Metabolic - week 7

What percentage of function do you loose before symptoms show

loose 90%

What are symptoms of kidney disease

High BP

changes in amount and number of times of urination, 

swelling/puffiness in your legs, ankles or around your eyes, then stomach and face as CKD progresses 

pain in your kidney area

What are some causes of kidney disease

Diabetes
High blood pressure,
Inflammation in the kidney and
Genetic disorders such as polycystic kidney disease

What are some intiative in rural communities

• Purple House - Aboriginal service based in Alice Spring

• Bush Balm Social Enterprise - first purpose-built space to accommodate all Purple House's bush medicine production made by hand

What are the progression of kidney disease

CKD = kidneys are damaged and gradually lose their ability to filter waste products from the blood

What health problems can CKD lead to 

• Damage to nephrons lost ability to filter blood

• Inflammation of Kidney - Reduces ability to function

• Scarring of Kidneys 

• Changes in Kidneys’ blood vessels - difficult for blood to flow to the kidneys

What is the cause of CKD

Loss and irreversible loss of nephrones = Toxic state such as uremia

What are the other causes ogf CKD

Acute kidney failure
Hypertension 
Diabetes
Polysistic kidney disease

What are the unmodifiable risk factors

History of kidney failure in first- or second-degree relative

Aged 60 years or older

Aboriginal or Torres Strait Islander

Maori or Pacific Islander

Modifiable riks factors of CKD

• Obesity

• Hypertension - damage blood vessels in the kidneys over time

• Diabetes - leading cause

• Smoking - harm blood vessels

What are the stages of CKD

Healthy - >60% working
Stage 1-2 - >60% working
Stage: - 30-59% working
Stage 4 - 15-29% working
Stage 5 - <15% working

What is the impact of ckd

• Fluid retention (can lead to swelling in arms/legs, high BP, or fluid in the lungs)

• Pericarditis (swelling in the sac around the heart)

• An increase in potassium levels in your blood

• Anaemia

What is the treatment for stages 1-2 of CKD

preventing the development of CVD complications
Implementing lifestyle modifications
Medications to manage blood pressure
Controlling blood glucose levels through appropriate pharmacotherapy

What is the treatment for stages 3-4 of CKD

Frequent medical evaluations, every 3-6 months

What is the treatment for stages 5 of CKD

Kidney transplantation

Dialysis

Supportive care to manage symptoms and improve quality of life

What is the aim of pharmacological interventions for CKD

Avoid toxicity and adverse effects
Reduce proteinuria and address mineral and bone disorders

What are some of the non pharmacological interventions

Nutrition and diet - control protein, sodium and potassium intake
Fluid management 
Smoking cessation
Alcohol intake moderation - <2 drinks per day

What is the evidence of exercise for CKD no dialysis

• Blood pressure   

• Physical function and capacity  

• Functional limitations 

• Health-related quality of life (QoL) 

What is the evidence of exercise for CKD on dialysis

• CV health and physical function  

• Muscular strength  

• Blood pressure control  

• Lipid profiles  

What are some special considerations for CKD exercise prescription

• Intra-Dialytic Exercise: Exercise during dialysis should be performed within the first 2 hours BP is optimal

• Exercise in Peritoneal Dialysis: better when fluid emptied reduces breathlessness and discomfort. 

• Upper Limb Exercise: Haemodialysis patients should avoid using the arm

• Monitoring: Regular monitoring of blood pressure and ECG during exercise

What are some contraindications for exercise

• Electrolyte Imbalances: Especially hypo/hyperkalemia. 

• Unstable Conditions: Recent ECG changes, or significant weight gain (>4 kg) since the last dialysis session. 

• Pulmonary Congestion: Presence of significant pulmonary congestion or peripheral edema.

What are some considerations for CKD stages 1-5

Kidney Health Australia recommends at least 2.5 of moderate intensity activity across the week.
exercises specifically aimed at improving or maintaining muscle strength, balance, and flexibility on at least 2 days a week.

What must be done in terms of risk assessment

All individual conditions
Dialysis Site : Infection risk, Avoid the insertion site

What is key to consider when working with those kidney transplantation

Side Effects of dialysis if they been waiting long time

Consequences/side effects of the immunosuppressant medications

What are some general recommendations for those with kidney transplantation

General physical activity should be encouraged in cases without contraindications
At least 2.5 of moderate intensity activity across the week
Exercise can be performed at least 3x/week
Structured exercise alone is not sufficient

What are the exercise prescription guideliens for those non dialysis patients

Aerobic
F: up to 180 min
I: 55-90%maxHR
T: Build up to 30-45 min
T: Walking, jogging, cycling 
Resistance 
F: Two non consecutive days
I: 60-70% RM
T: 10-15 reps
T: 8-12 exercises

What are the exercise prescription guideliens for those EKSD intra dialysis

Aerobic
F: up to 180 min
I: 55-70%maxHR
T: Build up to 30-45 min
T: cycling, arm or leg ergometer
*During first 2 hours of dialysis 
Resistance 
F: Two non consecutive days
I: 60-70% RM
T: 12-15 reps, up to 12 exercises
T: Weight bearing, thera band, light dumbbells 

What are the exercise prescription guideliens for those EKSD inter dialysis

Aerobic
F: up to 180 min
I: 55-70%maxHR
T: Build up to 30-45 min
T: cycling, walking
non dialysis days 
Resistance 
F: Two non consecutive days
I: 60-70% RM
T: 12-15 reps, up to 8-12 exercises
T: Weight bearing, thera band, light dumbbells