End Stage Renal Disease Flashcards
What is ESRD?
The complete or almost complete failure of the kidneys.
Characterised as stage 5 chronic kidney disease, where GFR drops to only 10-15%
Describe the incidence of ESRD
It generally takes around 10-20 years for CKD to reach end stage following diagnosis.
What are are the two most common causes of ESRD
Diabetes and high blood pressure
How does diabetes contribute to ESRD?
High levels of glucose in the blood damage the nephrons.
How does hypertension contribute to ESRD?
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).
The loss of excretory function of the kidneys results in:
- 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
Loss of regulatory function in the kidneys results in:
The inability to regulate extracellular volume and electrolyte concentrations
How does ESRD affect a persons ability to exercise?
People may be :
- weak and tired
- may become hypotensive during exercise
Why is timing of exercise is extremely important in ESRD?
Because there may be fluid build up before dialysis
How is ESRD diagnosed?
- 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
What is the mainstream treatments for ESRD?
Dialysis
What is this is the most common form of dialysis?
Haemodialysis
Generally describe Haemodialysis
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
Complications of Haemodialysis:
Hypotension, cramping, problems with bleeding, and fatigue
Describe Peritoneal Dialysis
Introduction of a dialysis fluid into the peritoneal cavity through a permanent catheter placed in the lower abdominal wall.
How is fluid introduced to a patient during Peritoneal Dialysis?
- 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)
What kinds of tests are inappropriate in ESRD?
Maximal
Submaximal
What kinds of tests are appropriate in ESRD?
stair climbing, 6MWT, sit-to-stand, and gait speed tests.
Special Considerations for clients with ESRD
- 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
When would be the best time to exercise for ESRD patients?
On non-dialysis days and may be able to tolerate higher intensity or duration
What frequency is recommended?
Aerobic: 4-5 days/week
RT: 2-3 days/week
Flexibility: daily (especially important during and after dialysis).
What intensity is recommended?
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
How would you progress?
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
What type of training would be most suitable for ESRD?
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.
