1. Nephrology Skills Laboratory
S. Smith, DO

2. Stages of CKD

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 at DRD

19. Resources national kidney foundation www.kidney.org
american association of kidney patients
fistula first
patient information
up to date