RRT

Question 1

what eGFR to start predialysis counselling

Answer 1

30

Question 2

what eGFR to consider transplant

Answer 2

<=15

Question 3

types of transplant donor

Answer 3

living or deceased

Question 4

CIs to transplant (4)

Answer 4

high BMI
heart problems
warfarin/DOACs
cancer
poor compliance with appointments/meds

Question 5

what risk important risk is there after transplant and why?

Answer 5

MALIGNANT MELANOMA due to immunosuppressants. must wear sunscrean (prescribed) and cover in the sun
(can also get other Ca bc of immunosuppressants)

Question 6

what scan is needed before going on transplant list

Answer 6

myocardial perfusion scan (myoview) - identifies areas of myocardium where ischaemia is inducible under stress

Question 7

average lif expectancy after starting dialysis

Answer 7

4 yr

Question 8

how much fluid goes into peritoneal cavity in peritoneal dialysis

Answer 8

2-2.5 L (fluid is prescribed)

Question 9

how many times a day do pts need to dialyse in PD

Answer 9

3-4, each 30 mins. can also use automatic machine that does it at night

Question 10

other things to know about PD

Answer 10

a home, tube always in situ, machine is portable

Question 11

risk in PD

Answer 11

PERITONITIS!!!

must have v clean room for it, great handwashing. if tube touches bed with cap off need to have IV abx

Question 12

CIs PD

Answer 12

weight
previous abdo surgery
stomas
ostomies
social - unclean house

Question 13

symptoms which mean dialysis should be considered

Answer 13

fluid overload incl SOB sx
vomiting
itching
fatigue
ALL OF THESE ARE V COMMON Sx - remember them!!

Question 14

electrolyte imbalances which mean pt may need to start on dialysis

Answer 14

urea
ca
k

Question 15

dietary restrictions in both types of dialysis

Answer 15

PD - fewer restrictions and can pee so can drink more fluid (benefit to many pts)
HD - 1L fluid, watch K, phosphate (and salt!)

Question 16

average wait for transplant

Answer 16

3.5 yr

Question 17

how long between making fistula and using it

Answer 17

1 year

Question 18

how long for haemo

Answer 18

3.5 hr 3 times a week

Question 19

what line is an alternative to a fistula

Answer 19

tunnel line (not as god bc infection risk). uideally they are temporary

Question 20

which dialysis slows down kidney decline

Answer 20

pd

Question 21

do pts pass urine in dialysis

Answer 21

PD - yes, HD, no

Question 22

sx after dialysis

Answer 22

cramps, BP drops, hungry, sweaty, fatigue, dizzy, headache, fluid overload, tremor, confused

Question 23

what can HD cause

Answer 23

heart failure?

Question 24

if don’t want transplant or dialysis

Answer 24

conservative care (resond to sx tha concern pt)
there is actually no evidence that >74 yo are better to have idlaysis than conservative care

Question 25

food with K in

Answer 25

``` rhubarb banana tomatoes (including tinned!!! no curry or spag bowl!!) mushrooms jacket potatoes beer ```

Question 26

food with phoshate in

Answer 26

dairy eggs shellfish

Question 27

what does dialysis remove

Answer 27

``` fluid ca urea k cr phosphate ```

Question 28

why must phosphate be managed

Answer 28

low -> bone problems, high -> cardiac problems. if kidney failure, phosphate is not excreted -? HYPERphosphataemia

Question 29

how to manage hyperphosphataemia

Answer 29

dialysis phosphate binders diet

Question 30

nb phos and ca don't cause acute problems

Answer 30

just chronic ones

Question 31

what does peritoneal fluid contain

Answer 31

dextrose electrolytes (mg cl k na ca) lactate bicarb

Question 32

sx peritonitis (EMERGENCY!!)

Answer 32

cloudy fluid abdo pain + tenderness gnerally unwell increased temp

Question 33

abx for peritonitis

Answer 33

vancomycin

Question 34

why is fistula/tunnel line important

Answer 34

IT IS THEIR LIFELINE (don't use for general access unless it is an emergency)

Question 35

where does a tunnel line sit

Answer 35

R atrium

Question 36

what weekly IM injection is needed in ESRD

Answer 36

erythropoetin

Question 37

other drugs that pts might need

Answer 37

``` activated vit d IV irons (cannot give oral bc already constipated from low fibre diet) ```

Question 38

acute reasons to dialyse (6)

Answer 38

- refractory hyperkalemia - volume overload - intractable acidosis - uraemic encephalopathy - pericarditis, or pleuritis; - removal of certain toxins

Question 39

complications HD

Answer 39

- hypovol -> hypotension, camps, nausea, headache, chest pain, fever, rigors - infection at access point

Question 40

complications PD

Answer 40

- peritonitis - herniation of abdo wall - infection at access point

Question 41

sx transplant rejection

Answer 41

PAIN / Sx of kidney failure

Question 42

transplant inmmunosuppressant

Answer 42

tacrolimus!! - calcineurin inhibitor