Hemodialysis Flashcards
What are indications for RRT if someone has a AKI?
A: Acid-base abnormality
E: electrolyte imbalances
I: intoxications
O: fluid overload
U: uremia, increased BUN
When do we start planning for RRT in patients with CKD?
- stage 4
- GFR <30
- graft preparation/ education
What are the primary indicators for beginning RRT?
- serositis
- acid/base abnormalities
- puritus
- inability to control volume status/BP
- Deterioration of nutritional status/ anorexia
- N/V
- declining serum albumin
- cognitive impairment
- GFR<15
What are the 3 options for RRT?
- HD
- peritoneal dialysis
- kidney transplant
How long does it take for an AV fistula to mature before using for HD?
1-2 months
How long does it take for an AV graft to mature before using for HD?
2-3 week
What is the least desirable HD access?
Venous HD Catheter
What method of dialysis removes fluid and wastes in a slow manner that is less likely to cause hypotension?
Continuous Renal Replacement Therapy (CRRT)
What are complications with peritoneal dialysis (at home)?
- exacerbation of DM
- chemical peritonitis
- malnutrition
- hernias
- Hemorrhoids
- back pain
What are reliable references for drug dosing in renal impairment?
- Drug Prescribing in renal failure ( green book)
- Goodman and Gilman’s
- American Hospital Formulary Service Drug Information
Which drugs are dosed according to CrCl using actual body weight?
- Dabigatran
- Dofetilide
- Edoxaban
- Pemetrexed
- Xarelto
- Betrixaban
What drugs are dosed according to GFR using MDRD?
- Glipizide
- Glimepiride
- Metformin
- Alogliptin
- Saxagliptin
- Sitagliptin
- SGLT2i
What factors lead to drugs more likely being removed during dialysis?
- smaller molecules
- large Vd
- higher blood flow rate
What factors lead to drugs being less likely being removed during dialysis?
highly protein-bound drugs
What principle of dialysis utilizes positive pressure on the blood side of the semi permeable membrane and negative pressures on the dialysate (filtrate side of the membrane to force water out of the patient during dialysis treatment?
ultrafiltration
