B5-092 Dialysis Flashcards
accumulation in blood of nitrogenous end products
azotemia
symptom complex resulting from failure to excrete nitrogenous end products
uremia
90% of patients with a GFR <30 are
anemic
appears at beginning of GFR stage 4
treatment for anemia due to CKD may require […] iron
(administration method)
IV
mineral and bone disorder is often evident in what stage of CKD?
3
most important symptom of CKD-MBD
vascular calcification
calcium deposits in small vessels of dermis
calciphylaxis
important player in the “trade-off” hypothesis of CKD-MBD
causes the increase in PTH
FGF23
most important cause of volume overload in CKD
sodium retention
diet for CKD
- low sodium
- low potassium
- low phosphorus
- fluid restriction
- protein restriction
meds for CKD
- phosphate binders
- calcitriol
- antihypertensives
- ESA
- treatment for renal disease
- treatment for comorbid conditions
indications for dialysis
- uremic pericarditis
- uremic encephalopathy
- severe bleeding with uremia
- fluid overload refractory to diuretics
- refractory metabolic disturbances
- refractory HTN
most common cause of death in CKD
heart disease
does kidney transplant or dialysis offer a better quality of life for CKD patients?
kidney transplant
if a patient had cancer and is currently in remission, and in need of kidney transplant, are they eligible?
yes after certain wait time depending on type of cancer
low bone density due to hormonal changes or calcium or vitamin D deficiency
osteoporosis
- occurs with a relatively suppressed PTH and alkaline phosphate levels
- associated with significant vascular calcifications
adynamic bone disease
defect of both low turnover and abnormal mineralization of bone
osteomalacia
why was osteomalacia more common in the past?
nephrologists used aluminum-based phoshorus binders
aluminum toxicity causes osteomalacia
class bone disease associated with renal failure
osteitis fibrosa
associated with increased bone turnover and elevated PTH and alkaline phosphatase
osteitis fibrosa
glucocorticoid therapy for primary renal disorder or renal transplant can lead to CKD patients developing
osteoporosis
bone disease in CKD with elements of both low and high bone turnover
uremic osteodystrophy
is osteoporosis typically caused by ESKD?
no
does increasing the frequency of dialysis improve survival or hospitalizations?
no
most likely positive outcome from increasing dialysis
improved blood pressure control
fluid removal
conservative management of ESKD has a […] shorter median survivial
2 year
patients who choose […] are more likely to die at home or in hospice and have lower rates of hospitilization overall
conservative management
individuals who chose […] maintain QOL over those who chose RRT
conservative management
patients who chose […] have shorter survival but fewer hospitalizations
conservative management
mortality and hbA1c have a […] relationship
U shaped
both high and low hemoglobin A1c are associated with
higher levels of mortality
lowest mortality in ESKD is seen in patients with a hemoglobin A1c of
7-8%
what should be done for a patient with persistent severe secondary hyperparathyroidism and four-gland hyperplasia who has not responded to medical therapy
subtotal parathyroidectomy
persistent PTH following kidney transplant with values above […] increase all-cause mortality and risk of graft loss
65
elevated PTH causes […] wasting
postassium
what procedure is required for evaluation prior to kidney transplant?
urethrocystoscopy with bladder capacity
[…] before kidney transplant is critical to prevent complications after transplant
urological assessent
many kidney transplant candidates have received dialysis for many years and have long periods of oliguria or anuria. This may result in
bladder dysfunction/atrophy
urethrocystoscopy prior to transplant to evaluate
patients who urinate greater than […] ml/d likely do not need urethrocystoscopy prior to transplantation
300
patients with <100 ml bladder capacity should receive treatment for […] prior to transplantation
improving bladder capacity
patients with a history of invasive bladder cancer must wait […] after successful treatment to be eligible for kidney transplant
2 years
superficial bladder cancer does not require waiting
patients who receive education and guidance from a multidisciplinary approach are more likely to choose
home-based modality
kidney transplants for a [….] donor are associated with longevity and fewer comorbidities
living
