4.8 I) J) To Iv) Renal Dialysis

Front 1

Signs of Chronic renal failure [CRF]

Back 1

1. HTN
2. Volume overload / pulmonary oedema
3. Pericarditis
4. Bleeding
5. Encephalopathy
6. Anaemia
7. Hyperkalaemia
8. Metabolic acidosis
9. Peripheral neuropathy

Front 2

Treatment of acute bleeding in CRF

Back 2

1. DDAVP [first line] stimulates vWF release
2. Cryoprecipitate [ I/II/VIII/XIII/vWF ]
3. PRBC transfusion

Front 3

Indications for Emergent Dialysis in CRF ; "AEIOU"

Back 3

Acidosis [ metabolic acidosis]
Electrolyte disturbance
1. hyperkalaemia
2. Hypercalcaemia
Ingestions [ Toxic ingestions ]
Overload [ pulmonary oedema / severe HTN ]
Uraemia
1. Encephalopathy
2. Pericarditis
3. Severe Nausea and vomiting ++

Front 4

Complications of Haemodialysis ?

Back 4

1. Hypotension [ 20-30% ]
2. Bleeding
3. Dialysis Disequilibrium Syndrome
4. Fistula-specific problems
5. Vascular access infection

Front 5

Causes of Haemodialysis hypotension? [7]

Back 5

1. Fluid shifts with spontaneous resolve**

[common]
2. AMI
3. Tamponade
4. Bleeding
5. Infection {Sepsis}
6. Anaphylaxis
7. Air embolism

Front 6

Causes and sources of Haemodialysis

bleeding?

Back 6

1. Platelet dysfunction
2. Transient thrombocytopenia
3. Anticoagulation

Typically puncture site bleeding

{most common}

Front 7

Treatment of bleeding associated with haemodialysis?

Back 7

1. DDAVP ** [ 0.3ug/kg IV ]
2. Cryoprecipitate
3. PRBC transfusion
4. Protamine [ heparin reversal ] 10-20mg

Front 8

List fistula-specific problems associated with Haemodialysis

Back 8

1. Puncture site bleeding **
2. True aneurysms [rare]
3. Pseudoaneurysm
4. Thrombosis
5. High output failure [ Branham sign ]
6. Infection [ Gram positive > G - ]

Front 9

Salient features of peritoneal dialysis-related peritonitis

Back 9

1. Fever + abdominal pain
2. Cloudy PD fluid
3. PD fluid :
a. > 100 WCC/mm
b. >50% Neutrophils
c. + Gram stain
4. Gram positive {Strep/Staph} > G- > anaerobes > fungi
5. Mx with intraperitoneal Antibiotics
a. Vancomycin
b. OR cephalosporin 3rd Gen.

Front 10

Mnemonic for Causes Chronic Renal Failure [CRF]: "He Gets Very Tired"

Back 10

Hereditary PKD
Glomerular Disease
1. Primary
2. Secondary [Diabetes** / SLE / Amyloid]
Vascular Disease
1. HTN**
2. Atheroma
3. Vasculitis
Tubulointerstitial Disease
1. Reflux / pyelonephritis
2. Nephrocalcinosis
3. Interstitial nephritis
4. Obstruction

Front 11

Key questions to ask the CAPD patient

Back 11

1. Cause of ESRF
2. Baseline values
a. weight
b. vital signs
c. laboratory values
3. Peritoneal dialysis parameters
a. concentration
b. exchanges per day
4. Recent complications of PD
5. Uraemia symptoms
6. Still urine producing?

Front 12

Key questions to ask the haemodialysis

patient

Back 12

1. Cause of ESRF
2. Baseline values
a. Dry weight
b. vital signs
c. laboratory values
3. Dialysis schedule
4. Recent comlpications of HD
5. Does patient make dry weight post HD
6. Intradialysis hypotension?
7. Currently functioning vascular access
8. Uraemia symptoms
9. Still producing urine?

Front 13

Causes of predialytic, intradialytic and post

dialytic hypotension?

Back 13

Predialytic
1. Preexisting hypovolaemia [starts below dry weight ]
a. GI bleeding
b. Sepsis
c. D + V
d. decreased salt/water intake
2. intradialytic hypotension
a. leaks from blood tubing / haemodialyser
3. Post Dialytic Hypotension
a. Excessive ultrafiltration
b. cardiac disease
c. pericardial disease

Front 14

The main initial areas for focus with the Renal HD patient presenting with hypotension.

Back 14

1. Volume status
2. Cardiac function impairment
3. Pericardial disease
4. Infection
5. GI bleeding

Front 15

What is "Dialysis disequilibrium" Syndrome?

Back 15

1. Occurs at the end of dialysis
2. Cerebral oedema from osmolar imbalance b/w brain and blood
2. Characterised by:
a. Nausea
b. Vomiting
c. Hypertension
3. Can progress to :
a. Seizures
b. coma
c. death
4. Treatment:
a. cease dialysis
b. IV mannitol

Front 16

Why is it important to ask the ESRF patient about their native kidneys?

Back 16

Retained native kidneys can be a continuing source of:

1. Hypertension
2. Infection
3. Calculi