Renal Disease Pt. 2

Question 1

What are the 2 leading causes of kidney failure?

Answer 1

• diabetes (38%)

- renal vascular disease (high BP) (16%)

Question 2

What are the 3 types of dialysis?

Answer 2

1. HD (intermittent, nocturnal, short daily)
2. PD (CAPD, CCPD)
3. CRRT (CVVH, CVVHD)

Question 3

What 3 mechanisms are involved in HD?

Answer 3

• diffusion
• osmosis
• ultrafiltration

Question 4

What is the difference between dry and fluid weight?

Answer 4

dry weight is the weight before dialysis, with no extra fluid. It is the goal weight after dialysis. It is used in determining how much fluid will be removed during dialysis

Fluid weight is accumulated between dialysis sessions
the goal is 1kg/d

Question 5

What are the 2 accesses for dialysis?

Answer 5

1. Central venous catheter

2. Arterio-Venous (AV) fistula

Question 6

What are the PD solutions?

Answer 6

Dextrose based

0.5%, 1.5%, 2.5%, 4.25%

Question 7

What are the protein recommendations?

Answer 7

> 50% from HBV
minimum of 0.8 g/kg IBW for HB
minimum of 0.9 g/kg IBW for PD

Question 8

When should ONS be given?

Answer 8

Should be given separately from regular meals?
Should be given during dialysis session
At night, to reduce length of nocturnal starvation

Question 9

Who needs IDPN?

Answer 9

HD patients, but they must be able to meet 50-60% of daily needs orally

Question 10

What are the complications of IDPN?

Answer 10

• hyperglycemia
  Reaction to IVFE
  Post IDPN infusion hypoglycemia
  Fluid overload

Question 11

What is CKD-MBD?

Answer 11

The presence of one or more of the following symptoms:

• abnormal levels of Ca, PO4, PTH and active vit D
• abnormal bone morphology RO
• calcification of blood vessels

Question 12

What is renal osteodystrophy?

Answer 12

• form of bone disease related to kidney failure
• affects more than 50% of patients with CKD by the time they require dialysis
• hyperphosphatemia leading to RO is an independent risk factor for morbidity and mortality

Question 13

What is metastatic calcification?

Answer 13

In the presence of high PO4 levels, Ca is more likely to precipitate into crystals of calcium phosphate which can lead to metastatic calcification

Question 14

What are the phosphorus recommendations?

Answer 14

800-1200 mg/d

Difficult to achieve with high protein requirements

Question 15

What steps can be taken to control phosphate levels?

Answer 15

• limit dietary P as possible while meeting protein needs
• evaluate actual P intake to plan the initial and subsequent binder doses
• Titrate the binder dose to meal or snack
• Ensure the patient understands when to take phosphate binders
• prescribe binders with consideration of medical needs, serum chemistries, patient preference/tolerance

Question 16

What are some possible treatments for constipation?

Answer 16

• stool softener
• stimulants
• osmotic laxatives
• bulking agents
• suppositories
• enemas