DPD: Dialysis

Question 1

List 5 physiological implications of renal failure

Answer 1

Electrolyte misbalance (Hyperkalaemia, hyponatraemia)
Acidosis
Fluid retention
Retention of waste products
Secretory failure (Erythropoietin, 1.25 vitamin D)

Question 2

List 4 symptoms caused by renal failure

Answer 2

Tiredness
SOB, oedema
Pruritis, nocturia, feeling cold, twitching
Poor appetite, nausea, loss of/nasty taste, weight loss

Question 3

List 2 conditions that may arise as a consequence of renal failure. What is the symptomatic impact of these?

Answer 3

Anaemia: exacerbates tiredness

Renal bone disease: aches + pains, pruritis

Question 4

What 7 pathological states may result if a patient with renal failure does not have renal replacement treatment?

Answer 4

Hyperkalaemia: arrythmias, cardiac arrest
Pulmonary oedema
Nausea + vomiting
Malnutrition / cachexia
Fits
Increasing coma
DEATH

Question 5

What are the available renal replacement therapies?

Answer 5

Haemodialysis
Peritoneal dialysis
Transplantation

Question 6

Describe haemodialysis

Answer 6

Hospital based treatment
4 hours, 3 x a week
Vascular access needed: Catheter or A-V fistula

Question 7

Describe peritoneal dialysis

Answer 7

Home based treatment
Daily + continuous
Less haemodynamic stress
Limited by access to peritoneum + ability to do technique

Question 8

What are 5 benefits of transplantation?

Answer 8

Better renal replacement
Improvement in metabolic disorders
Costs less in long-term
Prolonged survival
Improved QoL

Question 9

What are 4 risks/ disadvantages of transplantation?

Answer 9

Older + sicker patients not eligible
Immunosuppression (Increased infection + malignancy)
Not a cure (Surgical complications + frequent hospital visits)
Often worse off if/when transplant fails

Question 10

What conservative care non dialysis pathway may be taken in the elderly?

Answer 10

Active management of anaemia with ESA + IV iron
BP control: slow rate of decline + lower stroke risk
Optimise fluid balance: avoid over + under hydration
Symptom control, inc. pain
Joint management with palliative care team at end of life phase