Nephrology Skills Laboratory

1
Nephrology Skills Laboratory

• S. Smith, DO

2
Stages of CKD
3
(No Transcript)
4
Renal Replacement Therapy

• typically needed when about 90 percent or more of
  kidney function is lost
• Hemodialysis
• Peritoneal Dialysis
• Renal Transplant

5
Signs and Symptoms of Progressing Renal Failure

• decreased uop
• shortness of breath
• feeling tired and cold
• dry and itchy skin
• nausea and vomiting
• loss of appetite
• metallic taste in mouth (dysgeusia)
• better blood sugar control (less insulin use)

6
Dialysis
Peritoneal
Hemodialysis
7
Peritoneal Dialysis

• The lining of the abdomen (the peritoneal lining)
  acts as a membrane to allow excess fluids and
  waste products to diffuse from the bloodstream
  into the dialysate.

8
Peritoneal Dialysis

• Dialysate is infused into the abdomen through the
  catheter
• The fluid is held within the abdomen for a
  prescribed period of time ,called a dwell.

9
Peritoneal Dialysis

• During each cycle (an exchange) the dialysate in
  the abdomen is drained out and discarded.
• The peritoneal cavity is then filled again with
  fresh dialysate

10
Peritoneal Dialysis Types

• Continuous ambulatory peritoneal dialysis (CAPD)
• multiple exchanges during the day -4 to 5
• plus an overnight dwell
• you are not connected to tubing, but dialysate is
  in peritoneum at all times
• Continuous cycler peritoneal dialysis (CCPD)
• automated form where a machine performs exchanges
  while the patient sleeps
• may be a long daytime dwell, and occasionally a
  manual daytime exchange is performed
• also known as Automated Peritoneal Dialysis (APD)

11
Hemodialysis

• blood is pumped through a dialysis machine to
  remove waste products and excess fluids
• machine works by putting the patient's blood in
  contact with a special solution, called dialysate
• blood is separated from the dialysate by a
  membrane that allows substances to move (diffuse)
  from the blood to the dialysate.

12
Hemodialysis

• process of diffusion causes these substances to
  move from the blood across the membrane and into
  the dialysate
• blood is continuously returned to the body and
  the diasylate is continuously replaced with fresh
  solution

13
Dialysis
14
Dialysis schedule

• dialysis center
• three times a week
• three to five hours each visit
• may be on a Monday-Wednesday-Friday schedule or a
  Tuesday-Thursday-Saturday schedule

15
Vascular Access

• Central Venous Catheter
• Ash split
• Decathalon Gold

16
Arterio-Venous Fistula (AVF)

• The AVF is desirable, because rates of infection
  are very low and it is durable.
• It may take two to four months for the AVF to
  mature, so careful planning is required.

17
Arterio-Venous Graft

• Uses plastic tubing
• The AVG can be accessed a few weeks after
  grafting.
• Provides good flows but has a high complication
  rate.

18
Adequacy of Dialysis

• Kt/V
• Kt/V      -ln (R  -  0.03)    (4  - 3.5R)  x  (
  UF    W)
• K-the dialyzer clearance of urea
• t - duration of the dialysis treatment (t, in
  minutes)
• V-volume of distribution of urea in the body
• is approximately equal to the total body water
• values of 1.3 to 1.6 are now the norm in the US
• 1.2 at minimum, typically 1.4-1.6 at DRD

19
Resources

• national kidney foundation
• www.kidney.org
• american association of kidney patients
• http//www.aakp.org
• fistula first
• http//www.fistulafirst.org
• patient information
• up to date