 6 weeks to mature
  • Need surgery
  • Can ‘steal’ blood flow from distal arm
  • Can block and require revision
17
Q

Describe the pros and cons of a tunneled venous catheter?

A

Pros:

  • Easily to insert
  • Can be used immediatly

Cons:

  • Infection (Especially staph aureus)
  • Can damage veins
  • Become blocked
18
Q

Describe a tunneled venous catheter?

A

A catheter inserted into a large vein (Eg: Jugular,subclavian or femoral) for dialysis

19
Q

Describe tunneled venous catheter infection?

Investigation of infection?

Treatment?

A

Can progress to endocarditis, sepsis, death

Investigations: Blood cultures, FBC, exit site swap

Treatment: Vancomycin

Line removal or exchange

20
Q

What can do wrong with dialysis?

A
  • Fluid Overload (Pulmonary Oedema, LV Failure)
  • Blood Leaks (Patient can die from blood loss)
  • Loss of vascular access
  • Hypokalaemia and cardiac arrest
  • Hypotension
21
Q

How do you treat a patient with pulmonary oedema who has dialysis?

Do you use furoesemide?

A

Call the renal team

Don’t treat with Furosemide - it doesn’t do anything

22
Q

Describe Peritoneal Dialysis?

How is solute removal done?

How is glucose removal done?

A

Catheter goes through abomdinal wall into abdomen

The lining of the peritoneum is used as the semi-peritoneal membrane

Solute removal is done by diffusion

Water removal is done by osmosis (using a high glucose concentration in the dialysate)

23
Q

Describe the types of peritoneal dialsyis?

More or less mobile than haemo?

A

CAP - Continual Ambulatory Peritoneal

Patient has 4 bags which are changed in a day

Fluid drained out, new fluid drained in

Simple, easy, low tech

APD (Automated Peritoneal Dialysis)

1 bag of fluid stays in all day

Overnight machine drains in and out fluid for 9-10 hours per day

A LOT MORE MOBILE THAN HAEMO - PATIENTS CAN TRAVEL AROUND THE WORLD

24
Q

Infectious complications of peritoneal dialysis?

Investigations?

Treatment?

A

Infection - Perionitis or exit site infection

  • Due to staph, strep, diptheroid infection
  • Gut bacteria translocation

Culture of the peritoneal fluid

Antibiotics directly into peritoneum

Vancomycin and Gentamycin

May need catheter changed

25
Q

Other complications of peritoneal dialysis?

A

Membrane Failure (Becomes overloaded with fluid as unable to remove enough fluid)

Hernia (Raised intra-abdominal pressure)

26
Q

Which type of dialysis is better?

A

Very little difference in survival

Depends on patient

  • Peritoneal dialysis for independent patients who want to do it themself
  • Haemodialysis for patients who want someone to do it for them
27
Q

Metabolic complications during dialysis and end stage kidney disease?

A
  • Bone mineral metabolism problems (Vit D deficiency, hypocalcaemia, phosphate retention, PTH increase –> RICKETS)
  • Anaemia
  • Sodium and water retention
  • Accelerated CV disease
28
Q

When do we start dialysis?

A

Start based on blood (occasionally)

  • Resistant hyperkalaemia
  • GFR <5
  • Ur >45
  • Unresponsive acidosis

Start based on symptoms (most common)

  • Fatigue
  • Itch
  • Unresponsive fluid overload
  • Nausea and vomiting
  • Loss of Appetite

NO BENEFIT TO STARTING EARLY

29
Q

How do you start haemodialysis (Eg: Build up regime)?

A

Gradual build up

1st session = 2 hours

Subsequent sessions to build up to 4 hours

If correction is too quick you get fluid overload, cerebral oedema and seizures

30
Q

How do you start peritoneal dialysis (Eg: Build up regime)?

A
  • Training (as they do it themselves)
  • Start with small volumes
  • Fill volume increase in size to 2-2.5l
  • Regular clinic and nurse follow up
31
Q

Describe how you decide if everyone should get dialysis?

A

As age increases, survival with Renal Replacement Therapy decreases

Look at patient as a whole and decide who will benefit

Think about QoL

Assess each patient indivdually

32
Q

What do patients on dialysis die of?

A
  1. CVS
  2. Infection

Malignancy (Small)

Treatment withdrawal (Patient Choice)

33
Q

Describe withdrawal from dialsyis?

A

Active Patient Desicion

Informed Consent

May be due to many reasons - cardiovascular disease, peripheral vascular disease, general fraility

Palliative Care offered

34
Q

True or False:

Dialysis patients have a significantly lower QoL than the general population?

A

TRUE

Dialysis patients have a significantly lower QoL than the general population due to the all the restrictions

35
Q

Which treatment is best (for patients who are suitable)?

  • Transplant?
  • Dialysis?
A

Transplant is the best form of renal replacement therapy for patients who are suitable

Renal (34 decks)

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