Renal replacement therapy Flashcards Preview

Year 2 > Renal replacement therapy > Flashcards

Flashcards in Renal replacement therapy Deck (61):
1

Renal disease is associated with higher gastrointestinal risk. T/F

False - higher CVS risk

2

Describe the very basics of dialysis

Diffusion through a semi permeable membrane down a concentration gradient until equilibrium is reached

3

Dialysis allows the removal of four main toxins, name them

Potassium
Sodium
Urea
Creatinine

4

What is given to patients during dialysis? Why is this given?

Bicarbonate infusion
Patients become acidotic as hydrogen cannot be secreted into the urine

5

How fast does blood flow through a haemodialysis machine? How is this relevant?

300ml/min
You can't get this amount of blood through simple IV access

6

Which type of vascular access is needed in haemodialysis?

Arterovenous fistula
Tunneled venous catheter

7

How is hypoglycaemia avoided in haemodialysis?

Glucose is given to patients during dialysis

8

Describe the haemodialysis circuit

Water in -->
Reverse osmosis machine (purifies) -->
Dialysis through semi-permeable membrane -->
Waste removed and disposed

9

How is waste removed in haemodialysis?

Convection/filtration - movement of water across semipermeable membrane in response to a pressure gradient (negative pressure created by vacuum)

10

What is the GFR of patients on haemodialysis?

10-20 (i.e shitty)

11

What is the minimum time and frequency of haemodialysis?

3 times a week for four hours

12

Why are patients not given haemodialysis for longer?

Quality of life would be greatly reduced

13

What restrictions does haemodialysis put on patients?

1 litre fluid intake if anuric
Low salt diet (reduce thirst)
Low potassium diet
Low phosphate diet +/- phosphate binders with meals

14

Which foods are rich in potassium?

Banana's
Chocolate
Potatoes
Avocado

15

Which foods are high in salt?

Baked beans
Bread
Processed food

16

What type of patients suffer the most from dietary restrictions on haemodialysis?

Diabetics (super restricted diet)

17

Which foods are high in phosphate?

High protein foods (i.e meats)
Diet coke
Ready made meals

18

List some phosphate binders

Calcium
Aluminium
Magnesium
Lanthanum salts

19

Are AV fistulas likely to cause infection?

Nope

20

How long do AV fistulas take to mature?

6 weeks

21

At which sites can a tunnelled venous catheter be placed?

Jugular
Subclavian
Femoral

22

What is the major risk with tunnelled venous catheters?

Infection (usually staph. aureus)

23

Which types of infections tend to arise from tunnelled venous catheters?

Endocarditis
Discitis

24

How is tunnelled venous catheter infection treated?

Vancomycin
Removal of line +/- replacement

25

How are suspected tunnelled venous catheter infections treated?

Blood cultures
FBC
CRP
Exit site swab

26

How do patients with tunnelled venous catheter infections present?

Rigors with dialysis

27

What are the complications of haemodialysis?

Fluid overload
Blood leaks
Loss of vascular access
Hypokalaemia + cardiac arrest
Intradialyic hypotension

28

What should NOT be given to haemodialysis patients with fluid retention? What should be done?

Frusemide (cannot produce urine or pee) or any other diuretic

Dialysis

29

Blood leaks from haemodialysis can cause what?

Massive haemorrhage and death

30

How does intradialyic hypotension arise?

Too much fluid removed from intravascular space on dialysis (not continuously as in normal kidneys)

31

Explain the basics of peritoneal dialysis

Solute diffuses down a concentration gradient through the peritoneal membrane

32

How is water removed in peritoneal dialysis?

Osmosis occurs because of high glucose concentration in dialysis fluid

33

What type of access is used in peritoneal dialysis?

Tenckhoff catheter

34

Which type of dialysis is more efficient - haemo or peritoneal?

Haemodialysis

35

Which two types of peritoneal dialysis are available?

Continous (CAPD)
Automated (APD)

36

How frequent is CAPD?

4 bag exchanges per day

37

How long does a bag exchange on peritoneal dialysis take?

30 minutes

38

How frequent is APD?

1 bag of fluid stays in all day

39

How long does APD take?

9-10 hours overnight

40

Which type of dialysis can be taken on holiday?

Peritoneal dialysis

41

What are the main complications of peritoneal dialysis?

Infection
Membrane failure
Hernia

42

What types of infections occur in peritoneal dialysis?

Peritonitis
Exit site infection

43

How does infection occur in peritoneal dialysis? Which bugs are typical?

Contamination (staph, strep, diptheroids)
Gut bacteria translocation (e.coli, klebsiella)

44

How is infection treated with respect to peritoneal dialysis?

Intraperitoneal antibiotics (vancomycin & gentamicin)
+/- removal of catheter

45

How is PD infection cultured?

Peritoneal fluid used

46

When is PD catheter removed with respect to infection?

Staph aureus
Pseudomonas

47

How does membrane failure present? What must be done?

Fluid overload
Switch to haemodialysis

48

How do hernias occur with respect to PD dialysis? How are they treated?

Increased intra-abdominal pressure due to fluid
Repair + smaller fluid volumes

49

Is survival better on haemodialysis or peritoneal dialysis?

Not much difference - PD tends to be better for younger patients and haemo tends to be better for older patients

50

What metabolic complications can arise from end stage kidney disease?

Bone mineral metabolism abnormalities
Anaemia
Sodium & water retention
Accelerated CVS risk

51

How might bone mineral metabolism abnormalities present biochemically in chronic kidney disease?

Phosphate retained
Low 1,25 vitamin D
Hypocalaemia
Raised PTH

52

How might anaemia present biochemically in chronic kidney disease?

Erythropoetin deficiency
Iron deficiency

53

Which two parameters will be taken into consideration with regard to the decision to begin dialysis?

Symptoms
Blood results

54

What abnormalities of blood results would trigger the start of dialysis?

Resistant hyperkalaemia
GFR 45
Unresponsive acidosis

55

Which symptoms might trigger the start of dialysis?

Fatigue
Itch
Unresponsive fluid overload
Nausea
Vomiting
Loss of appetite

56

How is haemodialysis started?

Gradually build up (start at 2 hours then move on to 4)

57

What happens if you begin haemodialysis quickly?

Disequilibrium syndrome (cerebral oedema and seizures)

58

How is PD started?

Begin with small volumes then build up to 2/2.5 litres

59

Patients with short life expectancy +/- co-morbidities will still get dialysis. T/F

False - in most cases no (effect on QoL is too great)

60

When might withdrawal from dialysis be indicated?

Patient decision based on medical or social reasons

61

A young patient on dialysis will have the same life expectancy as an older patient. T/F

True - in most cases

Decks in Year 2 Class (72):