Kidneys Flashcards
Renin
kidney blood pressure hormone. It helps control how much sodium (salt) and fluid the body saves and how relaxed the blood vessels are. People with kidney disease usually need blood pressure pills because their kidneys no longer control blood pressure.
Erythropoietin (EPO)
kidney hormone that tells the bone marrow to make new red blood cells (using stem cells). Many people with kidney disease have anemia, a shortage of red blood cells, that makes them feel very tired. Injections of EPO are used to treat anemia, along with iron.
Calcitriol
activated form of vitamin D
a hormone that helps the body absorb calcium from food. Without calcitriol, the body steals calcium from the bones. Over a long period of time, this can cause bone disease. Calcitriol injections or pills are used to help avoid bone disease in people with kidney disease.
Amount of fluid/waste filtered
2 quarts
Causes of kidney failure
#1 - Type 2 diabetes #2 - hypertension (Normal BP = 120/80; Normal BP in CKD
Weight of kidney
5 ounces
size of fist
Acute Renal Failure (ARF)
sudden loss of kidney function caused by an illness, injury, or toxin that stresses the kidneys. Many cases of ARF can be treated and reversed.
Chronic Kidney Disease (CKD)
CKD is a long and usually slow process where the kidneys slowly lose function
More than 75% of the one million nephrons in each kidney must be damaged to cause illness. This means that small declines in renal function do not cause a problem right away. It can take many years to go from CKD to ESRD.
End-Stage Renal Disease (ESRD)
When the kidneys function at 15% or less
Warning Signs of CKD
Changes in urination – like foamy urine, blood in the urine, more or less urine than usual, or getting up at night to urinate
Fatigue – lack of usual energy and feelings of overwhelming tiredness can be related to kidney failure
Itching – the build-up of wastes in the blood can cause severe itching
Swelling in the hands and/or feet – failing kidneys don’t remove extra fluid, which builds up in the body
Shortness of breath – extra fluid can build up in the lungs, or anemia can cause shortness of breath
Pain in the small of the back – the pain is not made worse by movement
CKD Stage 1
Kidney damage with normal or increased GFR
GFR ≥ 90
Treat: Diagnose and treat other illnesses; reduce heart disease risk
CKD Stage 2
Kidney damage with mildly reduced GFR
GFR = 60 - 89
Treat: estimate the rate of CKD progression
CKD Stage 3
Moderately reduced GFR
GFR = 30 - 59
Assess and treat complications
CKD Stage 4
Severely reduced GFR
GFR = 15 - 29
Prepare for kidney replacement therapy
CKD Stage 5
Kidney Failure
GFR
Treatments
Anemia treatment – anemia (a shortage of red blood cells) starts very early in kidney failure and can make you very tired.
Medication – for example, blood pressure pills called ACE inhibitors or angiotensin receptor blockers (ARBs) can help protect kidney function.
Eating changes – some doctors believe a low protein diet can help slow kidney disease.
Avoiding certain pain pills – overuse of some over-the-counter pain pills with ibuprofen, naproxen, acetaminophen, or pain medications with caffeine in them can damage kidneys.
Regular blood pressure checks – high blood pressure can cause or speed up kidney failure.
Cut back or quit smoking – smoking tobacco can make kidney problems worse.
Uremia
When a person reaches ESRD, both kidneys have stopped or almost stopped and the body fills up with extra fluid and wastes that would normally be filtered out
Uremia Signs
Head – headaches, fatigue, and fuzzy thinking can be caused by uremia.
Mouth – food may taste bad or like metal, causing a loss of appetite.
Lungs – shortness of breath can be caused by a build-up of fluid in the lungs or by anemia.
Stomach – loss of appetite, nausea, and vomiting can occur if uremia is very severe.
Bladder – less (or no) urine may be produced. Some people still make urine, but it is mostly fluid—the wastes are not removed.
Hands – swelling can be caused by fluid build-up.
Feet – swelling can be caused by fluid build-up.
Skin – build-up of uremic wastes can cause severe itching.
Blood vessels – high blood pressure can occur, because the failing kidneys no longer keep blood pressure at normal levels.
ADA Glucose Test Recommendation
Annual glucose tests for:
- People with a family history of diabetes
- People who are obese
- Women who have delivered a baby weighing over 9 lbs.
- African-Americans, Hispanic Americans, Native Americans, Asian-Americans, and Pacific Islanders
How Dialysis Works
During dialysis, blood and dialysate are kept apart by a membrane (in PD, the peritoneal membrane has small blood vessels). Wastes and fluid flow out through tiny holes in the membrane. Blood cells and protein, which the body needs to keep, are too big to pass through, and stay in the blood.
Dialysate helps to pull the wastes out of the blood. Once dialysate is used, it is thrown away.
Peritoneal Dialysis
Uses your body (the peritoneum) instead of a machine
The peritoneum is a membrane that lines your abdominal cavity—it’s like a bag, holding your internal organs.
A PD catheter is placed in the lower abdomen, or less commonly, a “bathtub” or presternal catheter is placed in the chest
To do PD, this bag is filled up with a special fluid, called dialysate (dye-al’-i-sate). Wastes and extra fluid in the blood slowly flow into the dialysate. This is called a PD Exchange
Patients are trained to do it themselves at home
CAPD
Continuous Ambulatory Peritoneal Dialysis
Describes when people do PD exchanges by hand at home every few hours
3-5 exchanges per day; each takes ~30 min
Few food and fluid limits are needed; traveling is okay
Peritonitis
Infection associated with CAPD
CCPD (or Automated PD)
Continuous Cycling Peritoneal Dialysis
Uses a machine called a Cycler to do exchanges at night
Can be packed for travel or CAPD can be done while traveling
Medicare covers this immediately
PD Pros
Fewer limits on food and fluid
No ups and downs
You do the treatments yourself and decide the schedule
No needles; generally painless
Easier to travel
Gentle on the heart
PD Cons
Bloating; may need extra protein because of the sugar in the dialysate
Every exchange must be done carefully
Daily treatments
Catheter is permanently in your body
Works best for smaller people
Storing PD supplies takes space
Need precautions for some activities to avoid infection
Can cause weight gain
Hemodialysis (HD)
Uses special filter called Dialyzer - contains thousands of hollow fibers punctured with millions of tiny holes
Blood moves through inside of dialyzer fibers; blood cells and proteins are too big to pass through, so they go back to the body. Wastes and extra water go through holes and into dialysate fluid that is thrown away
Cleans 1 cup of blood outside the body at a time
Done 3x/week in a center for 3-4 hours each treatment; Longer is better
Only replaces about 10% - 15% of normal kidney function
Fistula Access
An artery and a vein are surgically linked to each other. Fistulas are usually placed in an arm. This is the best type of access because fistulas last longer and are less likely to clot or become infected
Graft Access
An artificial vein is used to surgically link an artery to a vein. Grafts can be placed in an arm or a leg.
Catheter Access
A Y-shaped plastic tube is placed into a large vein in the chest, neck, or groin. Because there is a high risk of infection, catheters are usually used only for temporary access.
HD Side Effects
Generally painless
if there is a lot of fluid to remove, painful cramping, headaches, faintness, nausea, shortness of breath, and other problems can occur
Salt and fluid limits are necessary
Some people want EMLA cream or liquid lidocaine to freeze the skin
In-Center HD Pros
Only 3x a week
Done by trained nurses and techs
Hours of personal time
Meet and spend time with other patients
Local anesthetics available
Usual activities okay
In-Center HD Cons
Very strict fluid limit and meal plan; treatment is time consuming
Centers are not necessarily comfortable
Treatment schedule may not fit your work schedule
Two needle sticks with large needles are used
Fistula or graft looks like a big, rope-like vein
Hard to travel spontaneously
Ups and downs depending on when the treatments are done
Toxins not removed on off days can build up over years and cause damage to nerves, joints and bones
In-Center Self Care HD
patients are trained to do as much of the treatment as they want to learn
Medicare starts right away instead of after three months
Home HD
Requires a partner to help
Doing longer and more frequent HD treatments can get rid of most symptoms
Medicare can start right away if home HD starts before the third month of dialysis
Center provides the machine, medicare pays
Done every other day since the two-day dialysis weekend can cause heart failure
Short, daily treatments = 5-7 times/week, 2+ hours per day
Nocturnal = at night for 8 hours, 3-6 nights per week
Medicare only pays for 3x per week so you need to appeal for more or get different health insurance
Benefits of Home HD
Fewer diet and fluid limits
With more HD, BP is more likely to be normal, so less likely to develop left ventricular hypertrophy
Blood chemistry levels are closer to normal, helping with problems like neuropathy, amyloidosis (build up of waxy protein in joints, tendons and bones) and bone disease
Kidney Transplant
Blood and tissue must match
Major surgery required
50% will have no further problems
35% will have some problems: new onset of diabetes, heart attack, complications, re-operation, hospitalization, rejection
15% will have major problems - die in the first year from heart attack, stroke, infection or other cause; some will return to dialysis; some will lose transplant function
Kidney Team
Nephrologist, RN, RD, and social worker with a masters degree (MSW)
Nurses
Licensed Practical Nurse (LPN) – completes a 2-year training program
Registered Nurse (RN) – completes a 2- or 4-year college degree and passes a special test
Certified Nephrology Nurse (CNN) – a registered nurse who also completes training focused on nephrology and passes a special test
Nurse Practitioner (NP) – completes special training for providing primary health care and passes a special test
Diet
Potassium does not get removed, so you must be careful with ingesting too much potassium because sudden heart failure can occur
Health Care Team B
Surgeon Home Dialysis Supplier Vocational Rehabilitation Counselor Physical Therapist Occupational Therapist Pharmacist
BP Medications
to prevent damage to your heart and blood vessels. Some blood pressure drugs (like ACE inhibitors and ARBs) also slow down some types of kidney disease. If you do peritoneal dialysis (PD) or daily or nocturnal hemodialysis (HD), most often at home, you may need fewer blood pressure pills, or you may not need them at all, since these treatments do a better job of controlling blood pressure than standard in-center HD treatments.
Cinacalcet
to help treat too-high levels of parathyroid hormone that can cause bone disease.
Erythropoietin stimulating agents (ESA)
injections to treat anemia (a shortage of red blood cells) by making more red blood cells. Treating anemia can give you more energy and help prevent heart damage.
People on dialysis get ESAs while they are treated, and they may have the drug injected into the dialysis tubing. ESAs are costly drugs, so some negotiation may be needed to get insurance to pay for them. For people who are on dialysis, ESAs are paid for by Medicare.
EPOGEN (Epoetin alfa, Amgen Inc.)
PROCRIT (Epoetin alfa, Ortho Biotech)
Aranesp (darbepoetin alfa, Amgen Inc.)
Reduce fatigue, increase appetite, improve endurance
Phosphate binders
antacids or special drugs taken to help your body get rid of extra phosphorus that can cause itching and long-term bone problems. If you do daily or nocturnal HD (most often at home), you may need fewer binders—or even no binders at all—since these treatments remove so much more phosphorus than standard in-center HD does.
Carnitine
to help build stronger muscles
Proteinuria
protein in the urine, measured with a dipstick test. Protein is usually too big to fit through nephrons, so protein in the urine indicates kidney damage
Microalbuminuria
microscopic amounts of albumin in urine. people with diabetes who have microalbuminuria are at high risk for kidney disease. Treatment with ACE inhibitors or ARB’s can help protect kidney function of condition is found early
ADA recommends all people with diabetes have urine checked once a year
Diet and Fluids
Symptoms range from none to flu-like, loss of appetite, metal taste in the mouth, aversion to meat, chicken and fish
malnutrition is a risk in normal weight patients - linked with higher risk of infection, hospital stays and death
drink excess fluids, eat less salt, eat less protein
PD - may gain weight from dialysate sugar
In-Center HD - fluid you drink depends on urine you produce
CHF
In-Center HD - may need to cut back on fluids to keep the heart from stretching, which forces the heart to pump harder without success, causing shortness of breath and CHF
Your heart pumps blood through your body. Heart failure means that your heart pumps too weakly to keep up with your body’s needs. Without a strong blood flow from your heart to the rest of your body, you feel tired and worn out. Also, blood backs up in your veins. Fluid can seep out of your veins and build up in your lungs and other parts of your body. This extra fluid can make it hard to breathe, and can build up in your legs, ankles, and other parts of your body.
Symptoms of congestive heart failure include:
Shortness of breath Decreased exercise tolerance Muscle weakness Swelling of the legs, feet, or ankles Swollen neck veins Abdominal swelling, pain, or nausea Mental confusion Palpitations (extra heart beats) Fast heartbeat
In-Center HD Fluid Advice
Suck on hard candies or mints (sugar-free if you have diabetes).
Use moist mouth swabs.
Swallow pills or capsules with soft foods (like applesauce or pasta) instead of using fluid.
Drink your fluids very cold, or even frozen (as ice cubes or “slushies”).
Put a bottle with your entire daily amount of your favorite fluid in the fridge. When it’s empty, you’re done for the day.
Buy and freeze plastic liquid-containing party ice cubes. Suck on them to get a nice, cold feeling without fluid (make sure these are free of leaks and large enough to avoid choking).
Eat soups, stews, and cereals with a fork to avoid the liquid.
HD Care
People may think that they need less HD because they feel better, but there is no such thing as too much
Vascular Access Care:
- Keep your access clean. Wash your access with antibacterial soap and iodine or alcohol before it is used for dialysis.
- Tell the nurse if your access is warm, red, has pus, or you have a fever.
- Learn how to feel the thrill (vibration) of the access and listen for the bruit (buzzing) in your access. Changes in the thrill or bruit help to diagnose when a blockage may be present in the access.
- Do not carry heavy weight across the access—but do go on with normal activities and use of the access limb. Squeezing a rubber ball or lifting moderate-sized weights can help the access develop and keep blood flow strong. Ask your doctor about it!
- Avoid pressure on the access during sleep.
- Exercise (as instructed) with a squeeze ball.
- Do not allow blood pressure checks or blood draws from the arm with the access.
Anemia
Shortage of oxygen-carrying RBC’s
As kidney’s fail, they make less EPO - less RBC’s being made - anemia
Most common symptom is fatigue
Symptoms: Fatigue/loss of energy Feeling cold all the time Shortness of breath/chest pain Pale skin, gums, and fingernail beds Trouble concentrating Dizziness/lightheadedness Headaches Changes in menstrual cycles (women) Difficulty with erections (men) Slower-than-usual growth (children)
Anemia and Iron
Iron is the building block for RBC production. Without iron, EPO can signal bones but RBC’c can’t be made.
Iron in food isn’t very well absorbed, almost all of the iron used to make RBC’s comes from the breakdown of old RBC’s
HD patients lose RBC’s at each treatment, and everyone drop of blood lost counts
Anemia begins EARLY in kidney disease - at about 45% function
Anemia Progression
- Kidney Dz
- Less EPO production
- Fewer RBC’s (anemia)
- Less oxygen to the body
- Fatigue, shortness of breath, etc.
Left Ventricular Hypertrophy (LVH)
Heart pumps harder to get more oxygen to the muscles, causing it to get bigger and bigger
LVH usually starts when kidneys are failing, after anemia has developed.
When kidney failure occurs, nearly 75% of people already have LVH
Treating Anemia
Erythropoiesis stimulating agents (ESA’s)
EPOGEN (Epoetin alfa, Amgen Inc.)
PROCRIT (Epoetin alfa, Ortho Biotech)
Aranesp (darbepoetin alfa, Amgen Inc.)
Reduce fatigue, increase appetite, improve endurance
**Doctor may prescribe IRON SUPPLEMENTS in addition to ESA’s
Small test dose will be given because 1% of people have a bad reaction to iron injections - if pt begins to wheeze or have trouble breathing, give epinephrine or corticosteroids to fight reaction
FDA Warning on ESA’s
ESA’s should be used to maintain a hemoglobin level between 10 and 12 g/dL
Higher HGb levels in patients with chronic kidney failure may increase risk of death
Iron Facts
Liver (all kinds), iron-fortified cereals, beef, pork chops, poultry, lima beans, and kidney beans are the food sources with the most iron? Some of these foods may not be good choices for people with kidney disease, so talk to a dietitian before making any food changes.
One out of every 200 to 300 people has a genetic problem called hemochromatosis, which causes a buildup of too much iron? The treatment: removing some blood.
Vitamin C helps you absorb more iron, when you take them together? (NOTE: People on dialysis should limit Vitamin C to 60 mg/day.)
Combining iron with coffee or a high-fiber diet means you absorb less?
Iron pills or vitamins containing iron are the number one cause of poisoning deaths in children under 6—even with childproof caps? (As with all of your drugs, keep iron pills out of the reach of children.)
Get iron in the diet by cooking in a cast-iron skillet
Measuring Anemia
CBC - measures Hgb (or Hb) and measures Hct (or crit)
(sometimes together nicknamed H&H)
When hgb levels are low, RBC’s lose their vibrant red color and appear pale and misshapen
Also check for Reticulocyte count (number of new RBC’s) and Iron Levels
Also check stool for occult (hidden) blood
Normal Hgb Values
Hgb:
Men: 14 - 18 g/dL
Women: 12 - 16 g/dL
M&W w/ Kidney Dz: 10 - 12 g/dL
Normal Hct Values
Hematocrit measures percent of blood that is made up of RBC’s
Sensitive to dehydration so not typically used for dialysis patients
Men: 40% - 50%
Women: 35% - 44%
M&W w/ Kidney Dz: 33% - 36%
Measuring Iron Levels
Ferritin or Serum Ferritin Transferrin Saturation (TSAT)
Serum Ferritin
Storage protein for Iron pool - test measures how much iron is stored in the body
Normal: 30 - 300 ng/mL
Dialysis: 100 - 1,200 ng/mL
low levels - doctor may prescribe iron
Too much iron can be dangerous because it can build up in tissues and organs, causing damage or death
Transferrin Saturation (TSAT)
How many building blocks of iron are in the body to make RBC’s
Low means iron deficiency (often r/t blood lose) or problems with your body releasing stored iron when it is needed
may need iron supplementation if low
Normal: 20% - 50%
Patient Role in Managing Anemia
- always ask to see lab test results and track them in a notebook
- ask doctor for target levels
- ask doctor to explain how to bring your lab tests back into target range if they are outside
- keep diary of symptoms - what, when, what helps
- if diagnosed with anemia but not being treated, ask doctor why
- keep track of dosages of ESA’s and iron
- take your medications in the right dose, right time and right way
Calcium Labs
Hypercalcemia - sick to your stomach, confused, irritable, and even coma
Hypocalcemia - depression, numbness, seizures, confusion or painful muscle spasms
PD: 8.4 - 10 mg/dL
Phosphorus Labs
Mineral that is vital to energy use; found in almost all foods
Measured in blood as phosphate; stored in bones and teeth
Kidney failure = phosphate levels increase
Hyperphosphatemia - itch all over, bone damage
hypophosphatemia - muscle weakness and coma (this is rare)
PD: 3.5 - 5.5 mg/dL
Early in Kidney Dz - extra P and Ca float in blood - extra P tells body to pull Ca out of storage - Weak bones
EXTRASKELETAL or METASTATIC CALCIFICATION- Sharp Ca/P crystals can form in blood and damage vessels
Take phosphate binders with food
Daily home HD or nocturnal HD removes more P than standard in-center Hd
Potassium Labs
Electrolyte that allows nerves and muscles to work
Healthy kidneys control blood potassium
Found in fruits and vegetables - oranges, bananas
Hyperkalemia - weak muscles and can stop your heart
Hypokalemia - fatigue, muscle weakness, paralysis, abnormal heart rhythms
K
Sodium Labs
Most plentiful ion outside your cells
Hypernatremia - excess thirst, raise blood pressure, headaches, retain water, edema
Hyponatremia - RBC bursting, low BP, feeling faint, muscle spasms, headaches, N/V, seizures and coma
Kidney Function Tests
BUN
Creatinine
GFR
BUN
Urea = breakdown of cells or dietary protein excreted in urine by the kidneys
Kidney failure = urea stays in blood
- Test BUN for kidney function and to calculate how much dialysis you are getting
Healthy: 5 - 25 mg/dL
Dialysis: 60 - 80 mg/dL
Creatinine
Waste product from normal use of muscles during activity - bigger muscles = more creatinine
Does not change with diet
More sensitive kidney disease test than BUN but doesn’t account for differences in weight, gender or race
Men: 0.5 - 1.5 mg/dL
Women: 0.5 - 1.3 mg/dL
Dialysis: 10 - 18 mg/dL
GFR
Estimation of kidney function based on gender, race and serum creatinine
Gold standard measure of kidney function
www.davita.com/gfr-calculator/
Normal: 135 - 200 L/d
Healthy: 90+ mL/min/1.73m2
Tests for Dialysis
hemodialysis adequacy
urea reduction ration (URR)
Hemodialysis Adequacy
In people on HD, the BUN is used to tell if the minimum dose of dialysis is being given, which is called HD Adequacy
Urea Reduction Ratio (URR)
Once a month, BUN is measured before HD and then again after the treatment. The two levels are compared in URR - tells you if you got the minimum dose
Standard In-Center HD: at least 65% or higher - higher is better because more dialysis is better
URR = (Predialysis BUN - Postdialysis BUN) / Predialysis BUN x 100
Kt/V
Another measure of HD adequacy
K = dialyzer clearance in mL/min t = length of dialysis treatment in minutes V = volume of water in body that contains urea
Standard In-Center HD: 1.2 or higher
Minimum prescribed dose should be at least 1.3
In PD, weekly Kt/V is calculated = should be at least 2.0
Parathyroid Hormone (PTH)
Parathyroids are four tiny glands in neck that make PTH when Ca levels fall - PTH helps absorb dietary Ca - high phosphate levels lead to high PTH
INTACT PTH (iPTH) are measured b/c high levels mean your glands may be getting bigger and making too much PTH - body responds by pulling Ca out of bones - frail bones
Healthy: 16 - 65 pg/mL
CKD III: 35 - 70 pg/mL
CKD IV: 70 - 110 pg/mL
CKD V: 150 - 300 pg/mL
iPTH: 150 - 300 pg/mL
Calcium-Phosphorus Product (Ca x P)
Multiply serum Ca by serum P
measure risk of developing Ca/P crystals
Kidney Dz & over 12 y.o.:
Urine Tests
Urine blood or urine hemoglobin (heme) Creatinine clearance Urine albumin Microalbuminuria Albumin-to-creatine ratio
Urine Hemoglobin
Tests to see if there is blood or Hgb in urine
Blood can mean damage to kidneys or urinary tract
also caused by heavy smoking, jogging, bladder infections
Creatinine Clearance
How fast kidneys remove creatinine from blood
24-hour urine collection
Blood sample and urine compared to see how much creatinine your body is making vs. how much kidneys are removing
Men: 97 - 137
Women: 88 - 128
(mL/min/1.73 m2)
Urine Albumin
How much protein passes through the kidneys and into the urine
Finding protein means tiny blood vessels are “leaky”
Measured with a dipstick
People with diabetes show that kidney dz starts slowly, even before protein can be found in urine
10 - 140 mg/L, or
Microalbuminuria
very tiny amounts of protein
highly sensitive measure of protein in urine
Can be treated with BP drugs
can be tested with a single urine sample or 24-hour urine collection
Albumin-to-creatinine ratio
one sample of urine in a cup is tested for protein and creatinine together
more convenient than 24-hour urine collection and not sensitive to hydration levels
Men: 250 mg/g
W: >355 mg/g
General Health Tests
Serum albumin Cholesterol Triglycerides Fasting blood glucose (FBG) Hemoglobin A1c (HbA1c)
Serum Albumin
measures overall nutrition
when kidneys are failing, you may not want to eat meat or other protein foods, which can cause malnutrition and result in death in people on dialysis
Good: > 4.0 g/dL
Cholesterol
soft, waxy fat in blood - insulates nerve cells, helps form cell membranes and helps with hormone production
measured after overnight food and alcohol fast
TC:
Good: 150 - 199 mg/dL
Borderline high: 200 - 239 mg/dL
High: 240 mg/dL or more
HDL:
Good: 60 mg/dL or more
Risk of heart dz:
Triglycerides
95% of all the fat in our diets and bodies
test measures risk of heart disease and body’s ability to use fat effectively
diabetes raises TG levels
measured after overnight food and alcohol fast
M: 40 - 160 mg/dL
W: 35 - 135 mg/dL
Fasting Blood Glucose (FBG)
measure of how much sugar is in the blood
high after overnight fast could mean diabetes
type 2 diabetes is the number one cause of kidney failure
Normal:
Hemoglobin A1c (HbA1c)
measure of average glucose levels over past 2-3 months
done every 3 - 6 months
CKD Meal Plan
- Limit protein: slow CKD progression and avoid build-up of urea, but can also lead to malnutrition
- Drink more fluids
- Phosphate binders
- Eat less phosphorus
- Limiting Salt
Protein Supplements (Dialysis)
Many high pro foods are also high in P
Whey protein powder added to foods like:
- pudding or cream pie fillings
- applesauce
- shakes, fruit juice or milk
- low sodium soups
Vegetarians on Dialysis
Beans, soy and grains have high levels of K and/or P
Visual Protein Measurements
1 oz = matchbook
3 oz = deck of cards
8 oz = paperback book
Sodium and PD
3,000 - 4,000 mg/day sodium
Starfruit and PD
Aka carambola
Hazardous on PD - can cause agitation, confusion and even death
Potassium and PD
3,000 - 4,000 mg/day
Levels are good if
K
Phosphorus and PD
Limit to 800 - 1,200 mg/day
Always check if you are in target ranges:
Calcium: 8.4 - 10 mg/dL
Phosphorus: 3.5 - 5.5 mg/dL
Calcium-phosphorus product:
Phosphate Binders
attract excess phosphorus and remove it in your stool
Antacids (Tums)
special drugs - Renagel, Renvela, PhosLo, Fosrenol
take within 5 - 10 minutes before or after your snacks and meals
Antacids
Not all are good binders
some calcium-based may be safe for dialysis
Rolaids, Milk of Magnesia, Mylanta, etc. may contain aluminum or magnesium - these can build up to toxic levels in people on dialysis
Vitamins and PD
Slightly different needs than healthy population because dialysis washes out some vitamins
dialysis-specific supplements
PD and Vit A
helps with eyesight, bone and tissue growth, and immunity
need 0
PD and Vit B1 (thiamin)
energy production, nerve function, carb use
1.0 - 5.0 mg/day
PD and Vit B2 (riboflavin)
turns nutrients from food into energy
1.2 - 1.7 mg/day
PD and Vit B5 (pantothenic acid)
energy use, use of food, hormones
4.0 - 7.0 mg/day
PD and Vit B6 (pyridoxine)
protein use, helps body form RBC’s, helps form DNA
10 mg/day
PD and Vit B12 (colabamin)
maintain healthy nerves and RBC’s, helps form DNA
2 mcg/day
PD and Vit C (ascorbic acid)
structure of bones, cartilage, muscle and blood vessels
60 mg/day
**Too much can hurt you on dialysis - creates crystal called oxalate - healthy kidneys can remove it, but dialysis cant as well
oxalate build up can cause bone and joint deposits and pain
PD and Vit D (calciferol)
helps Ca and P absorption
different for everyone
PD and Vit E (tocopherol)
protect cells from free radical damage
0
PD and Vit K (menadione)
blood clotting
0
PD and Biotin
helps body use protein, folic acid, and vits
0.03 - 0.1 mg/day
PD and Folic acid (folate)
helps form RBC’s and DNA
0.8 - 1.0 mg/d
PD and Niacin (nicotinic acid)
helps skin, nerves and digestive system
13 - 19 mg/d
Fluid and PD
Dialysis removes excess fluid because too much can cause:
edema, headaches, low energy, trouble breathing, heart damage, high blood pressure
Overtime, residual renal function drops, so fluid intake will depend on amount of urine made
Alert a dietitian or PD nurse:
- fluid build up
- rapid weight increase
- using more 4.25 strength solution than before
- headaches
Edema
shoes or rings don’t fit
Your eyesight may change
It may be harder to breathe (some people have mistaken fluid in the lungs for asthma)
If you have a lot of extra fluid, your ankles or legs may even dent when you press on them with a finger. This is called “pitting edema”.
