Acute Kidney Injury and CRRT - Dialysis Therapy - PDF

Acute Kidney Injury: Continuous Renal Replacement Therapy Miranda Smith Ed.D., AGACNP-BC  Learning Outcomes: 01 02 03 Discuss the impact of Describe the fundamental Compare and contrast acute...

Acute Kidney Injury: Continuous Renal Replacement Therapy Miranda Smith Ed.D., AGACNP-BC  Learning Outcomes: 01 02 03 Discuss the impact of Describe the fundamental Compare and contrast acute kidney injury (AKI) transport mechanism for the advantages and in the critical care setting solute removal. disadvantages of various dialysis options for AKI including hemodialysis, peritoneal dialysis, and CRRT. 1/8/2023 2  Functions of the Kidney Eliminate metabolic waste B/P Regulation Erythrocyte production Activation of vitamin D Autoregulation of blood flow Acid-Base Balance Fluid/electrolyte balance 1/8/2023 3  Acute Kidney Failure AKA Acute Kidney Injury Sudden failure of renal function either due to decreased perfusion, intrarenal disease, or obstruction. When the GFR decreases, the metabolic waste products build up and homeostasis is lost. 1/8/2023 4 Causes of AKI Prerenal Intrarenal Postrenal Decrease in perfusion of Direct damage to the Occurs from an kidneys kidney itself obstruction Examples: Examples: Examples: Dehydration Trauma Kidney stones Hemorrhage Surgery Enlarged prostate Sepsis These are further Bladder does not empty classified as tubular, Blood clots glomerular, interstitial, and vascular Cancer 5  Causes of AKI 1/8/2023 6  Acute vs Chronic Renal Failure ACUTE RENAL FAILURE CHRONIC RENAL FAILURE PATHOPHYSIOLOGY Occurs acutely Occurs over months or years, typically develops when a person has a chronic disease CAUSES Typically, hypoperfusion of the kidneys such Typically, other medical problems such as Diabetes as low BP, dehydration, hemorrhage, sepsis, and/or hypertension etc ASSESSMENT Inc BUN, creatinine, anemia, oliguria, Inc BUN, creatinine, Dec GFR, hyperkalemia, hypocalcemia, hyperphosphatemia, met hyperphosphatemia, hypocalcemia, met acidosis, anemia, acidosis, hyperkalemia oliguria, FVE, edema MANAGEMENT Correct issue with hypoperfusion (ex. if Dialysis, Peritoneal, CRRT (ICU setting only) dehydrated-give fluids; if septic-treat sepsis, etc) CRRT (ICU only) 1/8/2023 7  Does AKI always cause Chronic 1/8/2023 8  Dialysis or Not?? A: Acid/Base disturbances E: Electrolyte disorders I: Intoxication (lithium, ASA, antifreeze) O: Fluid Overload U: Uremia / Azotemia Azotemia and uremia are two different types of kidney conditions. Azotemia is when there's nitrogen in your blood. Uremia occurs when there's urea in your blood. 1/8/2023 9  Different Types of Dialysis Continuous Renal Replacement Hemodialysis Peritoneal Dialysis Therapy (CRRT) 1/8/2023 10 What is CRRT? Continuous Renal Replacement Therapy: Breakdown: Hemodynamically unstable patients Removes smaller amounts of fluid Done 24 hrs/day Client cannot tolerate NL hemodialysis Time consuming; 1:1 nurse ratio Puts less stress on the heart due to longer periods.  Ultrafiltration: Movement of FLUID through a membrane caused by a pressure gradient 1/8/2023 12  CRRT vs Hemodialysis CRRT Hemodialysis 1.Continuous 1.Intermittent 2.Can utilize venous access 2. May use arterial access 3.Less hemodynamic 3. Greater hemodynamic instability instability 4.Constant adjustment of 4. Faster clearance related to fluids and electrolytes greater flow rates 1/8/2023 13  Disadvantages of CRRT Specialty education required/labor intensive for bedside RN Frequent clotting of filter and access Need for anticoagulation Increased pt. acuity Decreased pt. mobility Drug dosing based on 24/hr. run…. 1/8/2023 14  Minimal changes in plasma So Why Use CRRT? osmolality Better control of azotemia, electrolytes, and acid/base status CRRT provides continuous therapy Easier administration of parenteral It closely mimics the body’s natural renal nutrition and medications function Effective removal of fluid Slow/gentle therefore, well tolerated by hypotensive patients Removal of large molecules with cardio-depressant, vasodilatory and Removes targeted amounts of fluid and waste inflammatory properties. Avoid peaks and troughs assoc. with IHD Removal of toxins Unlimited Fluid, Blood Products (no need for fluid restriction) 1/8/2023 15