Dialysis

Question 1

What are the implications of renal failure?

Answer 1

• Electrolyte imbalance (hyperkalaemia/ hyponatraemia)
• Acidosis
• Fluid retention
• Retention of waste products (small/ middle molecules and phopshate)
• Secretory Failure (EPO/ D3)
• Symptoms
• Anaemia (Low EPO)
• Renal bone disease (Low vit. D3)

Question 2

What symptoms do you get in renal failure?

Answer 2

Tiredness, lethargy
Shortness of breath, oedema
Pruritis, nocturia, feeling cold, twitching
Poor appetite, nausea, loss of/nasty taste, weight loss

Question 3

What are the implications if there is a lack of treatment?

Answer 3

Hyperkalaemia- arrhythmias/ cardiac arrest
Pulmonary oedema
N/V
Cachexia
Fits
Increasing coma
Death

Question 4

What are the types of renal replacement treatments (RRT)?

Answer 4

Dialysis
Transplant

Treatment not curative

Question 5

What are the types of dialysis?

Answer 5

Haemodialysis (Mostly hospital, can be done at home)
Peritoneal dialysis (home treatmeant)

Question 6

What are the aims of RRT?

Answer 6

• Correct electrolyte and fluid imbalance
• Remove waste
• Improve symptoms
• Maintain QoL for patients

Question 7

What is the timeline for RRT?

Answer 7

1. eGFR< 20 ml/ min- START CONVERSATION
   i. Educate
   ii. Establish chosen RRT
2. eGFR <10ml/min- START DIALYSIS if benefits > risks
3. eGFR <6ml/min- START DIALYSIS when no reversible features
4. START DIALYSIS if life threatening complications

Question 8

What are the benefits of dialysis?

Answer 8

1. Improve uraemic symptoms
   - Tiredness, nausea, pruritis
2. Correct fluid balance
   - Less SOB and oedema
3. Avoid life-threatening events
   - Severe acidosis
   - Severe hyperkalaemia
   - Pulmonary oedema resistant to diuretics

Question 9

What are the risks of dialysis?

Answer 9

1. Dialysis related complications
   - Infections
   - Hypotension, arrhythmias (HD only)
   - Access related
2. Adverse effects on QoL
   - Work
   - Family life
   - Travel

Question 10

What does dialysis not treat?

Answer 10

Low EPO
Low D3
Co morbidities like SLE, diabetes or vascular disease

Question 11

What are the features of haemodialysis?

Answer 11

• Hospital based
• 3x a week, 4 hrs also recovery and transport
• Vascular access needed
• QoL (limits travel and work, not at home, loss of independence)

Question 12

What are the features of periotneal dialysis?

Answer 12

• Home based
• Daily and continuous
• Less haemodynamic stress
  Limited by access to peritoneum and ability to do technique
• QoL (more independence, easier for work and travel, avoids swings, less dietary and fluid restrictions)

Question 13

What are the benefits of transplant?

Answer 13

Better renal replacement
Improvement in metabolic disorders
- Anaemia
- Renal bone disease
Costs less in long-term
Prolonged survival
Quality of life
- Avoids disadvantages of HD/PD
- Much easier to travel, work, maintain independence

Question 14

What are the risks of transplant?

Answer 14

Older and sicker patients not eligible
- Immunosuppression
- Increased infection
Increased malignancy
Not a cure
- Surgical complications
- Hospital visits – particularly frequent at start
Often worse off if/when transplant fails