Dialysis

Question 1

Generally, when should a patient start dialysis?

Answer 1

When the risks of uremic complications outweigh the risks of dialysis

Question 2

What are some specific indications for dialysis?

Answer 2

• volume overload refratory to diuretics
• hyperkalemia refractory to medical treatment
• uremic pericarditis
• uremic symptoms
• other metabolic derangements

Question 3

Estimations of GFR at very low kidney function values is __________.

Answer 3

inaccurate

Question 4

What did the IDEAL study show?

Answer 4

It demonstrated that starting dialysis early did not decrease mortality in CKD patients. (Because dialysis is a huge detriment to quality of life, providers now wait to start dialysis.)

Question 5

What are the pros and cons of AV fistulas?

Answer 5

Pros: lowest infection rate; longest lifespan; requires fewest procedures to maintain
Cons: can take months to mature; some are never usable; risk of “steal” syndrome–in which arterial blood gets diverted to the vein; needles

Question 6

What arteries and veins are common for AV fistulas?

Answer 6

Radiocephalic
Brachiocephalic
Brachiobasilic

Question 7

What are AV grafts?

Answer 7

Surgeons insert plastic tubing between an artery and a vein

Question 8

What are the pros and cons of AV grafts?

Answer 8

Pros: quicker than AVFs; good blood flow; lower infection rate than catheters
Cons: high rate of stenosis; shorter lifespan than AVFs; risk of steal syndrome; needles

Question 9

What are the pros and cons of dialysis catheters (those inserted into the internal jugular and SVC)?

Answer 9

Pros: immediate use; no needles; does not require surgery
Cons: highest infection risk; high rate of dysfunction; requires insertion-site care; associated with high mortality

Question 10

What are two main limitations of dialysis?

Answer 10

(1) Inability to remove fluid overload

(2) Hyperphosphatemia leading to bone disorders

Question 11

The IDEAL study failed to demonstrate benefits from _____________.

Answer 11

starting dialysis early

Question 12

Patients with __________ should be start dialysis.

Answer 12

severe co-morbidities

Question 13

Peritoneal dialysis is the _____________.

Answer 13

most common method of dialysis in the world

Question 14

Peritoneal dialysis can lead to _________ complications.

Answer 14

metabolic (hyperglycemia, hypertriglyceridemia, and hypokalemia)