dialysis Flashcards
what are the options for someone with CKD stage 5?
offer education to patients with all options
-conservative management (manage symptoms and let renal failure get worse until death)
- peritoneal dialysis
-haemodialysis
preemptive kidney transplant
What are the implications for starting renal replacement therapy ?
- eGFR 5-7
- body cannot excrete fluids causing an uncontrollable fluid overload
- biochemical measures e.g. hyperkalemia or acidosis
what is intermittent haemodilaysis?
its the transfer of uraemia solutes from the blood by diffusion across a semipermeable artificial membrane
can be done at home or hospital and need 2 session a week for 4 hours
why does an anticoagulant also need to be administered when a patient is having intermittent haemodialysis?
the machine can get bunged up due to blood clots so also administer anticoagulant and a bicarbonate.
what is peritoneal dialysis?
uses body own peritoneal cavity for dialysis so uses the body own peritoneum as a membrane
how does peritoneal dialysis work?
insert a tube into a cavity fill it with a fluid leave it for 30 mins and take it out.
can be done at home
do it continuously 3-4 times a day
how is a peritoneal tube inserted?
its a tenckofzf catheter which is inserted in a minor operation , biggest risk is infection do the catheter must be clean
what are some of the challenges of dialysis?
- Fluid restriction (500-1500ml)
- restrict all salt and K+ intake
- need to take phosphate binders to reduce GI absorption of phosphate
- Travel is hard as they must be close to a dialysis centre
- continued symptoms between dialysis waste build up
- infections
counselling points to stay well on dialysis?
- patients tend to have lower immune systems so stay up to date with vaccines
- regular screening of MRSA
- Reduce cardiovascular risk
- follow dietary advice
- blood pressure control
how is absorption affected by dialysis ?
- phosphate binders Amy affect the absorption of other drugs
- PPIs may be needed as the uraemia makes the environment acidic
- Oedemas gut which may affect the pharmacology of some drugs to not work
how are drugs withe a small volume of distribution affected by dialysis ?
dugs with a small volume of distribution are removed by the dialysis more easily as more drug is available
how is distribution affected by dialysis ?
dependant on the volume of distribution of the drug
how are drugs withe a large volume of distribution affected by dialysis ?
the drug is more in the tissues so small amounts are available to remove by dialysis
how does dialysis affect protein bound drugs ?
It should not as dialysis or normal functioning kidneys should not be removed from the blood
how does dialysis affect metabolism?
The kidneys are responsible for the bitransformation so reduction and hydrolysis is slowed
