Chronic Dialysis

Question 1

Purpose of dialysis

Answer 1

remove toxins normally cleared by kidney and maintain euvolemia in patient

Question 2

2 types of dialysis

Answer 2

hemodialysis = dialysis unit/home

peritoneal dialysis = home

Question 3

Indications for starting dialysis

Answer 3

1) severe hyperkalemia
2) severe volume overload
3) uremic pericarditis

Question 4

less severe symptoms = mild cognitive changes assoc with uremia would warrant dialysis if

Answer 4

patient has appropriate dialysis access (AV fistula or PD catheter)

Question 5

if life threatening symptoms, dialysis must be weighed against

Answer 5

risk of catheter infection

Question 6

is there a specific GFR for dialysis initiation

Answer 6

no specific GFR

no diff between early vs late start dialysis

Question 7

forms of hemodialysis

Answer 7

hospital or dialysis center = 3x/week 3-4 hrs ea

home = 5-6x/week or nocturnal

Question 8

Circuit of hemodialysis

Answer 8

1) blood removed by needle/catheter
2) enters tube with semi-permeable membrane

3) dialysate –> solutes move into dialysate (low concentration)
fluid removed by applying positive pressure to blood

4) blood returned

Question 9

AVF
pros
cons

Answer 9

pros =
lowest infection rate
used longer than other types

cons =
take time to mature

Question 10

AVG
pros
cons

Answer 10

pros =
synthetic grafts
used more quickly
higher primary success rate

cons =
fail quicker due to neointimal hyperplasia
higher infection risk

Question 11

dual lumen catheter
pros
cons

Answer 11

pros
used immediately

cons
higher infection rate

Question 12

where to place accesses?

Answer 12

NON DOMINANT ARM

IN STAGE 4

Question 13

pros cons hemodialysis

Answer 13

pros = rapid removal of small MW solutes urea
precise control of ultrafiltration

Cons
fluid removal no physiologic
so must remove large volumes of fluid

not effective to remove large MW solutes/protein bound

Question 14

complications of hemodialysis

Answer 14

1) infectious complications (gram positive = staph aureus and coag negative staph
2) hypotension, angina, or MI
3) disequlibrium syndrome

Question 15

peritoneal dialysis mechanism

Answer 15

1) catheter into peritoneum
2) dialysate with high dextrose and high oncotic pressure into peritoneum
3) fluid and solute from blood to peritoneal cavity

Question 16

2 types of peritoneal dialysis

Answer 16

1) CAPD = manual

2) CCPD = instills and drains throughout night auto

Question 17

pros of PD

Answer 17

1) easier daily life
2) gradual and continuous removal of fluid
3) no vascular access needed

Question 18

cons of PD

Answer 18

1) hernias due to incr intra-abd pressure
2) difficult in big patients
3) not assoc with blood stream but can have infectious peritonitis
4) if fungi, requires catheter removal
5) kinking or malposition