Chronic Kidney Disease & End Stage Renal Disease Flashcards
what are modifiable and non-modifiable CKD risk factors
modifiable
- diabetes
- hypertension
- history of AKI
- frequent NSAID use
Non-modifiable
- family histroy of kidney disease, diabetes or hypertension
- age 60 or older (GFR declines normally with age)
- race
when should a nephrologist get involved in CKD?
when the the patient hits stage 4… SO when their GFR falls to 30 or below
- this is when we start seeing abnormalities
- can also be seen with rapid progression of CKD
- significant proteinuria
what are indications for the initiation of dialysis?
- volume overload
- hyperkalemia
- metabolic acidosis
- uremia
what are symptoms of uremia?
- AMS (not being able to have clear thoughts)
- Metallic food taste (urea also suppresses appetite)
- pericarditis
- pruritis
- nausea, vomiting, anorexia
what are ways to slow progression of CKD?
- Blood pressure control: good blood pressure control; goal SBP < 130
- Target A1-C < 7
- avoid insult to kidney: Contrast, nephrotoxic medications
how does RAAS inhibition slow progression of CKD?
- decrease the pressure in glomeruli
- reduce proteinuria
- prolongs the life of kidney
what medications should be adjusted to GFR?
- allopurinol
- gabapentin
- reglan
- narcotics
- insulin
- anti-microbials
- methotrexate
- digoxin & other heart medications
what systems do CKD affect?
- Hematological effects; anemia
- cardiovascular effects
- mineral & bone disorder
- metabolic acidosis
detect and manage CKD complications: Anemia
- initiate iron therapy if TSAT < 30% and ferritin < 500ng/mL (IV iron for dialysis, oral for non-dialysis CKD)
- individualize erythropoiesis stimulating agent (ESA) therapy: and maintain Hb < 11.5. ensure adequate Fe stores
- appropriate iron supplementation is needed for ESA to be effective
detect and manage CKD complications: Mineral and bone disorder
- treat with D3 as indicated to achieve normal serum levles
- 2000 IU po qd is cheaper and better absorbed than 50,000 IU monthly
- limit phosphorus in diet (CKD stage 4/5), with emphasis on decreasing packaged products
- may need phosphate binders
detect and manage CKD complications: Metabolic acidosis
- usually occurs later in CKD
- serum bicarb > 22mEq
- correction of metabolic acidosis may slow CKD progression and improve patients functional status
detect and manage CKD complications: Hyperkalemia
- reduce dietary potassium
- stop NSAIDs, COX-2 inhibitors, potassium sparing diuretics
- stop or reduce beta blockers, ACEI/ARBs
- avoid salt substitutes that contain potassium
how is CKD a coronary artery equivalent?
- CKD can cause HTN, volume overload, calcium metabolism problems and proteinuria
- this can increase strain on the heart coronary calcification
- heart failure coronary artery disease arrythmias
what are treatments of end stage renal disease?
- comfort care
- hemodialysis
- peritoneal dialysis
- kidney transplant
- process whereby the solute composition of a solution is altered by exposing the solution to a second solution through a semipermeable membrane
Dialysis
what types of dialysis are there?
Hemodialysis: Acute dialysis, chronic dialysis
- Blood is filtered using an extracorporeal circuit and an artificial membrane
Peritoneal dialysis
- blood is filtered using native intraabdominal vessels and peritoneal membrane
what are the general principles of dialysis?
- diffusion: movement of solute down its concentration gradient. It may or may not reach equilibrium (hydrostatic pressure = hydrostatic pressure)
- convection: movement of solute in mass transfer along with movement of ultrafiltrate fluid (Ph> Ph)
- ultrafiltration: movement of fluid secondary to a pressure applied across the membrane
what are dailysis access options
a. Arterio-venous (AV) access (fistula, graft)
b. Catheter: tunneled, non-tunneled, central venous, periotneal
what are complication of dialysis?
dialysis related
- water/volume mediated: hypovolemia
- solute mediated: electrolyte shifts, alkalemia
Access related
- non-funciton
- infections
- steal syndrome (AVF > AVG)
- High output heart failure (AVF)
- Central venous stenosis (catheters)
what are the possible catheter complications?
- non-function: low flow, thrombosis
- infections: catheter lumen/bacteremia, tunnel, exit site
- central venous stenosis/ thrombosis
pros and cons of peritoneal dialysis?
Pros
- more physiological
- better life style
- better mental satisfaction
- better economics
- less cardiac effects
- maintenance of residual renal
Con
- peritonitis
- membrane failure
- uncontroleld diabetes
Pros and cons of hemodialysis?
Pros
- readily initiated
- predictable performance
- better volume control
- three times a week
- no issues with blood sugar contrl
Cons
- lifestyle restrains
- access infections
- loss of residual renal function
- cardiac stunning
