ESRD Flashcards
What are the two most common causes of ESRD in the US?
- DM
2. HTN
What age and race has the highest incidence of ESRD
Blacks
75+
How many stages of CKD are there? What stage is ESRD? What should you do in Stage IV?
ESRD is stage 5 (GFR~15)
What 5 Sx’s worsen with the progression of CKD?
- Anemia
- Malnutrition
- Metabolis acidosis
- Secondary Hyperparathyroidism
- Hyperkalemia
What two forms of dialysis are offered?
- Hemodialysis
2. Peritoneal Dialysis
What is the gold standard treatment of ESRD?
Kidney transplant
What are 4 absolute indictions for dialysis?
- Hyperkalemia
- Metabolic acidosis
- Pleuritis/Pericarditis
- GI dysfxn (nausea, vomiting, gastroduodenitis)
What are three forms of hemodialysis Access? what is the most desirable? What is the least desirable?
- Fistula (best)
- AV Grafts
- Central venous catheter (worst)
When should you use a AV Graft and what are some complications?
use when pts dont have good veins
side fx: bacteremia can adhere to surface
–grafts dont have as good blood flow as fistula
What side fx’s are common in dialysis pts? what should you do about it?
Anemia (decreased EPO) - give pts iron IV
Hyperparathyroidism - Cinacalcin
Hypotension - Cardiac problems
What is the target Hb level?
10 to 11.5
Which treatment has better survival in the first 1-2 years? what about after 1-2 years
Peritoneal dialysis - better than HD during first 2 years
HD - better survival after 2 years
What type of treatment can be used it patient has healthy peritoneal and has good transfer?
Cycler - pt can sleep while it is being used
What is a Side fx of Peritoneal Dialysis? how do you combat this?
Peritonitis - has to be done sterile (PT COMPLIANCE) outflow failure pericatheter leak ab wall herniation intestinal perforation
What are contraindications of HD?
Hemodynamic instability
recurrent access problems (venous stenosis = SVC syndrome)
