Unit 11 - Chronic Kidney Disease

Kidney Functions

A - acid-base balance

W - water balance

E - electrolyte balance (potassium and sodium)

T - toxin removal (e.g., urea and creatinine)

B - blood pressure control (RAAS)

E - erythropoiesis (RBC creation)

D - vitamin D activation

Glomerular Filtration Rate (eGFR)

The volume of blood filtered by the glomeruli in 1 minute.

Normally 125ml/min

Stages of CKD

Progressive, irreversible loss of kidney function.

Stages:

1. Normal - eGFR > 90

2. Mild - eGFR 60-89

3. Moderate - eGFR 30-59

4. Severe - eGFR 15-29

5. Kidney Failure eGFR < 15

Reduction in GFR = reduction in number of functional nephrons l/t kidney hyperfiltration.

Early stages usually undetectable.

Signs & Symptoms

Neurologic, cardiovascular, respiratory, hematologic, gastrointestinal, urinary, integumentary, musculoskeletal, reproductive, metabolic, and psychosocial symptoms.

Blood Urea Nitrogen

Reflects GFR and urine concentrating capacity; increases as GFR decreases.

Affected by hydration status, level of catabolism, protein intake, and GI bleeding; not a reliable measure of GFR.

Creatinine

End product of muscle metabolism.

Released into blood at a constant rate and eliminated at a rate related to renal function.

Most reliable measure of renal health.

Nutrition

Protein restriction: < 1.3 g/kg/day

Sodium restriction: 1-3 g/day

Potassium restriction: 60-70 mEq/day

Kidney Replacement Therapy

Cleans the blood, removes waste and excess water from blood, restores fluid and electrolyte balance, and restores acid-base balance.

Can take 4-5 hours.

Hemodialysis

• Blood passes through semi-permeable membrane external to patient.

• 3 times per week.

• Strengths:

  • Quick and efficient.

• Limitations:

  • Need suitable access point.

  • Vascular access with needles.

  • Must plan around hemodialysis schedule.

Peritoneal Dialysis

• Exchange of waste, fluid, and electrolytes occurs in peritoneal cavity.

• 7 times per week.

• Strengths:

  • Less stress on body.

  • More dietary choices.

  • Easier to travel.

  • Greater flexibility with treatment.

• Limitations:

  • Permanent catheter in abdomen.

  • Catheter must not get wet (no swimming).