Renal Replacement Therapy Flashcards
(25 cards)
What is dialysis?
A method of performing filtration artificially
When is dialysis used?
In end stage renal failure, or with complications of renal failure
What does dialysis involve?
Removing excess fluid, solutes and waste products
What mnemonic is used for the indications of acute dialysis?
AEIOU
Acidosis (not responding to Tx)
Electrolyte disturbance (severe hyperkal)
Intoxication (OD on medication)
Oedema (unresponsive pulmonary oed.)
Uraemia symptoms (seizures, reduced consciousness)
What are the indications for long term dialysis?
- CKD G5
- any of the AEIOU indications continuing log term
What dialysis options are there?
- Continuous ambulatory peritoneal dialysis
- Automated peritoneal dialysis
- Haemodialysis
Summarise peritoneal dialysis.
- Peritoneal membrane acts as a filtration membrane
- Dialysis solution containing dextrose is added to the peritoneal cavity
- Waste products leave the blood and enter the fluid by ultrafiltration
- The dialysis solution is then drained
What catheter is used in peritoneal dialysis?
Tenckhoff catheter
How does continuous ambulatory peritoneal dialysis work?
2L of dialysis fluid is put into the cavity, and is changed four times a day, it is never simply removed
How does automated peritoneal dialysis work?
- Occurs overnight
- A machine continuously replaces the fluid over 8-10 hours
What are the complications of peritoneal dialysis?
- bacterial peritonitis (common and serious)
- peritoneal sclerosis (thick/scarred peritoneal membrane)
- ultrafiltration failure (dextrose absorbed, reducing the filtration gradient)
- weight gain (absorb the carbs in the solution)
- psychosocial effects
Summarise haemodialysis.
- Blood filtered by machine
- 4 hours a day, 3 days a week
- uses a tunnelled, cuffed catheter or an AV fistula
Where is the tunnelled cuffed catheter in haemodialysis?
- Subclavian or jugular vein
- Tip sits in either SVC or RA of the heart
What are the complications of the cuffed catheter?
- Blood clot in the catheter
- Infection
Where might an AV fistula be placed?
- Radio-cephalic
- Brachio-cephalic
How do you examine an AV fistula?
- Skin integrity
- Aneurysms
- Palpable thrills
- Machinery murmur
What are the complications of an AV fistula?
- Aneurysm or stenosis
- Infection
- Thrombosis
- STEAL Syndrome
- High output heart failure
What is STEAL syndrome?
- Inadequate blood flow to the limb distal to an AV fistula
- Blood flows from arterial system to venous system, proximal to the affected part of the limb
- Ischaemia
What is high output heart failure?
- Blood flows rapidly from arterial to venous system through the AV
- This means rapid blood return to the heart
- Increased preload
- Myocardial hypertrophy and HF
How many years does transplant add compared to dialysis?
10 more years to longevity
How are kidney donors matched?
Human leukocyte antigen (HLA) type A, B and C on chromosome 6
Where is a kidney put in, and what scar does it leave?
- Anterior abdomen, iliac fossa
- Connected to external iliac vessels (A+V)
- Kidney anastamosed directly to bladder
- Leaves a ‘hockey stick scar’
What is a Pt given post transplant?
Lifelong immunosuppression:
- Tacrolimus
- Mycophenolate
- Prednisolone (ALL THREE)
What are the complications of transplant rejection?
- Rejection leading to damage and failure of function
- Electrolyte imbalances
