Dialysis Flashcards Preview

Nephro > Dialysis > Flashcards

Flashcards in Dialysis Deck (20):
1

Name the 6 functions of the kidney.

Metabolic waste excretion
Endocrine functions
Drug metabolism/excretion
Control of solutes and fluid status
Blood pressure control
Acid/base balance

2

What is the aim of dialysis therapy?

Homeostasis
- removal of nitrogenous waste product
- maintenance of normal electrolytes
- maintenance of normal extracellular volume
- correction of metabolic acidosis

3

What are the absolute indications for renal replacement therapy?

Hyperkalaemia
Fluid overload
Uraemia
Acidosis

4

What are the chronic symptoms of uraemic syndrome?

Anorexia
Metallic taste
Weight loss
Restless leg
Itch
Vomiting

5

What eGFR indicates someone should start renal replacement therapy?

No absolute rule
- generally between 5-10ml/min/1.73m2
- assessed on the basis of the individual

6

What are the renal replacement therapy options?

Transplant
- living or dead
Dialysis
- haemodialysis
- peritoneal dialysis
- CVVH
Conservative care

7

What is the aim of haemodialysis?

Removal of solutes via diffusion - e.g. potassium and urea
Removal of fluid via convection (osmotic pressureal

8

Describe how solutes are removed from the blood.

Patient's blood is passed down a tube with a semipermeable membrane separating it form the dialysate (which is moving in the opposite direction)
The blood is passed down a concentration gradient, allowing the solutes to continuously pass into the dialysate, even as the blood solute concentration falls

9

Describe how blood volume is reduced in dialysis.

Patient's blood is passed down a tube with a semipermeable membrane separating it form the dialysate (which is moving in the opposite direction)
The blood is passed down a pressure gradient, which forces the excess water out of the blood and into the dialysate

10

What are the practicalities of haemodialysis?

Hospital or home based - hospital more common
Standard - 4 hours, three times a week
Multiple other options (mainly home based)
- 6 hours, 3 times a week
- short daily dialysis
- daily overnight
Home based treatments are more flexible and empowering, but they need carers, space and capital investment

11

How is blood accessed from the body for haemodialysis?

Ateriovenous fistula
- radiocephalic
- brachiocephalic
Tunneled line

12

Name some complications of haemodialysis.

Hypotension
Dialysis disequilibrium
Cramps
Fatigue
Hypokalaemia
Air emoblism
Blood loss
Access problems

13

What are the principle of peritoneal dialysis?

Peritoneal cavity filled with dialysate
Peritoneal membrane used as a semi-permeable membrane
- diffusion
- glucose used as an osmotic agent for osmosis

14

What are the practicalities of peritoneal dialysis?

Home based therapy
Better with some residual renal function
Different glucose concentrations of dialysate to provide more or less ultrafiltration
Dialysate contains other electrolytes like in haemodialysis
Gradual treatment (not for AKI)
Simple procedure
Maintains independence

15

What are the two types of peritoneal dialysis?

CAPD (continous ambulatory peritoneal dialysis)
- manual exchange performed by the patient
APD (automated peritoneal dialysis)
- machine performs the exchages whilst the patient is asleep more common)

16

What are the complications of peritoneal dialysis?

Infection - peritonitis
Glucose load - development of diabetes
Mechanical - hernia, diaphragmatic leak, dislodged catheter
Peritoneal membrane failure
Encapsulating peritoneal scerosis

17

In what patients is peritoneal dialysis not suitable?

Fat people
Intra-abdominal adhesions
Frail
Home not suitable

18

Who is conservative care used for in and why?

Frail and elderly population
- survival better if they are put on RRT, but the quality of life wont be
Symptom based management

19

Why choosing which RRT to use, what must be taken into consideration?

Lifestyle
Frailty
Vascular access
Time - travel to and from the hospital
Carer
Physical
- concurrent medical problems
- severe dementia
- severe psychiatric disease

20

What problems are not helped by dialysis?

Anaemia - need EPO and iron
Renal bone disease - need phosphate binders and vitamin D
Neuropathy
Endocrine disturbances
Not as good as transplant (only 10ml/min eGFR)