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Flashcards in Dialysis Deck (18):
1

What are the functions of the kidneys?

Excretion of nitrogenous waste products

Maintenance of acid and electrolyte balance

Control of blood pressure

Activation of vitamin D

Production of erythropoietin

Drug metabolism and disposal

2

What is end stage renal disease?

Irreversible damage to a person's kidneys so severely affecting their ability to remove or adjust blood wastes that, to maintain, life, he or she must have either dialysis, or a kidney transplant

3

What are the clinical features of advanced chronic renal failure (CRF)?

Until the GFR decrlined to 30ml/min the patient may be asymptomatic

The syndrome of advanced CRF is called uraemia

Uraemic symptoms can involve almost every organ system but the earliest and cardinal symptom is malaise and fatigue

4

What are some of the signs and symptoms or Uraemia?

Progressive weakness and easy fatigue,

Loss of appetite due to nausea and vomiting,

Muscle atrophy,

Tremors,

Abnormal mental function,

Frequent shallow respiration and metabolic acidosis.

5

What are the types of renal replacement therapy?

Haemodialysis

Peritoneal dialysis

Renal transplant

6

What are the types of peritoneal dialysis?

Continuous ambulatory peritoneal dialysis (CAPD)

Intermittent peritoneal dialysis (IPD)

7

What is dialysis?

Process whereby the solute composition of a solution, A, is altered by exposing solution A to a second solution, B, through a semipermeable membrane

8

What are the 2 basic principles of dialysis?

Diffusion
-Solutes filtered out

Ultrafiltration
-Fluids will follow solutes

9

What are the pre-requisites for dialysis?

Semipermeable membrane (artificial kidney in haemodialysis or peritoneal membrane)

Adequate blood exposure to the membrane (extracorporeal blood in haemodialysis, mesenteric circulation in PD)

Anticoagulation in haemodialysis

Dialysis access (vascular in haemodialysis, peritoneal in PD)

10

Give some examples of what is contained in the Dialysate

Freely permeable:
-Na+
-K+
-Ca2+
-HCO3-

Moves into dialysate from blood:
-Creatinine
-Urea

11

What are the indications for commencing dialysis in ESRD?

Advanced uraemia, usually GFR 10ml/min

Severe acidosis (bicarbonate 6mmol/l)

Fluid and salt retention not controlled with diuretics

Nephrologist's clinical judgment is important

12

What should the dietary intake be for a dialysis patient?

Protein = 1.2-1.4 g/kg/24hrs

Calories 35-40 kcal/kg/24hrs

Vitamins: supplement water soluble vits

Restriction of dietary intake of potassium and salt

Restriction of dietary phosphate and use of phosphate binders

13

What is the fluid balance in haemodialysis?

Usually restricted to 500-800 ml/24hrs intake allowed = urine output + insensible loss

14

What is the fluid balance in peritoneal dialysis?

Usually more liberal intake than haemodialysis as continuous untrafiltration is often achieved

15

What drugs area dialysis patients usually prescribed?

Erythropoietin stimulating agent

One alpha vit-D or calcitriol

Phosphate binders with meals

Iron supplements

Water soluble vitamins

?antihypertensives

?lipid lowering drugs

16

What are the complications of haemogialysis?

Clotting of vascular access

Hypotension and cramps

Cardiovascular problems

Heparin related problems

Allergic reactions to dialysers and tubing

Catastrophic dialysis accidents (rare)

17

What are the complications of peritoneal dialysis?

Peritonitis

Exit site infection

Tunnel infection

Ultrafiltration problems

Abdominal wall herniae

18

What factors determine choice of dialysis modality (haemodialysis or peritoneal)?

Patient related

Cost

Remuneration

Perceptions of effectiveness

Patient choice