Nephrology Skills Laboratory S. Smith, DO

Stages of CKD

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

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)

Dialysis Peritoneal Hemodialysis

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.

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.

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

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)

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.

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

Dialysis

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

Vascular Access Central Venous Catheter Ash split Decathalon Gold

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.

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.

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

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