Coping with CKD

Question 1

What are the management options on offer to patients with CKD?

Answer 1

Conservative = diet, fluid control, medication
Dialysis = haemodialysis, peritoneal dialysis, medication
Transplantation = cadaveric, living donor, medication

Question 2

What are the physical effects of CKD?

Answer 2

Thirst = dehydration
Vitamin/mineral imbalance = osteopenia
Loss of interest in food = nausea, depression
Malnutrition
Anaemia = fatigue, tiredness

Question 3

What are some psychological effects that CKD may have on patients?

Answer 3

Self perception, despair, helplessness, anger, denial, depression

Question 4

What are some lifestyle areas that may be impacted with CKD?

Answer 4

Loss of employment, money struggles, inability to have children, relationship problems, loss of self-confidence, feeling stigmatised, loss of social support, inability to travel

Question 5

Why may fluids need to be restricted?

Answer 5

To prevent fluid overload = may be limited to 1-1.5 L per day of total fluid (including that from food)

Question 6

What effect can excess of some electrolytes have on the body?

Answer 6

Excess K+ = heart, hypertension, neurological
Excess salt = hypertension, neurological
Excess PO4 = bones

Question 7

How may patients have to change their behaviour?

Answer 7

Become more careful about fluids
Alter the amount of fruit and veg they eat
Changing their recipes

Question 8

What are some individual strategies that patients use to manage their dietary restrictions?

Answer 8

Using a small cup, cold flannel, sucking an ice cube or sweet, spices and herbs, using small quantities to add flavour

Question 9

What are the most common dietary treats that patients indulge in occasionally?

Answer 9

Chocolate, closely followed by crisps and cheese

Question 10

What are some foods that are high in potassium that need to be restricted?

Answer 10

Fruit and vegetables, potatoes, fish and seafood = some need prolonged cooking and rinsing

Question 11

What are some foods that are restricted in patients with CKD?

Answer 11

Dairy, red meat = high in PO4

Protein

Question 12

Why does alcohol need to limited?

Answer 12

Volume is the main issue = 1 pint of beer could be 1/3 to 1/2 of the daily allowance

Question 13

What are the benefits of renal replacement therapy?

Answer 13

Restores electrolyte and fluid balance
Removes urea and creatine from blood
Maintains erythropoietin production

Question 14

What is the main benefit of a transplant?

Answer 14

Offers patient more freedom = doesn’t have the same ties that dialysis does

Question 15

What is quality of life a good measure of?

Answer 15

Allows quantification of disease effects = can be used to explore transition effects and evaluate treatment effectiveness

Question 16

What are some side effects of drugs used to treat CKD?

Answer 16

Infections = UTI, GI, respiratory
Cancer (especially skin)
Adrenal suppression (for life)
GI upset and weight gain/loss
Hirsutism and change in body shape 
Tremors

Question 17

What are the negative aspects about transplants?

Answer 17

Patients have fear of transplant failing

Medications can make it difficult to get through airport security and require regular clinic appointments

Question 18

What impact do transplants have on carers?

Answer 18

Increased responsibility, pressure on relationships, depression, fatigue

Question 19

What are some coping mechanisms?

Answer 19

Avoidance coping = minimise importance, avoid confrontation, tends to be more acute response
Approach coping = confront, collect information, take action, tends to be response after longer time