Chronic Kidney Disease

Question 1

What are particular problems in people with chronic kidney disease?

Answer 1

• hypertension (from fluid and salt retention, activation of RAAS)
• FVE
• metabolic acidosis
• hyperkalemia
• anemia
• bone disease (low calcium levels will prompt loss of calcium from bone)

Question 2

When does a patient with chronic kidney disease require dialysis?

Answer 2

• uremia
• hyperkalemia
• metabolic acidosis
• FVE not responding to diuretics or fluid restriction

Question 3

What are the different types of dialysis?

Answer 3

• hemodialysis

- peritoneal dialysis

Question 4

What types of things should a nurse monitor for when a patient is receiving dialysis?

Answer 4

• need to be aware of what medications will be removed with the dialysis
• massive impact on lifestyle, assess coping
• monitor for clotting in the circuit, air embolism
• ensure no leaks in system, no contamination

Question 5

What medications might someone with chronic kidney failure be receiving?

Answer 5

• calcium supplement
• phosphate binding agent
• activated vitamin D
• antihypertensive (and cardiac meds)
• bicarbonate?
• EPO and iron

Question 6

What nutritional changes might someone with chronic kidney disease make?

Answer 6

• fluid restriction
• sodium restriction
• low potassium diet
• low protein
• high calorie
• supplementation (calcium, activated vitamin D?)

Question 7

Explain hemodialysis.

Answer 7

• can be short term or long term
• patients usually have 3 times a week for 3-4 hours
• blood removed, put through dialyzer where the is a synthetic membrane and dialysate solution
• waste, electrolytes, water are drawn out by osmosis and diffusion
• patients receive heparin so their blood doesn’t clot in the system
• requires vascular access (CVC, fistula)

Question 8

Explain peritoneal dialysis.

Answer 8

• peritoneal membrane used as a semi-permanent membrane
• dialysate solution with particular concentrations used to draw out waste and water using diffusion, osmosis
• cycles of exchanges (infusion, dwell, drainage)
• it is normal to see some blood in the first few exchanges
• takes hours, can be done at night

Question 9

What key diagnostic value is monitored in chronic kidney disease?

Answer 9

GFR

Question 10

How is chronic kidney disease categorized using GFR?

Answer 10

stage 1 - GFR under 90
stage 2 - GFR 60-89
stage 3 - GFR 30-59
stage 4 - GFR 15-29
stage 5 - GFR under 15, kidney failure/end stage renal disease

Question 11

What are main complications of dialysis?

Answer 11

hemodialysis:

• infection of access site
• clotting or bleeding

peritoneal dialysis:
- peritonitis