Renal Replacement Therapy Quiz

Renal Replacement Therapy

• Renal replacement therapy (RRT) encompasses different modalities for managing patients with kidney failure
• Treatment options include transplantation and dialysis (hemodialysis and peritoneal dialysis)
• Hemodialysis is a method of filtering blood outside the body
• Key aspects of hemodialysis involve access (fistula, graft, catheter), dialysate, and dialyzer procedures, and adequacy assessment
• Continuous renal replacement therapy (CRRT) is a continuous method of blood purification
• Peritoneal dialysis utilizes the peritoneum as a filtration membrane
• Peritoneal dialysis procedures include fluid exchange and dwell times
• Kidney transplantation is a procedure to replace a diseased kidney with a healthy donor kidney

Dialysis Options

• Hemodialysis: Center-based or home-based, intermittent treatments (3 times a week or more) using an external machine to filter blood
• Peritoneal dialysis: A home-based, continuous method using the lining of the abdomen (peritoneum)
• Extracorporeal therapy: Uses an external machine
• Intermittent Hemodialysis, Slow-Low efficiency Dialysis (SLED)
• Continuous Hemofiltration (CAVH, SCUF, CVVH, CAVHDF, CVVHDF)
• Intracorporeal therapy: Uses the internal body

CRRT Modalities

• SCUF: Slow Continuous Ultrafiltration
• CVVH: Continuous Veno-Venous Hemofiltration
• CVVHD: Continuous Veno-Venous Hemodialysis
• CVVHDF: Continuous Veno-Venous Hemodiafiltration

Hemodialysis Principles

• Dialysis replaces three key kidney functions: removes waste, excess fluid, and regulates electrolytes
• Dialysis cannot automatically manage blood pressure or produce hormones like erythropoietin
• Dialysate is a physiologic solution with inorganic ions and glucose
• Specific electrolyte levels in the dialysate are crucial for patient safety
  • Normal sodium range: 135-145 mEq/L
  • Normal potassium range: 3.5-5.5 mEq/L
  • Normal calcium range: 2.25-3.0 mEq/L
  • Normal magnesium range: 0.5-1.0 mEq/L
  • Normal chloride range: 100-115 mEq/L
  • Normal bicarbonate range: 30-40 mEq/L

Dialyzer

• Dialyzer consists of semi-permeable membranes with pores allowing solute passage
• Dialyzer flux measures water transfer rate across the membrane
• Low and high flux ratings based on ultrafiltration coefficient

Dialyzer Permeability

• Measures clearance of middle molecular weight molecules (example: β2 microglobulin)
• Classified as low or high permeability based on clearance values

Dialyzer Efficiency

• Measures urea clearance
• Classified as low or high efficiency based on KoA values

Vascular Access

• Three main types: Fistula, Graft, and Catheter (CVC)
• Fistula involves surgically connecting an artery and vein to improve blood flow for dialysis
• Graft uses a synthetic tube connecting an artery and vein
• CVC involves placing a catheter into a large vein and directly connecting to the dialysis machine

Kidney Transplantation

• A surgical procedure replacing a diseased kidney with a healthy donor kidney
• Donors can be living or deceased
• Important considerations related to the procedure and outcomes are immunosuppression needs of the patient and potential complications like graft rejection

Peritoneal Dialysis

• Employs the peritoneum as a filtration membrane
• Fluid is exchanged and toxins are removed from the body through the peritoneal cavity

Adequacy of Hemodialysis

• A measure of the efficiency of dialysis related to the minimum amount of urea clearance and nutritional intake
• Aspects of adequacy include improved nutritional status, anemia/acidosis control, bone mineral disease control, blood pressure control, and relief of uremic symptoms.
• Key measurements to assess adequacy are: urea kinetics modeling (UKM), urea reduction ratio (URR), and Kt/V

Complications of Hemodialysis

• Diverse complications, both technical (e.g., clotting) and patient-related (e.g., hypotension, nausea)
• Complications can arise from technical issues in the dialysis procedure or arise from patient-related issues in their health and wellbeing

Continuous Renal Replacement Therapy (CRRT)

• A continuous method for blood purification
• CRRT is an extracorporeal blood purification used when a patient cannot be treated through traditional dialysis
• It's an extended period of treatment and allows for a continuous removal of fluids and waste products from the blood

Test your knowledge on renal replacement therapy, including the various methods used to manage kidney failure such as hemodialysis, peritoneal dialysis, and kidney transplantation. This quiz will cover key concepts about each treatment modality, their procedures, and clinical implications.