Dialysis and Renal Replacement Therapies

Acid-base abnormalities

The decision to start dialysis is not eGFR driven, what is the 'A' indication for dialysis?

Electrolyte abnormalities

The decision to start dialysis is not eGFR driven, what is the 'E' indication for dialysis?

Ingestion

The decision to start dialysis is not eGFR driven, what is the 'I' indication for dialysis?

Volume overload

The decision to start dialysis is not eGFR driven, what is the 'O' indication for dialysis?

Uremia

The decision to start dialysis is not eGFR driven, what is the 'U' indication for dialysis?

Semipermeable

Hemodialysis is the most common type of renal replacement therapy where the patient's blood and dialysate are on opposite sides of a ______ membrane and run countercurrent to ensure that the blood is effectively filtered.

Diffusion, convection

Hemodialysis uses ______ or ________ to cause substances to move across the semipermeable membrane from the blood to dialysate.

Low flux

This type of dialysis membrane is used to remove smaller molecules, such as creatinine or urea, because it is made up of small pores.

High efficiency

This type of dialysis membrane contains small pores but has a larger surface area to increase the removal of small molecules because there is more contact space between the blood and dialysate.

High flux

This type of dialysis membrane is the most common type to use where it contains larger pores to be able to remove high molecular weight substances.

High flux

This type of dialysis membrane allows for shorter treatment times.

Ultrafiltration

This process involves the movement of water across a semipermeable membrane due to hydrostatic or osmotic pressure.

Convection

This process involves the movement of dissolved solutes that are pulled across a semipermeable membrane with the transport of water.

Ultrafiltration

This is the primary method for fluid removal

Ultrafiltration

This process is used to treat volume overloaded patients, and the hydrostatic or osmotic pressure can be changed to control the amount of fluid removed.

Convection

This is the primary method for larger molecule removal

Convection

This process can alter the efficiency of solute clearance by changing the pore size of the dialysis membrane.

Arteriovenous fistula

This hemodialysis access site has the longest survival time, lowest rate of complications, but requires 1-2 months to fully mature and get big enough to support the pressure from dialysis.

Arteriovenous graft

This hemodialysis access site is synthetic, has shorter survival time, higher rate of infection or thrombosis, and requires 2-3 weeks before it is mature enough for dialysis use.

Venous catheter

This hemodialysis access site involves a central line in the femoral, subclavian, or internal jugular vein. It has shorter survival time and a higher rate of infection or thrombosis, but this site can be immediately used.

Ultrafiltration

Muscle cramps that are associated with hemodialysis are typically caused by excessive _________

Vitamin E

To treat muscle cramps associated with hemodialysis, a patient can supplement with 400 IU of ______ at bedtime.

Hypertension

A patient may experience ______ during hemodialysis due to RAAS system activation, is volume overloaded, or antihypertensive medications are removed during dialysis.

Carvedilol

Hemodialysis may increase the clearance of Metoprolol, Atenolol and ACE inhibitors because they are water soluble. If a patient is experiencing hypertension, they should switch to _____, ARBs or Amlodipine

Hypotension

This is the most common complication that may occur during the hemodialysis procedure because excessive amounts of fluid were removed.

Midodrine

If a patient is experiencing hypotension during the hemodialysis procedure, the patient can be given ______ 5mg 2-3 times daily.

Alpha 1 agonist

Midodrine is an ________ that works by increasing arteriolar and venous tone to increase systolic and diastolic blood pressure.

Supine hypertension

What is the blackbox warning of Midodrine?

Gram positive

If an infection develops at the insertion site, the hub or both, give the patient a broad spectrum ______ antibiotic to decrease the risk of losing the access site.

Venous catheter

Thrombosis may occur more with a ______ access site especially if a patient is exhibiting symptoms from the Virchow's Triad.

Forceful saline flush

This is the first line therapy to use to remove a clot that has formed at the access site of hemodialysis.

Heparin

This is used to prevent the dialysis catheter from clotting off where it prevents fibrin clot formation by inhibiting the conversion of fibrinogen to fibrin

Alteplase

This is used to try to salvage the dialysis catheter by breaking down the clot that was formed. It stimulates the conversion of plasminogen to plasmin and the plasmin will break up fibrin molecules.

Continuous

This type of hemodialysis is used for critically ill patients because the ultrafiltration rates are low and are gentler.

Peritoneal membrane

What structure within the abdominal cavity functions as the semipermeable membrane for peritoneal dialysis?

Diffusion, ultrafiltration

Peritoneal dialysis contains the peritoneal membrane that acts as a semipermeable membrane where molecules are removed by either ______ or _______

Osmotic

Ultrafiltration is achieved during peritoneal dialysis by _____ pressure gradient between the dialysate and blood.

Dextrose

The dialysate used in peritoneal dialysis contains _______ which can raise the blood sugar of diabetic patients, increase adipose tissue deposition and decrease appetite, which all leads to the malnutrition of the patient.

Hemodialysis

This renal replacement therapy requires closer monitoring of the patient by healthcare professionals where they adjust the dialysis based on the patient's vitals.

Hemodialysis

This renal replacement therapy allows for higher solute and fluid clearance.

Hemodialysis

This renal replacement therapy has intermittent sessions throughout the week but requires multiple visits per week to a center.

Hemodialysis

This renal replacement therapy has better defined dialysis parameters and better control of the rate of dialysis by adjusting the components of the dialysate.

Hemodialysis

This renal replacement therapy is associated with side effects occur more often where complications are associated with vascular access.

Peritoneal dialysis

This renal replacement therapy allows the patient more freedom to do daily activities

Peritoneal dialysis

This renal replacement therapy has more hemodynamic stability and is less likely to cause hypertension, hypotension, or muscle cramps

Peritoneal dialysis

This renal replacement therapy has increased clearance of larger solutes because it is not dependent on the pore size of the semipermeable membrane.

Peritoneal dialysis

This renal replacement therapy allows for more preservation of renal function longer

Peritoneal dialysis

This renal replacement therapy is associated with less blood loss or iron deficiency, increased risk of inadequate fluid and solute removal

Peritoneal dialysis

This renal replacement therapy is associated with a risk of technique failure, peritonitis and obesity.