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30 Cards in this Set

  • Front
  • Back
What are indications for dialysis?
Significantly reduced GFR: <10

Weight loss

Acidosis

High BUN, creatinine
What are the goals for dialysis therapy?
Replace filtration functions: get rid of the crap!

Maintain electrolyte balancing

Replaceerythropoetin, Vitamin D analogs to control hyperparathyroidism
What types of veins are used for urgent dialysis?
Can't use a peripheral vein!

Commonly used ones:
Jugular
Subclavian
Femoral
What vessels are typically used in chronic dialysis?
Fistulas between:

Radial and cephliac

Brachial and cephalic
What are risks for dialysis by a catheter?
Infection
Poor flow-->clotting
What are the advantages of a fistula? Disadvantages?
Advantages:
Durable
Good flow
Low infection risk

Disadvantage:
Hard to create
The fistula needs to mature before use
What are the disadvantages of arterio-venous grafts?
High thrombosis risks
What is the effect of mass on diffusion rate? Concentration gradient?
Smaller the mass, greater the diffusion

Greater gradient, more diffusion
What determines convection rates in dialysis? What happens with this?
Pressure differences

Molecules and solutes are pulled with the water due to the pressure differences
What are the ways that the amount of dialysis completed is measured?
Urea reduction ratio: urea concentration after compared to before

KT/V:

(Clearance*time)/(Volume of distribution of urea)
If the patient is hyperkaelemic, what kind of diasylate should be given to them?
Diasylate with low potassium --> have a gradient for potassium out of the blood
What substance move out of the blood by convection? What carries them?
Sodium, larger molecules

Water
What is the target weight for a person who is on dialysis?
Get them to their dry weight: the weight at which the px. is comfortable, doesn'thave edema, has normal BP,and isn't orthostatic
What are complications that can arise from dialysis pertaining to the therapy? Why?
Dialysis disequilibrium syndrome: vertigo caused by changes in Na concentrations
Hypotension
Bleeding, hemolysis: px. is on anticoagulation
infection
What are complications of dialysis related to end stage renal disease?
Premature CV mortality
Renal osteodystrophy
What is the typical schedule for a person on dialysis?
3x a week, 4 hrs/therapy
What is the membrane for the exchange of solutes in peritoneal dialysis?
The patients'own peritonealmembrane
Where does the diasylate sit inside a patient during peritonal dialysis?
Inside the peritoneal cavity - it just sits there.
What is the base equivalent given in peritoneal dialysate? Why not bicarb?
Lactate

Bicarb will precipitate out - bad news!
Why is dextrose include in the peritoneal dialysis fluid?
Osmotic agent: it pulls water into the peritoneal fluid, bringing things in by convection
What is meant by a fast/slow transport time in peritoneal dialysis?
People who are slow transporters don't move the dextrose across their peritoneal membrane quickly --> maintain the gradient to draw things into the peritoneum longer
What is the main mechanism by which peritoneal dialysis occurs?
Diffusion
What substances are found in a high concentration in the blood of a person on dialysis?
Urea
Creatinine
Potassium
Unmeasured metabolic baddies

We take creatinine as a proxy for these other guys - they're the ones that really cause the problems, not creatinine
In peritoneal dialysis, is base a higher concentration in the blood or in the dialysate/
In the blood
How long should a person let peritoneal dialysis last?
4 hours
What is the effect of infection on peritoneal dialysis?
It causes someone to become a "faster" dialyze: in infection the vascularitoy of the peritoneum is increased.
What is added to the dialysate to facilitate water removal in peritoneal dialysis?
Dextrose

You can have different concentrations of it to facilitate removal from the body of more/less fluid
What are disadvantages to using glucose as an osmotic agent?
1. Excess calories!
2. Doesn't maintain a concentration gradient for long
What determines the amount of fluid removed by during peritoneal dialysis?
1. Concentration of the glucose in the dialysate

2. Length of time the dialysate is in the peritoneal cavity

3. Individual variation
What are the complications that can occur with peritoneal dialysis?
1. Exit site infection - THINK OF THIS!
2. Loss of AAs, protein in the dialysate
3. Calories, poor appetite from the glucose
4. Hernia development
5. Peritoneal sclerosis
6. Burn out --> your peritoneal membrane gets worn out from having things exchange through it for so long.