Chronic Kidney Disease Flashcards
Chronic Kidney Disease
Progressive, irreversible loss of kidney function
Most common causes of CKD
DM
HTN
Diabetic Nephropathy
damage to small vessels that supply the glomeruli due to DM condition
CKD RISK FACTORS
Age > 60 years
Males
Cardiovascular disease
Diabetes
Ethnicity – AA and Native Americans
Exposure to nephrotoxic drugs (severe IV infections) – contrast dye
Family history of CKD
Hypertension
If at risk of CKD, then you should get screened
annually
If albuminuria is present
use drugs to delay progression
-ACE, ANGIOTENSIN receptor antagonists
CKD pts need to tightly control
HTN and BG
Individuals with CKD are frequently
asymptomatic 70%
usually underdx and undertx
What are the stages of CKD?
1,2,3,4
Stage 5: ESRD or Kindey failure
Treatments of CKD are determined by
underlying cause
The stages of CKD are determined by
GFR
Stage 1 CKD GFR #
90+
Stage 1 CKD kidney function
normal function
BUT structural changes indicate damage
lacks perfusion
Normal GFR
125
Stage 2 CKD GFR #
60-89
Stage 2 CKD kidney function
damage with a mild decrease in GFR
UNDETECTABLE
Stage 3 CKD GFR #
30-59
Stage 3 CKD kidney function
+ Creatinine level
moderate to poor
increase in creatinine levels
At stage 3 CKD, you should use caution with
nephrotoxic agents (dye)
Stage 4 CKD GFR #
15-29
Stage 4 CKD kidney function
Prep for
poor
Dialysis prep
monitor electrolytes closely
no nephrotoxic
What electolyte should be closely monitored through diet and labs for Stage 4 CKD ?
K
CKD occurs after
pt does not hit the recovery phase
irreversible damage
Stage 5 CKD GFR**
15 OR LESS
Stage 5 CKD kidney function
End-stage renal disease
little to no function
What is needed for a Stage 5 CKD
RENAL REPLACEMENT or Transplant
build up of toxins (uremia) and only if desired
S/S of CKD
Devastating SYSTEMIC effect
Sodium/fluid balance alteration
increase of K
Toxic build up
Neurological symptoms
Altered calcium and phosphorus levels
Metabolic acidosis
Chronic anemia
HTN
Tx ESRD Metabolic acidosis
Bicarb
Lab Values of CKD
High serum creatinine/BUN/potassium
HIgh Mg (anemia and bleeding)
LOW creatinine clearance (excreted)
EITHER WAY serum sodium
LOW serum calcium
LOW CO2/hemoglobin & hematocrit
In general, is in ESRD the Na should be limited to
2 g a day
Nursing Managements of CKD
Preserve existing kidney function
Reduce risks of cardiovascular events and disease (CVD)
Prevent complications
Provide for patient’s comfort
Nutrition/glycemic control
Fluid management
Medication: ADVOCATE against nephotoxic
Monitor VS and lab values
Monitor I&O and daily weight
Skin care – tight and fragile
________ recognition, diagnosis, and treatment can slow the progression of kidney disease
Early
What medication needs to be used with caution for diabetics, and why?
Insulin
stay in system longer as usually filtered by the kidneys
Hemodialysis needs to evaluated
patency
infection
Hemodialysis arms should not take
BP
blood samples
Nutrition for ESRD
monitor and restrict:
protein (lean meats chicken or fish)
fluid (diuretics = no overload)
Na and K
Phosphate
Pts of Peritoneal Dialysis need to watch out for what in nutrition
protein intake high to compensate for loss
may need to increase
Protein InTAke for CKD
Should be carefully monitored
Normal for HD patient
Increased for Peritoneal D patient**
What lab parameters need to be watched for CKD?
Albumin
pre albumin
ferritin
Phosphate is _________ in ESRD
RESTRICTED
What juice is contraindicated in end-stage renal failure pts?
citrus = 480 mg of Potassium
give apple or water with sugar
Dietary approaches to stop HTN
fruits, vegetables, fat-free or low-fat milk and milk products, whole grains, fish, poultry, beans, seeds, and nuts
-leafy greens
What meal plan should be used for ESRD?
DASH
The DASH plan is significantly
lower BP
and lowers LDL cholesterol
Drug Therapy for CKD
K based on levels
control HTN and hyperlipidemia
bone disease = low Ca
anemia
Hyperkalemia
Restriction of high-potassium foods and drugs
IV glucose and insulin
IV 10% calcium gluconate
Sodium polystyrene sulfonate (Kayexalate)
**Dialysis may be needed **(too much K)
AntiHTN drugs
ACE
ARBs
Lethal Injection is
HIGH K
muscle relaxant
sedative
ACE reduces
reduce systemic vascular resistance in patientswith hypertension, heart failure or chronic renal disease
ARBs are used to
treat high blood pressure and heart failure. They are also used for chronic kidney disease and prescribed following a heart attack.
CKD- MINERAL AND BONE DISORDER
ca and Phosphours out of balance
- receiving dialysis
Phosphate not restricted until patient
requires renal replacement therapy
What phosphate is given for CKD-MBD
Phosphate binders
What should be avoided with phosphate and supplemented?
avoid aluminum
supplement Vitamin D
Phosphate BInders for Ca
Calcium acetate (PhosLo)/Calcium carbonate (Caltrate)
- bind and excreted in bowels
Sevelamer hydrochloride (Renagel)
lowers cholestrol and LDL
without cuasing High Ca
If anemis occurs in a CKD pt
Erythropoietin
aka Epoetin alfa (Epogen, Procrit)/Darbepoeitin alfa (Aranesp)
Erythropoietin does
GLYCOPROTEIN STIMULATES MARROW TO INCREASE RBCS
increased Hct and Hemoglobin 2-3 weeks effect
Erythropoietin side effects
Thromboembolism
HTN
Erythropoietin needs to be used with
iron
folic acid
Vitamin B12
Iron supplements used when
lower than 100 ferritin level
Iron causes
gastric irritation
constipation
dark-colored stool
Folic acid needed for
RBC formation
removed by dialysis
Blood transfusions
avoid if possible but if erythropoietin
Lasix
increase antibody development
Iron and fluid overload
Drug Therapy Complications for Anemia Toxicity by ESRD
Digoxin
Diabetic agents (insulin sensitivity)
Antibiotics
Opioid medications**(esp. after surgery)
Furosemide (Lasix)
The most frequently prescribed loop diuretic
Acts in the thick segment of the ascending Loop of Henle to block the reabsorption of water
Can promote diuresis even when renal blood flow and GFR are low
- lower K and pull fluid off
How long does it take erythropoietin to take effect?
2-3 weeks
