RRT

Question 1

What are the three types of dialysis?

Answer 1

Haemodialysis (HD)
Haemodiafiltration (HDF)
Peritoneal dialysis (PD)

Question 2

What does RRT stand for?

Answer 2

Renal Replacement Therapy

Question 3

Why do we need dialysis?

Answer 3

To remove toxins that build up because the kidney’s cannot excrete them.

Question 4

What is the blood flow rate in HD?

Answer 4

300-350mls/min

Question 5

How does dialysis get rid of solutes?

Answer 5

Toxins diffuse from high conc in blood to low conc in dialysis fluid

Question 6

How does dialysis get rid of water?

Answer 6

Negative pressure gradient between blood and dialysis fluid forces water out of plasma

Question 7

What does adsorption affect?

Answer 7

Plasma proteins and molecules bound to them

Question 8

What role does adsorption play in dialysis?

Answer 8

Removes small proteins from the blood by binding them to the membrane

Question 9

How does HDF differ from HD?

Answer 9

HD just relied on conc gradient

HDF relies on pressure gradient too

Question 10

When is HDF used?

Answer 10

AKI

Question 11

What things can affect HFD rate?

Answer 11

Water flux (rate and volume)
Membrane pore size (big or little holes, and their respective ratios)
The pressure difference (hydrostatic pressure) applied to and across the membrane
Viscosity of the fluid within the membrane pores
The size, shape and electrical charge of each molecule

Question 12

What additional thing needs done in HFD?

Answer 12

Fluid replacement

Question 13

What restrictions are caused by dialysis?

Answer 13

Fluid, Na, K and P intake

Question 14

What kinds of venous access are available for dialysis?

Answer 14

Scribner Shunt
Tunneled Venous Catheter
Fistula

Question 15

Describe a Tunneled Venous Catheter

Answer 15

Catheter inserted into large vein such as internal jugular

Question 16

What are some advantages of Tunneled Venous Catheter?

Answer 16

Easy access

Question 17

What are some disadvantages of Tunneled Venous Catheter?

Answer 17

High infection risk
Can be blocked easily
Can damage veins and cause thrombosis etc

Question 18

Describe a fistula for dialysis

Answer 18

Link artery to vein to cause Arteriovenous Fistula (AVF)

Question 19

What are some advantages of a fistula?

Answer 19

Good blood flow

Less chance of infection

Question 20

What are some disadvantages of a fistula?

Answer 20

Requires surgery
6-12 weeks before it can be used
Limit blood flow to distal arm
Thrombose or stenose

Question 21

What are some potential side effects of dialysis?

Answer 21

Hypotension
Haemorrhage 
Loss of vascular access
Arrhythmia- Electrolyte imbalance
Cardiac arrest

Question 22

How does PD work?

Answer 22

Use peritoneum as membrane for diffusion and filtration. Fill with high glucose solution to draw out water.

Question 23

What two forms of PD are available?

Answer 23

Continuous Ambulatory Peritoneal Dialysis (CAPD)

Automated Peritoneal Dialysis (APD)

Question 24

How do Continuous Ambulatory Peritoneal Dialysis (CAPD) and Automated Peritoneal Dialysis (APD) differ?

Answer 24

CAPD- 4x2L bags per day each taking 30 mins

APD- 1 bag of fluid that’s removed over 10hr at night

Question 25

What are some problems with PD?

Answer 25

Infection- Skin or gut Peritoneal membrane failure- Results in fluid overload and uraemic Hernias

Question 26

When should dialysis be started?

Answer 26

Based on bloods or symptoms

Question 27

What bloods suggest starting dialysis?

Answer 27

Resistant hyperkalaemia eGFR < 7 ml/min Urea > 40 mmol/L Unresponsive metabolic acidosis

Question 28

What symptoms suggest starting dialysis?

Answer 28

``` Nausea Anorexia Vomiting Profound fatigue Itch Unresponsive fluid overload ```

Question 29

How long of a session do you start with HD?

Answer 29

60-90mins

Question 30

How long is a standard HD session?

Answer 30

4h

Question 31

What can happen if you HD to quickly?

Answer 31

Disequilibrium syndrome

Question 32

What are some signs of Disequilibrium syndrome?

Answer 32

Cerebral oedema Confusion Seizures Death

Question 33

How long after inserting a PD catheter can you start dialysis?

Answer 33

3-6 weeks

Question 34

Why give a patient a renal transplant?

Answer 34

Better survival than dialysis Improves quality of life Cost effective

Question 35

What are the two sources of organs for transplant?

Answer 35

Cadaveric | Live donor

Question 36

What is the main issue with organ transplant?

Answer 36

Immune attack by host

Question 37

What is the main barrier to organ transplant?

Answer 37

Comorbidities

Question 38

What must you be to receive a renal transplant?

Answer 38

Life expectancy >5y | Ability to survive surgery

Question 39

What are some contraindications to transplant?

Answer 39

``` Untreated malignancy or solid tumour in last 3-5 y Active HIV or TB Severe IHD or airway disease Vasculitis Hostile bladder ```

Question 40

What two immunological things must you try to match for a transplant to be successful?

Answer 40

Blood and tissue group

Question 41

What are sensitising events?

Answer 41

Events that lead to preformed Ab in the blood against nonself

Question 42

Give some examples of sensitising events

Answer 42

Blood transfusion Pregnancy/miscarriage Previous transplant

Question 43

What is desensitisation?

Answer 43

Removal of blood group or donor specific antigens

Question 44

How id desensitisation done?

Answer 44

Plasma exchange | B cell antibody (rituximab)

Question 45

What are the types of organ rejection?

Answer 45

Hyperacute- Due to preformed antibodies. Unsalvageable Acute- Due to Ab. Increase immunosuppression Chronic- Slow decline in function.

Question 46

What is an important complication of immunosuppression?

Answer 46

Cytomegalovirus disease