RISE ICHD Study Guide: Kidney Theory, Clinical Practice, and Complications

Vocabulary practice flashcards covering renal theory, dialysis transport mechanisms, infection control, vascular access management, treatment adequacy, and clinical complications.

Ultrafiltration

The transport mechanism in hemodialysis where fluid is pushed through the semipermeable membrane (SPM).

Convection

The transport mechanism where solutes are dragged across the semipermeable membrane (SPM) along with fluid.

Diffusion

The transport mechanism where particles move from an area of high concentration to an area of low concentration.

Osmosis

The transport mechanism where fluid moves from an area of low concentration to an area of high concentration.

Acid Concentrate

A dialysate component that provides the concentration gradient for diffusion to occur and assists in normalizing patient electrolytes.

Hyperkalemia

A condition defined by a serum potassium level $> 5.5\,\text{mEq}$, characterized by symptoms such as extreme muscle weakness, abnormal heart rhythm, and potential cardiac arrest.

Hypokalemia

A condition defined by a serum potassium level $< 3.5\,\text{mEq}$, presenting with fatigue, muscle weakness, paralysis, respiratory failure, cardiac instability, arrhythmias, and cardiac arrest.

Uremia

A buildup of waste products in the blood due to kidney failure that adversely affects all body systems.

Pericarditis

Inflammation of the membrane (pericardial sac) surrounding the heart, treated clinically by decreasing or stopping heparin and initiating more frequent dialysis.

Left Ventricular Hypertrophy (LVH)

A cardiac condition caused by prolonged fluid overload and hypertension that can lead to ischemic heart disease, arrhythmias, myocardial infarction, and sudden death.

Erythropoietin (EPO)

A primary hormone secreted by functioning kidneys whose deficiency causes anemia in ESKD patients, in whom red blood cell life span is reduced to $60\,\text{days}$ compared to the normal $120\,\text{days}$.

CKD-Mineral Bone Disorder (CKD-MBD)

A systemic condition caused by abnormal levels of calcium, phosphorus, PTH, and Vitamin D (Calcitriol), manifesting as bone disease, soft tissue calcification, itching, muscle weakness, and pathological fractures.

Acute Kidney Injury (AKI)

A broad spectrum of kidney issues, ranging from less catastrophic functional changes to acute kidney failure, where eliminating the underlying cause can often restore kidney function.

V-tags

Regulatory citations that provide specific conditions and interpretive guidance to be met for dialysis quality and infection control, used by CMS surveyors to cite deficiencies.

Strikethrough

An event where fluid enters the machine and contaminates the internal pressure transducer protector, creating a microbial reservoir that risks patient blood infections.

HBsAg

Hepatitis B surface Antigen, which is tested monthly in hemodialysis patients who are susceptible to Hepatitis B or are non-responders.

Glomerulus

The specific anatomical part of the kidney that provides filtration and fluid/toxin removal, functioning similarly to the dialyzer's semipermeable membrane.

SMART Communication

A standardized documentation framework representing Simple (clear message), Meaningful (purposeful), Actual (factual reporting), Read (reviewing intended message), and Teach (sharing practice).

Target Weight (TW)

The physician-prescribed post-dialysis weight that a patient can safely and reasonably achieve, modified based on patient tolerance, fluid status changes, and signs of fluid overload.

Maximum Ultrafiltration Rate

The fluid removal rate limit which should not exceed $13\,\text{mL/kg/hr}$ during hemodialysis unless specifically ordered by a physician.

Interdialytic Weight Gain (IDWG)

The fluid weight accumulated between hemodialysis treatments, calculated as the patient's pre-weight minus their last post-treatment weight.

Anastomosis

The surgical site where a native artery and a vein are connected to create an arteriovenous fistula (AVF).

KDOQI Rule of 6's

Surgeon-evaluated maturation criteria for an arteriovenous fistula consisting of blood flow $> 600\,\text{mL/min}$, depth $< 0.6\,\text{cm}$, diameter $> 0.6\,\text{cm}$, and a duration of $6\text{--}8\,\text{weeks}$ post-operatively.

Tunneled CVC

A central venous catheter featuring a Dacron cuff into which patient tissue ingrows to anchor the line for longer-term placement.

Rope Ladder Method

A cannulation technique involving systemic rotation of needle puncture sites over a $14\text{-day}$ healing period to promote vessel recovery and avoid pseudoaneurysms.

BEST TIPS

A mnemonic identifying vascular access complications and prevention: Bleeding, Erosion, Stenosis, Thrombosis, Infection, Pseudoaneurysm/aneurysm, and Steal syndrome.

Single Pool Kt/V (spKt/V)

A calculation reflecting hemodialysis adequacy by measuring urea clearance ($K$) and session time ($t$) divided by urea distribution volume ($V$), with a clinical goal of $\ge 1.2$ for thrice-weekly treatments.

Urea Reduction Ratio (URR)

A laboratory parameter measuring the percentage reduction of blood urea nitrogen achieved by a hemodialysis session, with a clinical target of $\ge 65\%$.

Organ Stunning

Ischemia and acute tissue injury sustained by vital organs (heart, brain, kidneys, and gut) secondary to hypovolemia induced by excessive or rapid ultrafiltration.

Reverse Osmosis (RO)

A core water treatment component that removes organic and inorganic materials, bacteria, and endotoxins to produce dialysate-grade water.

Dialysis Disequilibrium Syndrome (DDS)

A central nervous system condition triggered by rapid shifts in extracellular fluid and drastic BUN clearance, presenting with headache, hypertension, restlessness, confusion, and seizures.

Pyrogen Reaction

An acute inflammatory reaction typically presenting $45\text{--}75\,\text{minutes}$ into dialysis caused by pyrogens (endotoxins), manifesting as fever, chills, hypotension, vomiting, and muscle pain.

Disinfectant Infusion

An adverse event where chemical sterilant enters the patient's bloodstream, presenting with localized venous pain, lip tingling, flushing, back pain, and chest discomfort.

Hemolysis

The breakdown of red blood cells during dialysis caused by hypotonic dialysate, high dialysate temperature, chloramines, or pre-pump arterial pressures exceeding $-260\,\text{mmHg}$, producing cherry red blood.

Transmembrane Pressure (TMP)

The pressure gradient across the semipermeable dialyzer membrane; clotting in a low-flux dialyzer causes TMP to increase, whereas clotting in a high-flux dialyzer causes TMP to decrease.

KDQOL 36

A 36-item CMS-mandated assessment administered annually to evaluate physical health, mental health, burden of kidney disease, and the disease's impact on daily life.

Immediate Jeopardy (IJ)

The most severe CMS survey deficiency reflecting actual or imminent harm to patient safety, which halts dialysis treatments or surveys and allows up to $23\,\text{days}$ to correct before decertification.