Haemodialysis

Question 1

Haemodialysis

Answer 1

Higher rate of decline in RRF in new HD patients compared to PD patients- urine output may decline rapidly in first 3-12/12
Potassium and phosphate levels may increase- review fluid restriction

Target is five hours on dialysis

Question 2

URR

Answer 2

Urea reduction ration- reduction in urea as a result of dialysis

One measure of how effectively a dialysis treatment removed waste products from the body
Commonly expressed as a percentage

Question 3

Kt/V

Answer 3

Another way of measuring dialysis adequacy
K- dialysed clearance, rate at which blood passes through the dialysed, expressed in ml/ min
T+- time
KT - clearance multipled by time, representing the volume of fluid completely cleared of urea during a single treatment
V- volume of water a patients body contains

Question 4

Kt/V compared with URR

Answer 4

Kt/V mathematically relayed to the URR
Kt/V also takes into account urea generated by the body during dialysis and extra urea removed during dialysis along with excess fluid
The Kt/V is more accurate than the URR in measuring how much urea is removed during dialysis (primarily because the Kt/V also considers the amount of urea removed with excess fluid)

Question 5

Recirculating problems

Answer 5

Haemodialysis access recirculating is an important cause of inadequate dialysis delivery to individual patients
The re- entry of dialysed blood into the extracorporeal circuit reduced solute concentration gradients across the dialysis membrane by mixing already dialysed blood with undialysed blood
Such mixing reduces the efficiency of dialysis
Interdialystic weight gain associated with fluid retention and CV mortality- should aim to maintain 2kg interdialtic weight gain

Question 6

Renal diet considerations

Answer 6

Physical assessment- SGA validated, assess muscle wastage and signs of oedema
Energy- PD/HDX - increase requirements, aim for >50% HBV sources, prevent malnutrition and disease progression. Need to take phosphate binders correctly (phosphate in protein foods)
Fluid- increased Na and fluid - increased interdialytic weight gains and HT
Sodium- advice should be individualised, reduce as RRF declines
Potassium- monitor intake, affected by constipation and acidosis
Phosphate - 10-12mg/ g of protein. Hidden sources- phosphate additives, binder type and timing
Micronutrients- losses, altered biochemical, inadequate intake