AKI and CKD: Dialysis Nursing and Kidney Transplant Complications

What is the primary function of dialysis?

To replace essential filtering actions of the kidneys by diffusing wastes and removing excess water.

What is the mechanism of hemodialysis?

An external machine (dialyzer) filters blood outside the body.

What types of access can be used for hemodialysis?

Surgical AV fistula, AV graft, or central venous tunneled catheter.

How often is hemodialysis typically scheduled?

3 times per week for 3-4 hours at a specialized outpatient clinic.

What dietary restrictions are required during hemodialysis?

Strict restrictions on fluids, sodium, potassium, and phosphorus due to large multi-day gaps between sessions.

What is the mechanism of peritoneal dialysis?

The patient's abdominal lining (peritoneum) acts as the natural filtering membrane inside the body.

What type of access is used for peritoneal dialysis?

A permanent, flexible silhouette tube is surgically placed in the abdomen.

How often is peritoneal dialysis performed?

Daily at home, can be continuous ambulatory or automated.

What are the dietary allowances during peritoneal dialysis?

More liberal diet and fluid allowance because metabolic toxins and fluids are cleared continuously every day.

What should be assessed for patency in dialysis patients?

Check AV fistula or graft for a thrill (vibration) and bruit (swishing).

What should be avoided in the arm with AV access?

Never take BP, draw blood, or insert an IV; avoid tight clothing or jewelry.

What signs indicate potential infection at dialysis access sites?

Monitor for redness, swelling, warmth, or drainage.

What electrolytes should be monitored in dialysis patients?

Track potassium, phosphorus, BUN, and creatinine.

What dietary compliance is necessary for dialysis patients?

Reinforce strict fluid restrictions and low-sodium, low-potassium, and low-phosphorus diets.

What medications may need to be held for dialysis patients?

Antihypertensives and water-soluble medications; monitor for bleeding as anticoagulants may be prescribed.

What complications should be monitored in dialysis patients?

Hypotension, DDS (neurological changes), and peritonitis.

What are the indications for kidney transplants?

Late-stage CKD/ESRD (GFR < 15 mL/min), dialysis dependence, life expectancy of 5 years or more.

What are some contraindications for kidney transplants?

Untreated infections, recent malignancy, severe comorbidities, and non-compliance.

What is hyperacute rejection in kidney transplants?

Triggered by existing antibodies, occurs within minutes to hours, causing massive systemic fever and anuria; requires immediate graft removal.

What is acute rejection in kidney transplants?

Occurs days to weeks post-transplant, driven by T-cell or antibody-mediated activation; treatable with IV corticosteroids.

What is chronic rejection in kidney transplants?

A slow, gradual immunologic scarring process leading to progressive proteinuria and steady decline in GFR over months to years.

What nursing interventions are important post-kidney transplant?

Hourly urine output tracking, fluid and electrolyte replacement, early ambulation, and dietary restrictions (no grapefruit).