Chronic Kidney Disease Overview

Chronic Kidney Disease (CKD)

• CKD is defined as abnormalities of kidney structure or function that last for more than three months, impacting health.
• Includes people with kidney damage and a glomerular filtration rate (GFR) below 60 mL/min/1.73 m2 on at least two occasions, 90 days apart, with or without kidney damage markers.
• Characterized by progressive, irreversible loss of kidney function.
• Nephons lose functionality, decreasing GFR; this leads to azotemia (waste buildup in the blood).

Effects and Manifestations of CKD

• Cardiovascular: Elevated blood pressure, heart rate, fluid retention (edema), dysrhythmias, abnormal heart sounds, pericardial friction rub.
• Respiratory: Increased respiratory rate, Kussmaul respirations (deep, rapid breathing), crackles, decreased oxygen saturation, shortness of breath.
• Renal: Reduced urine output, azotemia, proteinuria, hematuria, hyperuricemia.
• Integumentary: Bruising, itching, dry skin, changes in skin color (ashen to yellowish), dry/brittle hair/nails.
• Gastrointestinal: Anorexia, nausea, vomiting, halitosis, metallic taste, gastrointestinal bleeding.
• Neurological: Peripheral neuropathy, restless legs syndrome, altered consciousness, lethargy, confusion, encephalopathy, motor function changes.
• Musculoskeletal: Renal osteodystrophy (bone disease), decreased calcium levels, impaired Vitamin D metabolism, hyperparathyroidism, pathological fractures.
• Immune: Increased susceptibility to infections (local and systemic).
• Hematological: Anemia (weakness, fatigue, pallor, lethargy, bleeding).

End-Stage Renal Disease (ESRD)

• ESRD occurs when GFR falls below 15 mL/min/1.73 m2.
• Kidneys lose filtering, secreting, reabsorbing, and excreting functions.
• Requires renal replacement therapy for survival.

Common Lab Tests and Findings in CKD

• Creatinine: Breakdown product of creatinine phosphate in muscle; used to estimate kidney function, higher levels indicate lower filtration.
• Blood Urea Nitrogen (BUN): Formed by liver during protein breakdown; filtered by kidneys; elevated BUN reflects reduced filtration.
• Oliguria: Urine output less than 400-500 ml in 24 hours.
• Anuria: Urine output less than 100 ml in 24 hours.

Renal Replacement Therapies

• Used when kidneys are unable to function properly (GFR<15 ml/min).
• Peritoneal Dialysis: Uses the peritoneum (abdominal lining) as a membrane to filter fluids and waste; dialysate is placed in peritoneum (dwell), then drained.
• Hemodialysis: Machine cleans blood, returning filtered blood to the patient; vascular access (fistula or catheter) is required.

Key Concepts Not Covered by the Sources (General Information)

• Five stages of CKD based on GFR levels.
• Specific treatment options for each stage of CKD.
• Complications associated with CKD (cardiovascular, bone disease, anemia, electrolyte imbalances)
• Long-term CKD management (lifestyle, medications)

Care of Patient Receiving Hemodialysis

• Frequency: Typically three times a week for two hours each time.
• Dry weight: Ideal weight patient can tolerate after dialysis without fluid volume issues.

Acid-Base and Electrolytes

• Pre-dialysis: Metabolic acidosis, high potassium, low sodium, low calcium, high phosphate, high magnesium, high glucose, uremia
• Post-dialysis: Metabolic alkalosis (sometimes), electrolyte shifts (generally opposite of pre-dialysis imbalances)
• Nursing Assessments: Monitor electrolyte imbalances like hyponatremia, hypernatremia, hypokalemia, hyperkalemia, hypocalcemia, hypercalcemia, hypophosphatemia, hyperphosphatemia including symptoms and potential issues

Other Assessments (for patients)

• Cardiovascular: Monitor blood pressure, pulses, edema, heart sounds, for fluid volume issues.
• Respiratory: Assess breathing patterns, lung sounds, oxygen saturation.
• Renal: Observe urine output, kidney palpation.
• Integumentary: Skin conditions (dryness, bruising), color changes.
• Gastrointestinal/Abdomen: Bowel sounds, abdomen size and firmness, signs of nausea, vomiting, or bleeding.
• Neurological: Mental status, reflexes, alertness, potential confusion.

Vascular Access Assessment

• Inspection: Visual assessment for sores, infections, inflammation around the access site.
• Palpation: Palpate for thrill, pulses above and below, capillary refill above and below the access site.
• Auscultation: Presence of bruit over the access site.