Part 1 Dialysis

Question 1

Define hemodialysis

Answer 1

Perfusion of blood and a physiologic solution on opposite side of semi-permeable membrane
Blood removed from body

Question 2

Define peritoneal dialysis

Answer 2

Peritoneal membrane serves as the semipermeable membrane

Question 3

HD Dialysis access created:

Answer 3

GFR less than 25
SCr great than 4
1 year prior to anticipated need for dialysis

Question 4

The need for dialysis is recommended if

Answer 4

GFR or CrCl less than 15

Question 5

***Acute indications for dialysis

Answer 5

Acidosis
Electrolytes (hyperK)
Intoxication (drug over dose
Fluid overload
Uremia

Question 6

***Chronic indications for dialysis

Answer 6

Signs of kidney failure (acid base, electrolyte imbalance, pruritus)
Inability to control volume status or BP
Deterioration in nutritional status
Cognitive impairment

Question 7

Conventional or standard dialyzers

Answer 7

Small pores limit clearance to small molecules (urea or creatinine)
Low blood flow rate

Question 8

High efficiency dialyzers

Answer 8

Large surface area (increased capacity to remove water, urea, small molecules)
High blood flow rate

Question 9

High flux dialyzers

Answer 9

Large pores increase removal of high molecular-weight substances
High blood flow rate

Question 10

Dialysate solution

Answer 10

Composed of purified water, glucose, sodium, K, Ca

Question 11

Dialysis solution bases

Answer 11

Base is added to dialysate to neutralize acids

Acetate –> bicarbonate in liver (bicarb is more expensive)

Question 12

Bicarbonate is

Answer 12

drug of choice in liver impairment and sever acidosis

Question 13

Vascular access is:

Answer 13

major challenge for success and long-term feasibility of HD

Question 14

Types of access

Answer 14

AV fistula
AV synthetic graft
Venous catheter

Question 15

Advantages of AV fistula

Answer 15

Longest survival
Lowest complication rate
Increases survival and decreased hospitalization rate

Question 16

Disadvantages of AV fistula

Answer 16

Take 1-2 months to mature

Difficult to create in elderly or PVD pts

Question 17

Advantages of AV synthetic graft

Answer 17

Easily implanted

Longer survival than others

Question 18

Disadvantages of AV synthetic graft

Answer 18

Short survival than fistula
Higher rate of complications
2-3 wks to endothelialize prior to use

Question 19

Advantages of venous catheters

Answer 19

Immediate use
Easy to place and remove
(femoral, subclavian or internal jugular vein)

Question 20

Disadvantages of venous catheters

Answer 20

Short survival
High risk of infection
May not provide adequate blood flow

Question 21

Urea reduction ratio (URR)

Answer 21

Percentage of blood being cleared of urea
100X(predialysis BUN - postdialysis BUN)/predialysis BUN
>60% is adequate

Question 22

Intermittent HD

Answer 22

3 sessions/wk
3-5 hrs/session
Sustained Low-Efficiency Dialysis (SLED)
PRN basis***

Question 23

Continuous HD

Answer 23

Based on access

Question 24

Advantages of HD over PD

Answer 24

Intermittent treatment
Effectiveness more easily measured
Low technique failure rate
Closer monitoring of pt

Question 25

Disadvantages of HD

Answer 25

Loss of independence Long adjustment time Risk with vascular access More rapid decline in renal function

Question 26

PD Principles

Answer 26

Blood filled compartment: Blood vessels that supply and drain abdominal viscera, musculature and mesentery Dialysate filled compartment: peritoneal cavity Semipermeable membrane: peritoneal membrane

Question 27

PD Effiacy is not as easily manipulated bc

Answer 27

Distance between compartments Cannot regulate blood flow No countercurrent flow Cannot change permeability

Question 28

Continuous Ambulatory Peritoneal Dialysis (CAPD)

Answer 28

Manual exchange every 4-8 hrs during the day Requires about 20 minutes per exchange No machine

Question 29

CAPD Advantages and disadvantages

Answer 29

A: independence D: infection risk

Question 30

Automated peritoneal dialysis (APD)

Answer 30

Automatic cycler performs exchanges at night

Question 31

APD Advantages and disadvantages

Answer 31

A: fever exchanges, sterility, convenience D: machine in bedroom

Question 32

Continuous cycling peritoneal dialysis (CCPD)

Answer 32

APD with "wet" day | Multiple exchanges at night with a long daytime dwell

Question 33

Tidal peritoneal dialysis

Answer 33

Initial partial fill, then drain, then replacement | Creates tidal flow

Question 34

Nightly intermittent peritoneal dialysis

Answer 34

APD with "dry" day | Multiple exchanges at night without a daytime dwell

Question 35

Intermittent Peritoneal DIalysis

Answer 35

Reserved for acute pts | Operater can change concentration, volume, time

Question 36

Disadvantages of Intermittent Peritoneal DIalysis

Answer 36

High cost and risk of infection

Question 37

Advantages of PD over HD

Answer 37

Continuous removal of solutes Improved clearance of larger solutes Better preservation of renal function Increased independence

Question 38

Disadvantages of PD

Answer 38

``` Predisposition to malnutrition Excessive glucose load Continued aseptic technique Time consuming exchanges Injury prone peritoneum Peritonitis ```