CKD Treatment & Management (PDF)

CKD And It’s MNT More essential functions :  Release hormone Erythropoietin ( to produce RBCS in the Bone marrow  The only organ which is able to release 99% of phosphorus from the body  Excrete renin hormone for the regulation of blood pressure  Activation of vitamin D  Removal of free...

CKD And It’s MNT More essential functions :  Release hormone Erythropoietin ( to produce RBCS in the Bone marrow  The only organ which is able to release 99% of phosphorus from the body  Excrete renin hormone for the regulation of blood pressure  Activation of vitamin D  Removal of free radicals from the body  Detoxification of drugs Acute renal failure / Acute kidney injury (ARF/ AKI)  Reduction in the glomerulus filtrate rate  Pre renal part is damaged which can effect both the in renal and post renal part of kidneys  GFR is decreased  Damaged arterioles  Common in patients with UTI  If post renal part is damaged it is considered as Chronic failure / injury Etiology  Caused by 3 diseases  Diabetes  HTN  Nephrotic syndrome damage to nephrons or glomerulonephritis Calculation of GFR  eGFR for females [(140 –age )x (body weight in kg x 0.85) / (72 x s.cr)  eGFR for males [(140 –age )x (body weight in kg ) / (72 x s.cr) Types of dialysis  2 kinds of dialysis  Hemodialysis 1. Permanent Through fistula or central vein cathetar or juglar vein , process of 3-5 hrs. performed 3 times/ week 2. Conventional (performed 5 -6 times /week , takes 2-4 hrs.) 3. Nocternal (Performed after every 8 hrs. 5-6 times /week) Peritoneal dialysis 1. Continuous ambulatory peritoneal dialysis (CAPD)  Fluid dialysate : high dextrose concentrated solution is injected in peritoneum  Captures waste material by the blood from the concentration gradient & release waste by pump attached to it  Performed 3 to 5 times a day takes 20 min Disadvantage : 400 -800 kcal additional by the dextrose causes obesity 2. Automated / cyclic peritoneal dialysis  Automated cyclic dialysis performed at night with the help of a machine and a dialysate ( high conc. Solution )  Performed after every 4 hr./day , 20 minutes required  Easily performed at home Goals  resolving edema  Resolving sodium loss  resolving hypernatremia  Supplementation of calcium and vitamin D Mnt  Protein requirement 20- 30 g of protein is lost after every dialysis 1.2g/kg 60% HBV 40 % LBV  Energy 35kcal/body weight for Hemodialysis 30- 35 kcal/ body weight for peritoneal dialysis  Sodium 1500- 2000 mg /day ( HD, PD)  Potassium 40mg/kg 2300- 3100mg/day For anureac patient less than 2000 mg/day  Phosphorus less than 1000 mg/day  Fluid 750 – 1000 ml/day In summers there is increased feeling of thirst then Keep ice in mouth Eat Freezed fruits Suck sour candies  Micronutrients for dialysis  vitamin C 60mg/day – 200 mg/day  Folic acid 1mg  Thiamin 1.5mg  Niacin 20mg  B12 66 microgram  B7 0.3mg  B6 10mg