Q.560. What are the possible outcomes associated with nocturnal HDX?
HEMODIALYSIS
Q.560. What are the possible outcomes associated with nocturnal H.DX?
A. NHDX is
ass. é marked benefits compared to conventional HDX. Some benefits hav been clearly shown, while others require
further analysis. Clearance of urea, Po4 &
beta2-microglobulin are markedly enhanced é NHDX. Limited data sugg.:“quality
of life” may be improved. Excellent B.P. control is achieved,
with almost all ptn.s no longer requiring anti-H.T. dreugs. Incr. evidence
also sugg.: NHDX regression of LVH. Sleep disturbance is minimal during NHDX
& sleep architecture appears to improve. NHDX also
signif. liberates dietary intake of DX. ptn. Ptn.s are kept on a free
diet incl.: unrestricted
intake of salt, water, K, PO4 & protein. 😊
No signif. conclusions appear
concerning effect of NHDX on
survival. Depending upon consumable/personnel cost ratio in different
centers, NHDX cn be less or more expensive than in-center
conventional HDX. Enthusiastic acceptance by ptn. & favorable financial
profile, NHDX shd be cons-idered for ptn. who’re willing &
capable of performing home DX. Current obsta-cles to adoption of NHDX
are unfamiliarity é home HDX & financial impact of high frequency
of DX.
Q561. Compare the outcomes of intensive home hemodialysis with in-center three times
weekly HDX. .?
A. No randomized controlled trials hv
directly studied the effect of daily HDX. on survival. Two large observational studies hv now shown improved survival ass. é intensive home HDX. compared é in-center three times weekly HDX..
Q.562. What
is the role of A/V fistula (AVF) on
precipitating heart failure? 💔
A. Creation
of AVF hs signif. effects on both systolic & diastolic function. It
is ass. é incr. bld flow, P.H. & C.O. Although
us. clinically insignif., incr. C.O. & bld flow may be so great at times
tht they result in overt H.F.. This is esp. true if ptn. hs underlying heart
dis. and/or the
access has flows 👉> 2000 mL/min.
Ptn.
CVS sta-tus shd influence decisions about type of DX modality & DX access. Monitoring/
surveillance should be performed in ptn. at incr. risk [= ptn of advanced age and/or those é P.H. of heart dis. and/or an upper
arm access. We recmm.: access mon-itoring (physical examination) be done weekly & that surveillance
be performed on a regular (monthly) basis. If a C.P. of H.F. is evident or
emerges over time, ptn. shd also be eval. by determining the ratio of flow betw. access
(Qa) & (C.O.). A Qa : CO ratio > 0.3 ➤🠉risk for high-out-put H.F. Iry indication for ttt is intractable H.F.
If fluid control & pharmacological management is not
effective, then approach to 🠟🠟 in cardiac work load presented by the access. In
attempt to pre-serve DX access, 1st approach to ttt of this
complication shd be a flow reduction procedure.
If this’s not successful, then access closure should be considered.
Q.563. What are
the immune abnormalities developed in CKD/ESRD?
A. Abnormal in immune function in CKD
patient developed as a result of:
(1) Direct
effect of uremic toxins on immune cell function.
(2) Underlying renal condition.
(3) Therapy of
underlying R. condition.
(4) Effect of proteinuria.
Q.564. What is the effect of uremia on immune
system in CKD patients?
A. Uremia is
ass. é hypermethylation
of a No. of genes ass. é inflmm., ath-eroscl. & aging Ø changes in gene
expression & cell function. Uremia cn
affect: 👌
1) T-cell maturation.
2) T-helper (CD4)
cell function.
3) T-cell activation thr. defective costimulatory
signaling.
Neutrophil
function inhibition can occur thr. a No. of peptides tht’re detected
in HDX. U.F. & P.D.
effluent, wch. incl.:
1) Granulocyte inhibitory
proteins. (GIP) &
2) Degranulation inhibitory
proteins (DIP).
These proteins
inhibits all stages of neutrophlic response incl.: 👌
1. Chemotaxis.
2. Phagocytosis.
3. Degranulation.
This inhibition ➤ incr. susceptibility to bacterial infections in CKD & ESRD.
Monocyte/Macrophage:
Uremia ➤
Changes in cell surface expression of a No. of costimulatory
molecules necessary for effective Ag presentation & T-cell activation ➤ defective phagocytosis.
Monocyte activation➤ MIA. synd. (Malnutrition, Inflmm., Atherosclerosis) .
Q.565 What is the effect of proteinuria on the
immune function?
A. Nephrotic ptn loose proteins in
urine é non-selective proteinuria esp. Ig (Ig.
G. mainly) & complement components.
So, NRP➤ impaired
both: i. Innate (complement). & ii. Adaptive (IgG)
immune system, which➤ 🠉 risk
of infection esp. é encapsulated bacteria e.g. pneumococcus sp.. Risk of
infc. incr. if there’s breakdown † in
“skin integrity”, that may develop in severe edema.
COMMENTS