eGFR < 30ml/min
When do we begin preparing the patient for dialysis?
eGR < 25ml/min
When do we place an AV fistula?
signs/symptoms of kidney failure, inability to control volume status/BP, progressive decline in nutritional status/cognitive impairment
When do we start dialysis? (3)
b
Which requires no "maturity time"?
a) AV fistula
b) Venous Catheter
c) AV graft
b
Which has the highest rates of thrombosis & infection?
a) AV fistula
b) Venous Catheter
c) AV graft
a
Which has the longest survival time of placement device?
a) AV fistula
b) Venous Catheter
c) AV graft
b
Which is used in patients with diabetes/severe vascular disease?
a) AV fistula
b) Venous Catheter
c) AV graft
b
Which is the worst in terms of morbidity & mortality?
a) AV fistula
b) Venous Catheter
c) AV graft
c
Which is used when vessels are not suitable for anastomosis/fistula?
a) AV fistula
b) Venous Catheter
c) AV graft
c
Which takes only 2-3 weeks after placement to be ready for use?
a) AV fistula
b) Venous Catheter
c) AV graft
cephalic vein + radial artery
AV Fistula =
Basilic or Cephalic vein + brachial artery
AV Graft =
concentration of solute in blood/dialysate, solute characteristics, dialyzer membrane composition, blood/dialysate flow rate
What does the rate of diffusion depend on? (4)
Ultrafiltration
-Movement of water across the dialyzer membrane due to hydrostatic or osmotic pressure
b
Movement of substances from high to low concentrations.
a) Ultrafiltration
b) Passive diffusion
a
The primary means of removing excess fluid.
a) Ultrafiltration
b) Passive diffusion
b
Which membrane is used more?
a) Low flux
b) High flux
b
Which has a shorter treatment time?
a) Low flux
b) High flux
<=500 daltons
What is the size of molecules that can pass through Low Flux membranes?
3 sessions per week; 3-5 hrs each
How does Typical Dialysis work?
5-7 sessions per week; 1.5-5 hours
How does Intensive Dialysis work?
3-7 short or long treatments
How does Home HD work?
Urea reduction ratio (URR)
-the reduction in urea because of dialysis
Kt/V
-fraction of the patient's total body water that is cleared of urea during a dialysis session
predialysis BUN- Postdialysis BUN/ predialysis BUN x 100
URR formula?
k= rate at which blood passes through dialyzer(ml/min); t= time on HD (min); V= patients volume of distribution of urea(ml)
In the Kt/V formula, what do each of the variables represent?
tells us the urea made during dialysis and urea removed with fluid during dialysis
Why is Kt/V more accurate than URR?
>1.4
What is the target Kt/V?
intradilaytic hypotension, chronic hypotension, intradialytic/post HD hypertension, muscle cramps
What are the most common complications seen with HD? (4)
a,c
Which has the highest rate of aneurysm and stenosis?
a) AV fistula
b) Venous Catheter
c) AV graft
b
Which has the highest rate of thrombosis?
a) AV fistula
b) Venous Catheter
c) AV graft
b
Which has the highest rate of infection?
a) AV fistula
b) Venous Catheter
c) AV graft
mupirocin ointment at exit site
How do we prevent infection in patients with Catheters?
empiric therapy; vancomycin + AG
How do we treat infections?
high solute clearance (only 3 treatments a week), clearly defined adequacy; able to identify underdialysis quickly, low technique failure, close monitoring of patient
What are the advantages of Hemodialysis? (5)
Travel to dialysis center, AE, issues w vascular access, rapid decline in residual renal function
What are the disadvantages of Hemodialysis? (4)