Dialysis

Question 1

Define diffusion

Answer 1

• movement of solutes from high concentration to low concentration gradient across a semi-permeable membrane

Question 2

Factors affecting diffusion

Answer 2

• concentration gradient
• molecular weight of solute
• properties of semi permeable membrane

Question 3

In dialysis what is removed from patients blood

Answer 3

• urea and creatinine
• potassium
• sodium

Question 4

What is infused into a patient in dialysis?

Answer 4

• bicarbonate

- glucose

Question 5

What is the blood flow rate needed for haemodialysis?

Answer 5

• 300-350mls/min

Question 6

What is the main vascular access used in haemodialysis?

Answer 6

• Arteriovenous fistula

Question 7

What is the name of the fluid used in dialysis?

Answer 7

• dialysate

Question 8

During dialysis what are patients treated with?

Answer 8

• heparin

Question 9

What method is employed in dialysis to maximise gradient

Answer 9

• countercurrent flow of the dialysate and blood

Question 10

What is the order from most prominent to least of the method of haemodialysis?

Answer 10

• diffusion
• convection
• adsorption

Question 11

Explain convection

Answer 11

• pressure gradient created

- solute drag = ultra filtration

Question 12

Explain adsorption

Answer 12

• plasma proteins stick to membrane surface

Question 13

Difference of haemodiafiltration and haemodialysis

Answer 13

• HDF requires an extra-covective fluid replacement

- convection –> diffusion –> adsorption

Question 14

Where is a arteriovenous fistula most commonly located?

Answer 14

• artery and vein in radio-cephalic

Question 15

How often is a AVF scanned?

Answer 15

• every 6 months

Question 16

Where is a TCVC placed?

Answer 16

• tunnelled central venous catheret

- internal jugular vein

Question 17

Average dialysis prescription?

Answer 17

• 4 hrs

- 3 times weekly

Question 18

Restrictions for a dialysis patient

Answer 18

• fluid
• salt
• potassium
• phosphae

Question 19

What may occur if dialysis goes wrong?

Answer 19

• hypotension
• haemorrhage
• arrythmia
• cardiac arrest

Question 20

When should dialysis be started?

Answer 20

• eGFR <7ml/min
• urea >40
• persistent hyperkalaemia
• unresponsive metabolic acidosis

Question 21

Explain peritoneal dialysis?

Answer 21

• use of the peritoneal cavity as the semi-permeable membrane

Question 22

2 types of peritoneal dialysis?

Answer 22

• continous

- automated

Question 23

Risk in peritoneal dialysis

Answer 23

• infection
• membrane failure
• hernia

Question 24

Why should initiating dialysis be done slowly?

Answer 24

• to reduce risk of disequilibrium syndrome

Question 25

Types of transplantation

Answer 25

- deceased heart beating - non-heart beating - live donation

Question 26

What life expectancy of a patient with ESKD if acceptable for transplantation?

Answer 26

- greater than 5yrs

Question 27

Contraindications to transplantation

Answer 27

- Malignancy - Active HIV - Active HCV - Untreated TB

Question 28

In tissue typing what must match?

Answer 28

- Blood groups

Question 29

In tissue typing what doesn't need to match?

Answer 29

- HLA groups

Question 30

What is given for immunosuppression post transplant

Answer 30

- Calcineurin inhibitors (cyclosporine) - Anti-proliferative - corticosteroids (prednisolone)

Question 31

Acute kidney rejection treatment?

Answer 31

- IV methypredinsolone

Question 32

When is desensitisation required in transplantation?

Answer 32

- non-matching HLA or MHC - plasma exchange - B cell antibody depletion

Question 33

Complications of renal transplantation

Answer 33

- bleeding - infection - venous kinking - infection

Question 34

Immunosuppression complications

Answer 34

- PJP lung infection - CMV disease - BK nephropathy - Cancer

Question 35

Cancers associated with transplantation

Answer 35

- non-melanoma skin cancer | - lymphoma