Renal replacement therapy

Question 1

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

Answer 1

False - higher CVS risk

Question 2

Describe the very basics of dialysis

Answer 2

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

Question 3

Dialysis allows the removal of four main toxins, name them

Answer 3

Potassium
Sodium
Urea
Creatinine

Question 4

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

Answer 4

Bicarbonate infusion

Patients become acidotic as hydrogen cannot be secreted into the urine

Question 5

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

Answer 5

300ml/min

You can’t get this amount of blood through simple IV access

Question 6

Which type of vascular access is needed in haemodialysis?

Answer 6

Arterovenous fistula

Tunneled venous catheter

Question 7

How is hypoglycaemia avoided in haemodialysis?

Answer 7

Glucose is given to patients during dialysis

Question 8

Describe the haemodialysis circuit

Answer 8

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

Question 9

How is waste removed in haemodialysis?

Answer 9

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

Question 10

What is the GFR of patients on haemodialysis?

Answer 10

10-20 (i.e shitty)

Question 11

What is the minimum time and frequency of haemodialysis?

Answer 11

3 times a week for four hours

Question 12

Why are patients not given haemodialysis for longer?

Answer 12

Quality of life would be greatly reduced

Question 13

What restrictions does haemodialysis put on patients?

Answer 13

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

Question 14

Which foods are rich in potassium?

Answer 14

Banana’s
Chocolate
Potatoes
Avocado

Question 15

Which foods are high in salt?

Answer 15

Baked beans
Bread
Processed food

Question 16

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

Answer 16

Diabetics (super restricted diet)

Question 17

Which foods are high in phosphate?

Answer 17

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

Question 18

List some phosphate binders

Answer 18

Calcium
Aluminium
Magnesium
Lanthanum salts

Question 19

Are AV fistulas likely to cause infection?

Answer 19

Nope

Question 20

How long do AV fistulas take to mature?

Answer 20

6 weeks

Question 21

At which sites can a tunnelled venous catheter be placed?

Answer 21

Jugular
Subclavian
Femoral

Question 22

What is the major risk with tunnelled venous catheters?

Answer 22

Infection (usually staph. aureus)

Question 23

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

Answer 23

Endocarditis

Discitis

Question 24

How is tunnelled venous catheter infection treated?

Answer 24

Vancomycin

Removal of line +/- replacement

Question 25

How are suspected tunnelled venous catheter infections treated?

Answer 25

Blood cultures FBC CRP Exit site swab

Question 26

How do patients with tunnelled venous catheter infections present?

Answer 26

Rigors with dialysis

Question 27

What are the complications of haemodialysis?

Answer 27

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

Question 28

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

Answer 28

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

Question 29

Blood leaks from haemodialysis can cause what?

Answer 29

Massive haemorrhage and death

Question 30

How does intradialyic hypotension arise?

Answer 30

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

Question 31

Explain the basics of peritoneal dialysis

Answer 31

Solute diffuses down a concentration gradient through the peritoneal membrane

Question 32

How is water removed in peritoneal dialysis?

Answer 32

Osmosis occurs because of high glucose concentration in dialysis fluid

Question 33

What type of access is used in peritoneal dialysis?

Answer 33

Tenckhoff catheter

Question 34

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

Answer 34

Haemodialysis

Question 35

Which two types of peritoneal dialysis are available?

Answer 35

Continous (CAPD) | Automated (APD)

Question 36

How frequent is CAPD?

Answer 36

4 bag exchanges per day

Question 37

How long does a bag exchange on peritoneal dialysis take?

Answer 37

30 minutes

Question 38

How frequent is APD?

Answer 38

1 bag of fluid stays in all day

Question 39

How long does APD take?

Answer 39

9-10 hours overnight

Question 40

Which type of dialysis can be taken on holiday?

Answer 40

Peritoneal dialysis

Question 41

What are the main complications of peritoneal dialysis?

Answer 41

Infection Membrane failure Hernia

Question 42

What types of infections occur in peritoneal dialysis?

Answer 42

Peritonitis | Exit site infection

Question 43

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

Answer 43

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

Question 44

How is infection treated with respect to peritoneal dialysis?

Answer 44

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

Question 45

How is PD infection cultured?

Answer 45

Peritoneal fluid used

Question 46

When is PD catheter removed with respect to infection?

Answer 46

Staph aureus | Pseudomonas

Question 47

How does membrane failure present? What must be done?

Answer 47

Fluid overload | Switch to haemodialysis

Question 48

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

Answer 48

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

Question 49

Is survival better on haemodialysis or peritoneal dialysis?

Answer 49

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

Question 50

What metabolic complications can arise from end stage kidney disease?

Answer 50

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

Question 51

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

Answer 51

Phosphate retained Low 1,25 vitamin D Hypocalaemia Raised PTH

Question 52

How might anaemia present biochemically in chronic kidney disease?

Answer 52

Erythropoetin deficiency | Iron deficiency

Question 53

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

Answer 53

Symptoms | Blood results

Question 54

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

Answer 54

Resistant hyperkalaemia GFR 45 Unresponsive acidosis

Question 55

Which symptoms might trigger the start of dialysis?

Answer 55

``` Fatigue Itch Unresponsive fluid overload Nausea Vomiting Loss of appetite ```

Question 56

How is haemodialysis started?

Answer 56

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

Question 57

What happens if you begin haemodialysis quickly?

Answer 57

Disequilibrium syndrome (cerebral oedema and seizures)

Question 58

How is PD started?

Answer 58

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

Question 59

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

Answer 59

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

Question 60

When might withdrawal from dialysis be indicated?

Answer 60

Patient decision based on medical or social reasons

Question 61

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

Answer 61

True - in most cases