Chronic Kidney Disease Flashcards
What is CKD defined as?
Irreversible loss of kidney function, typically resulting from:
AKI: Long-term impairment if not managed properly
Hypertension: Prolonged HBP can damage blood vessels in the kidneys, leading to decreased filtration capacity.
Diabetes Mellitus: HBS levels contribute to nephron damage and promote glomerulosclerosis, where kidney tissues become hardened
Infection: Chronic infections can lead to inflammatory changes within the kidneys, causing further damage
What are some symptoms of CKD?
- Fluid overload
- Electrolyte imbalance
- SOB
- Altered mental status
What are some appropriate managements for CKD for HCP?
- Fluid management
- Medication administration
- Potential need for dialysis
What is essential and secondary hypertension in regards to CKD?
Essential hypertension: HBP without a known cause
Secondary Hypertension: Directly related to underlying kidney conditions and is responsible for approximately 85% of all secondary hypertension cases
What does this hypertension cause?
Damage to the renal blood vessels reduced blood supple to the kidneys, leading to ischemia
What does the kidney do in response to ischemia (decreased blood flow)?
They activate RAAS (Renin-Angiotensin-Aldosterone System)
This leads to vasoconstriction and increased BP to maintain perfusion.
How does Diabetes Mellitus impact kidney function?
Effects on the mesangial cells int he juxtaglomerular complex
What does High Blood Sugar Levels cause in regards to CKD?
Elevated glucose levels stimulate mesangial cells to proliferate and produce extracellular components, leading to the formation of scar tissues in the local glomerular area
What does scarring in the afferent arterioles cause?
Leads to increased pressure within the glomeruli, causing hyperfiltration injury
What happens when there is reduced filtration in regards to CKD?
Over time, the increased pressure and resultant stress on the glomeruli reduce their ability to filter waste effectively, leading to a decline in overall kidney function
What are some facts in relation to CKD and Cardiac Arrest?
- Sudden Cardiac Arrest is very common in CKD (75% of patients suffering a cardiac arrest have renal impairment)
- High potassium (hyperkalaemia) regularly occurs in 40-50% in patients with CKD = leads to life threatening arrythmias
- 32% of out-of-hospital cardiac arrest patients are found to have hyperkalaemia
What is the management of a patient with hyperkalaemia in a cardiac arrest?
History - fatigue, nausea, abdo pain, recently missed dialysis appt.
Look for ECG changes - hyper-acute T waves, sine waves, prolonged P-R interval
Recommended treatments:
- Calcium Chloride or Calcium Gluconate to stabilise cardiac membranes (HEMS/MERIT/BASICS)
- Sodium Bicarbonate to counteract acidosis
- Nebulised Salbutamol as a treatment for post-ROSC
What are some managements of CKD that patients can do?
Lifestyle and Dietary Advice:
- A balanced diet low in sodium, phosphorus, and potassium can help manage kidney function
- Weight management and regular physical activity are encouraged
Blood Pressure Management:
- Use of ACE inhibitors or ARBs is often recommended, particularly for diabetic patients
Cardiovascular Disease Treatment:
- Identifying and treating cardiovascular risk factors is critical as patients with CKD are at increased risk for heart disease
Referral to Primary Care
Fistula Awareness:
- For patients on dialysis it is important to monitor arteriovenous fistulas for function
- Check for a ‘thrill’ to confirm patency
- Never cannulate a fistula and avoid taking BP measurements on the same side as the fistula to prevent complications
What is Dialysis?
- Critical intervention for patients with end-stage renal disease, aimed at removing waste products and excess fluids when the kidneys are unable to function adequately
What are the two types of dialysis?
Haemodialysis
Peritoneal Dialysis
What is the procedure for Haemodialysis?
Blood is drawn from the body through an access point in the arm or leg (usually via a fistula, which connects an artery and a vein)
Blood passes through a dialyser (artificial kidney) where it is filtered and then returned to the body
What is the frequency and setting of Haemodialysis?
This procedure is typically performed three times per week in a hospital or dialysis centre and can take 3 to 5 hours per session
What is the Procedure of Peritoneal Dialysis?
This method uses a patients own peritoneal membrane as a filter
A catheter is placed in the abdominal cavity, and a sterile fluid called dialysate is infused
Waste products and excess fluid pass from the blood vessels in the peritoneum into the dialysate
How often is peritoneal dialysis?
Can be done at home and typically involves multiple exchanges of dialysate throughout the day
Each session lasting around 30 minutes
Different dialysate solutions can be used to control the removal of various substances based on individual needs
What are some complications of dialysis?
Deranged blood chemistry: Imbalances in electrolytes if sessions are missed
Excess fluid: Symptoms similar to heart failure to fluid overload
Exhaustion: Demands of dialysis treatments
Infection: Particularly peritonitis in patients undergoing peritoneal dialysis
