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PHM601 AKI/CKD > Dialysis > Flashcards

Dialysis Flashcards

1
Q

What is dialysis?

A

removal of waste products

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2
Q

By what mechanism does dialysis work?

A

Diffusion

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3
Q

What does “CKD5D” mean?

A

Someone whose GFR is <15 ml/min that is on dialysis

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4
Q

What does “CKD5ND” mean?

A

Someone whose GFR is <15 ml/min who is not on dialysis.

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5
Q

What is ESRD

A

End stage renal disease

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6
Q

Requirement for dialysis

A

ESRD w/ >3 months needed to sustain life.

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7
Q

Methods/Mechanisms of drug removal during dialysis

A

Diffusion
Convection - ultrafiltration

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8
Q

Dialysis Modalities/ Types of Dialysis

A

-Hemodialysis
-Peritoneal dialysis
-Continuous kidney replacement therapy (CKRT)

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9
Q

Direction of fresh dialysate

A

top - bottom

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10
Q

Direction of clean blood

A

bottom to top

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11
Q

Hemodialysis access points

A

Arteriovenous fistula
Arteriovenous graft
Central venous catheter

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12
Q

HD Access w/ highest risk of infection and thrombosis

A

Central venous catheter

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13
Q

HD Access w/ lowest risk of infection and thrombosis

A

Arteriovenous fistula

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14
Q

How long does arteriovenous fistula take to mature

A

3 months

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15
Q

Preferred HD Access

A

Arteriovenous fistula

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16
Q

Types of peritoneal dialysis

A

CAPD: continuous ambulatory peritoneal dialysis
APD: Automated peritoneal dialysis (nighttime)

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17
Q

Peritoneal Access

A

Catheter

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18
Q

What is Continuous kidney replacement therapy?

A

A “slow hemodialysis” for critically ill pts w/ unstable hemodynamics

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19
Q

CKRT Modalities

A
  • CVVH
  • CVVHD
  • CVVHDF
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20
Q

Which clearance mechanism is better for large solutes?

A

Convection

21
Q

Drug factors influencing dialysis drug removal

A
  • Molecular weight
  • Protein binding
  • Volume of distribution/Lipophilicity
22
Q

Patient factors influencing dialysis drug removal

A
  • Albumin
  • Fluid status
  • Blood pressure
23
Q

Drug removal is increased by

A

Small molecular weight
Low protein binding
Small Vd/lipophilicity
High flux hemodialysis
Semi-synthetic/synthetic dialysis membranes

24
Q

What to do prior hemodialysis? (Dosing)

A
  • Hold AntiHTN drugs
  • Therapeutic dose monitoring
25
Q

What to do during hemodialysis? (Dosing)

A

Give intra-dialytic meds:
- ESA’s
- Active Vitamin D

26
Q

What to do after hemodialysis? (Dosing)

A
  • Supplemental doses of drugs removed
  • Administer meds significantly removed eg ABx
27
Q

What drugs need a supplemental dosing

A

Drugs removed >30 - 40%

28
Q

How much supplemental dose needed? (Equation)

A

Normal dose x fraction removed by HD

29
Q

CrCl IN CKRT

A

Assume 20 - 25 ml/min
**difficult to predict drug removal
**use drug literature

30
Q

Complications of drug dosing

A

Hypotension
Cramping
Fatigue
Infection***
Thrombosis
Bleeding

***#2 cause of mortality in HD

31
Q

Causes of hypotension w/ Hemodialysis

A
  • Hypovolemia
  • excessive fluid removal
  • antiHTN admin prior to HD
  • autonomic dysfunction
32
Q

How to prevent hypotension w/ HD

A
  • Select the appropriate dry weight
  • Hold the antiHTN meds
33
Q

How to manage hypotension w/ HD

A
  • Small fluid bolus 100 - 250 ml 0.9% NaCl
  • Decrease fluid removal (ultrafiltration)
  • Midodrine
34
Q

Midodrine MOA

A

alpha 1 agonist pro drug for peripheral vasoconstriction

35
Q

Midodrine dosing

A

2.5 - 10 mg PO 30 mins before HD

36
Q

Midodrine Adverse Effects

A

bradycardia, hypertension (???), peripheral ischemia, urinary retention

37
Q

Midodrine DDIs

A
  • MAOi’s
  • sympathetic activating drugs
38
Q

Causes of cramping w/ Hemodialysis

A
  • hypovolemia
  • decreased muscle perfusion
39
Q

How to prevent cramping w/ Hemodialysis

A

Selection of appropriate dry weight

40
Q

How to manage cramping w/ Hemodialysis

A
  • small fluid bolus 0.9% NaCl
  • decrease fluid removal
  • Vitamin E 400 IU PO QHS

***NEVER GIVE QUININE (FDA WARNING)

41
Q

Site of infection in Hemodialysis

A

Bloodstream leading to pneumonia

42
Q

2 leading cause of death in Hemodialysis?

A

Infection

43
Q

How to treat MRSA?

A

Vancomycin

44
Q

What type of ABx to use in dialysis infections?

A

Broad spectrum gram +ve or -ve ABx’s

45
Q

Causes of Thrombosis w/ Hemodialyis

A

Virchow’s Triad
- use of ESA’S

46
Q

How to prevent thrombosis w/ Hemdialysis

A

Heparin w/ dialysis

***Risk of HIT

47
Q

How to manage thrombosis w/ Hemodialysis

A

Alteplase (Cathflo) 2mg/2ml for 30 -120 mins

48
Q

Complications of Peritoneal Dialysis

A
  • Peritonitis
  • Fluid Overload
  • Hyperglycemia
49
Q

Vancomycin in ESRD

A

PHM601 AKI/CKD (5 decks)

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