End Stage Renal Disease

Question 1

What is ESRD?

Answer 1

The complete or almost complete failure of the kidneys.

Characterised as stage 5 chronic kidney disease, where GFR drops to only 10-15%

Question 2

Describe the incidence of ESRD

Answer 2

It generally takes around 10-20 years for CKD to reach end stage following diagnosis.

Question 3

What are are the two most common causes of ESRD

Answer 3

Diabetes and high blood pressure

Question 4

How does diabetes contribute to ESRD?

Answer 4

High levels of glucose in the blood damage the nephrons.

Question 5

How does hypertension contribute to ESRD?

Answer 5

increased pressure forced upon the small vessels in the kidneys leads to damage and also prevents the vessels from performing their job (filtering the blood).

Question 6

The loss of excretory function of the kidneys results in:

Answer 6

• build-up of toxins in the blood, which can negatively affect enzyme activities
• inhibit systems such as the sodium pump, resulting in altered active transport across cell membrane potentials

Question 7

Loss of regulatory function in the kidneys results in:

Answer 7

The inability to regulate extracellular volume and electrolyte concentrations

Question 8

How does ESRD affect a persons ability to exercise?

Answer 8

People may be :

• weak and tired
• may become hypotensive during exercise

Question 9

Why is timing of exercise is extremely important in ESRD?

Answer 9

Because there may be fluid build up before dialysis

Question 10

How is ESRD diagnosed?

Answer 10

• blood test: determine levels of serum creatinine (waste product that should be filtered out of your body)
• urinalysis: determine blood urea nitrogen
• Renal ultrasound or CAT scan: to rule out obstruction or congenital abnormalities that may contribute to increased creatinine levels in the blood
• Renal biopsy: to determine the eitiology of the disease

Question 11

What is the mainstream treatments for ESRD?

Answer 11

Dialysis

Question 12

What is this is the most common form of dialysis?

Answer 12

Haemodialysis

Question 13

Generally describe Haemodialysis

Answer 13

Clearance of fluid and toxic solutes from the blood via:
Two needles in a fistula, one directs blood out of the body and to the artificial kidney to be filtered (dialyzer), and the other directs blood back into the body.
The dialyzer clears substances from the blood

Question 14

Complications of Haemodialysis:

Answer 14

Hypotension, cramping, problems with bleeding, and fatigue

Question 15

Describe Peritoneal Dialysis

Answer 15

Introduction of a dialysis fluid into the peritoneal cavity through a permanent catheter placed in the lower abdominal wall.

Question 16

How is fluid introduced to a patient during Peritoneal Dialysis?

Answer 16

• Machine (which cycles fluid in and out over an 8-12 hour period)
• Manually (with 2-2.5L bags that are attached to tubing and emptied by gravity in and out of the peritoneum)

Question 17

What kinds of tests are inappropriate in ESRD?

Answer 17

Maximal

Submaximal

Question 18

What kinds of tests are appropriate in ESRD?

Answer 18

stair climbing, 6MWT, sit-to-stand, and gait speed tests.

Question 19

Special Considerations for clients with ESRD

Answer 19

• Individuals have a largely physically inactive lifestyle, therefore are fatigued and unwell.
• Education as to what levels of exercise are safe and necessary is important for the client and their family as well

Question 20

When would be the best time to exercise for ESRD patients?

Answer 20

On non-dialysis days and may be able to tolerate higher intensity or duration

Question 21

What frequency is recommended?

Answer 21

Aerobic: 4-5 days/week
RT: 2-3 days/week
Flexibility: daily (especially important during and after dialysis).

Question 22

What intensity is recommended?

Answer 22

Aerobic: based on RPE as heart rates are highly variable in this population. Once they can achieve 20mins of continuous exercise, Warm-up, conditioning and cool down: RPE of 9-10

Question 23

How would you progress?

Answer 23

Gradually decrease the rest interval and increase the work interval as exercise becomes more tolerable. To progress, they should gradually increase duration to 20-30 minutes or more at an RPE of 12-15

Question 24

What type of training would be most suitable for ESRD?

Answer 24

Interval training may prove to be useful when the client can only manage a few minutes of exercise at a time.
Non-weight bearing cardiovascular activity may be better for this population due to weak muscles and joint discomfort.