Progression of Chronic Kidney Disease - PowerPoint PPT Presentation

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Progression of Chronic Kidney Disease

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Title: Dialysis Chronic Complications Author: 74th MEDICAL GROUP Last modified by: Teresa Kaufold Created Date: 1/31/1996 1:16:40 PM Document presentation format – PowerPoint PPT presentation

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Title: Progression of Chronic Kidney Disease


1
Progression of Chronic Kidney Disease
  • Preparation
  • Options
  • Complications

2
Preparation of the Patient
  • Manage CRF
  • Control BP
  • Control glucose
  • stop oral agents!
  • Prevent Hyper PTH
  • Vit D
  • Calcium acetate
  • Phosphate binder
  • Diet Education

3
Preparation of the Patient
  • Manage Fluids
  • Dialysis education
  • Access Placement
  • Prevent anemia
  • Prevent Malnutrition
  • metolazone
  • NKF program
  • AV fistula, PD cath
  • Epogen, Iron
  • This can get tricky

4
Progression of CRF
5
Transition to End StageEffect of Malnutrition
Wt
Measured Wt 85 Kg
GFR
6
Indications for Dialysis
  • A acidosis
  • E electrolyte abnormalities
  • I intoxication/poisoning
  • O fluid overload
  • U uremia symptoms/complications

7
Dialysis for Intoxications
  • T theophylline
  • A aspirin
  • B barbiturates
  • L lithium
  • E ethylene glycol, methanol

8
Relative Contraindications
  • Alzheimers disease
  • Multi-infarct Dementia
  • Hepatorenal syndrome
  • Advanced cirrhosis with encephalopathy
  • Advanced malignancy
  • HIV with dementia

9
Types of Renal Replacement
  • Acute RRT
  • Standard Hemodialysis
  • Redy 2000
  • Acute Peritoneal Dialysis
  • CAVHD
  • CVVHD
  • Hemoperfusion

10
Acute RRT choices
  • Volume Status
  • Hemodynamic status
  • Access
  • Bleeding
  • Poisoning
  • CAVHD?
  • Tolerate Hemo?
  • Abdominal surgery?
  • Anticoagulation?
  • How catabolic is pt
  • Hemoperfusion?

11
Renal Replacement Therapy
  • Chronic RRT
  • Standard Hemodialysis
  • Peritoneal Dialysis
  • Continuous vs Intermittent
  • Ambulatory vs Cyclic
  • Cycler Plus
  • Combinations

12
The Mystery of Dialysis
  • Its no mystery!
  • Clearance
  • simple diffusion
  • Ultrafiltration
  • dialysate pump
  • Monitors to make sure nothing bad happens

blood in
dialysate plus Ultrafiltrate out
dialysate in
blood out
13
Hemodialysis
  • Advantages
  • standard treatment
  • widely used
  • Pt has days off
  • Good reimbursement for Nephrologist
  • We have control

14
Cuffed Tunnelled Hemodialysis Catheters.
15
Tesio catheter
16
Hemodialysis
  • Disadvantages
  • Pt has no control
  • strict attn to diet
  • travel restricted
  • need for vascular access
  • Specific risks
  • Inadequate clearance

17
Peritoneal Dialysis
  • Clearance
  • How much fluid the patient puts in
  • Ultrafiltration
  • How much fluid comes out
  • Dextrose used as osmotic agent

18
(No Transcript)
19
Peritoneal Dialysis
  • Advantages
  • continuous
  • middle molecules
  • pt has control
  • vary tx with diet
  • adjust to lifestyle
  • no need for vascular access
  • no need for anticoag.

20
Peritoneal Dialysis
  • Disadvantages
  • Abdominal surgery
  • limited clearance
  • limited Uf
  • Needs motivated, compliant pt
  • risk of peritonitis

21
RRT Choices
  • Renal Transplant should be goal
  • Peritoneal Dialysis for the right pt
  • Hemodialysis for everyone else

22
DialysisChronic Complications
  • Not seen until after chronic access possible
  • 1967 Alfree reported dialysis dementia
  • Due to impurities in water (100L/tx)

23
DialysisComplications
  • Bleeding disorders
  • Anemia
  • Bone disorders
  • Arthritis
  • Neuropathy
  • Cardiovascular

24
Dialysis ComplicationsBleeding disorder
  • Due to platelet dysfunction Prolonged bleeding
    time
  • Treatment - more dialysis - dDAVP 0.3
    microgm/Kg - Estrogen

25
Dialysis ComplicationsAnemia
  • Due to reduced Erythropoietin - blood loss,
    reduced response
  • Treatment - more dialysis - rHuEPO 2,000
    units/tx - Androgens

26
Dialysis ComplicationsArthritis
  • Due to accumulation of - Beta-2-microglobulin
  • Treatment - more dialysis - Biocompatable
    membranes - Joint replacement (Hips)

27
Dialysis ComplicationsNeuropathy
  • Manifestations - Peripheral Neuropathy -
    Autonomic dysfunction - Dementia -
    Dysequilibrium syndrome
  • Treatment - More dialysis - gradual start of
    tx - remove water impurities - prevention is
    best.

28
Dialysis ComplicationsCardiovascular
  • Manifestations - Accelerated atherogenesis -
    Lipid abnormalities - Associated disorders (DM
    etc) - Leading cause of mortality
  • Treatment - More dialysis - Treatment of lipid
    disorders - Control of HTN - Carnitine?

29
Adequacy of Dialysis
  • Markers
  • mortality
  • hospitalization
  • nutrition
  • NCDS
  • Gotch and Sargent
  • KT/V clearance
  • NPCR nutrition

30
Summary
  • Incidence of ESRD
  • Progression of CRF
  • Indications and contraindications
  • Choices of RRT
  • Complications of CRF, dialysis
  • Adequacy
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