48 Questions
What is adaptive hyperinflation?
it is the process in which the kidneys are able to adapt to damage by increasing the filtration rate in the remaining normal nephrons.
What long standing issues can kidney damage be due to?
diabetes mellitus, hypertension, autoimmune disease, or some inherited diseases
Name 3 risk factors for CKD
Diabetes, hypertension, CVD, family history, obesity, smoking, being 60 or older
Define CKD
Is defined as the presence of kidney damage usually detected as urinary albumin excretion or decreased kidney function for 3 months or more (defined as estimated glomerular filtration rate)
CKD is divided into 6 stages that are characterized by the extent of which 3 factors?
kidney damage, glomerular filtration rate and the presence of albumin in the blood
What is the downside to adaptive hyper filtration?
Results in long term damage to the glomeruli of the remaining nephrons, which is manifested by proteinuria and progression to renal failure
Progressive renal failure causes loss of excretory and regulatory functions which leads to ESRD and results in uraemic syndrome
True
What is the purpose of cycling during dialysis treatment?
To assure the dialysis staff and the patient that cycling does not have adverse effects on the dialysis treatment
Exercise training can help improve blood pressure and glucose control in dialysis patients.
True
What is the potential benefit of exercise training for transplant recipients on prednisone?
Improvements in muscle strength, although slower and with lower absolute gains than in healthy individuals
Removal of fluid from the beginning to the end of dialysis can cause resting and exercise heart rates to vary by ______________ beats/minute.
15-20
What is the outcome of exercise training for patients with CKD?
Maintenance or prevention of loss in exercise capacity and physical function over time
Transplant recipients and patients who undergo dialysis respond to exercise training with a magnitude of change in strength and exercise capacity similar to healthy individuals.
True
What is the benefit of exercise training for patients' daily lives?
Improved ability to perform activities of daily living
Exercise training can help patients with CKD experience fewer ________________________ (e.g.).
symptoms or problems
What is the effect of exercise training on medication use for dialysis patients?
Reduced need for medications
What is the leading cause of CKD?*
Dibabetes
Which of the following is a manifestation of the uraemic state?*
All of the above
Which of the following in the drug of choice for hypertension in CKD?*
ACE inhibitors
What is the most common form of renal replacement therapy?
Haemodialysis
Which of the following results directly from reduced kidney function
Oedema
Which of the following is an established risk of of long term prednisone use?
All of the above
Which of the following is not a typical exercise response for a CKD patient?
Higher maximal heart rates
Which of the following should be avoided in a haemodialysis patient?
Exercise in the last 2 hours of dialysis
Which of the following exercises should be avoided with a peritoneal dialysis patient
Hydrotherapy
Which of the following is incorrect
Exercise should be below the calf pain threshold in PVD
What are the 3 types of RRT
Haemodialysis, peritoneal dialysis or renal transplantation
What is the difference btw haemodialysis and peritoneal dialysis?
Haemodialysis is through the arm and peritoneal is taken form the abdomen
What does the loss of excretory function of the kidneys mean for the renal system?
This results in the build up of toxins in the blood, any of which can negatively affect cellular enzyme activities and inhibit systems such as the sodium potassium pump, resulting in altered active transport across cell membranes and altered membrane potentials
How does the loss of the regulatory function of the kidneys negatively affect the cardiovascular and cellular functions?
By the inability to regular extracellular fluid volume and electrolyte concentrations
Most patients with advanced CKD are volume overloaded. This results in hypertension and often congestive heart failure
True
What metabolic abnormalities are associated with uraemia?
Insulin resistance and hyperglycaemia
Define uraemia
Is a condition associated with declining renal function and characterized by fluid overload, electrolyte imbalances, and metabolic abnormalities. The term mean ‘urine in blood’ which develops most commonly in chronic and ESRD
What does treatment typically involve?
Control of BP and diabetes, lowering urine protein, weight loss, smoking cessation, and regular exercise
What dietary adjustments are important for the management of renal failure?
Adjustments for protein, sodium, and fluid intake
What are the common symptoms of CKD
Oedema, hypertension, decreased urine output
What are some signs that might indicate CKD?
Anaemia, fluid build up in tissues, loss of bone minerals, hypertension
What symptoms might a patient with CKD complain about?
Fatigue, SoB, loss of appetite, restlessness, change in urination patterns.
What is management of CKD direct at?
Minimizing the consequences of accumulated uraemic toxins that are normally excreted by the kidneys
What should protein and fluid intake look like in a diet with someone with CKD
Low protein and limited fluid intake
How does excess fluid in the system cause issues?
Excess fluids ultimately results in peripheral oedema, congestive heart failure and pulmonary congestion
Name a few long term complications of dialysis
Metabolic abnormalities, malnutrition, CVD,
Name a few long term complications associated with kidney transplantation
Rejection, CVD, infectious, musculoskeletal disorders, obesity
What is the exercise response in CKD patients typically categorized by?
Progressively lower peak exercise capacity, earlier muscle fatigue, lower maximal heart rates, and hypertensive pressor response
What testing is appropriate for people with CKD
Function testing like a 6min walk test or sit to stand
What is Oedema?
It is fluid retention. Occurs when the fluid isn’t removed from the tissues.
What is the importance in exercise for people with CKD?
To reduce risk of CVD. People with CKD are more likely to die from CVD than CKD because CKD patients tend to live sedentary lives and are not accustomed to being physically active.
What are some contraindications for exercise in ESRD
Electrolyte abnormalities, peripheral oedema, recent changes to the ECG
Study Notes
Exercise Prescription for CKD Patients
- Any prescription should begin with a lower volume of exercise and gradually progress to prevent discouragement and additional feelings of fatigue or muscle soreness.
Client-Clinician Interaction
- The dialysis staff can be influential in patients' participation in exercise and should be considered for support in the patient's overall care.
- Patients should be encouraged to increase lifestyle physical activity levels, including simple tasks such as shopping, cleaning their homes, or doing yard work.
Special Exercise Considerations
- Many CKD patients live sedentary lives and are not accustomed to being physically active.
- Cardiovascular disease is the main cause of death in CKD patients.
- Patients with CKD not yet receiving dialysis are likely to be diabetic, hypertensive, and overweight or obese.
Haemodialysis Patients
- Patients have extremely low fitness levels.
- Timing of exercise sessions should be coordinated with dialysis sessions; non-dialysis days are usually preferred by patients.
- Gradual progression is crucial, and heart rate prescriptions are typically invalid; use of RPE is recommended.
- Maximal exercise testing may not be feasible in all patients, but should be used whenever appropriate.
Transplant Patients
- Patients are initially weak, so gradual progression is recommended.
- Exercise heart rate responses are normalized after transplant, but the increase in blood pressure during exercise is often excessive or abnormal.
- Patients may experience a lot of orthopedic and musculoskeletal discomfort with strenuous exercise.
Exercise Recommendations - Mode
- There are no restrictions on the type of activity that can be prescribed for patients with CKD.
- Many ESRD patients have poor musculoskeletal function and experience joint discomfort; therefore, non-weight-bearing cardiovascular-type activity may be best tolerated, at least initially.
Exercise Recommendations - Duration and Progression
- Pre-dialysis CKD patients can often start with 15 – 20 minutes of lower-intensity continuous exercise.
- ESRD patients tend to be very deconditioned and may need to be treated differently; determine the duration of activity they can comfortably tolerate during the initial sessions.
- A progressive increase in duration of 2 – 3 minutes per session or per week is recommended, depending on individual tolerance.
Exercise Training
- Maintenance or prevention of loss in exercise capacity and physical function over time may be viewed as a favorable outcome for some patients.
- Transplant recipients and patients who undergo dialysis respond to exercise training with a magnitude of change in strength and exercise capacity that is similar to that for healthy individuals.
Assess your knowledge of Chronic Kidney Disease, its causes, stages, and effects. Learn about adaptive hyperinflation, risk factors, and the downsides of adaptive hyperfiltration.
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