Education
- Chronic Kidney Disease
- Vascular Access
- Medication
- Routine/Expected Tests
- Infection Control
- Treatment Options
CKD
CHRONIC KIDNEY DISEASE
- Renal
- Renal failure aka Kidney disease
- Renal function
- Chronic Kidney Disease
WHAT ARE KIDNEYS?
Kidneys are organs located in the abdominal cavity on either side of the lower back. Every person has two kidneys, each one about the size of a human fist.
- Kidneys serve the following functions:
- Removing extra fluid from the body
- Removing bodily wastes or metabolic end products from the blood
- Helping to regulate blood pressure
- Helping to maintain the proper amount of red blood cells
- Helping with the proper metabolism of calcium, phosphorus, and vitamin D to maintain strong bones and proper function of muscles.
There are many possible causes of kidney failure including high blood pressure, diabetes, and chronic infections just to name a few. Some are hereditary such as polycystic kidney disease.
Chronic kidney disease or chronic kidney failure is characterized by a gradual loss of kidney function. This disease progresses in 5 distinct stages which are based on eGFR test results. eGFR (estimated glomerular filtration rate) is a measurement of how well your kidneys are functioning. These are the five stages of chronic kidney disease:
Stage 1: eGFR >= 90
- Mild kidney damage
Stage 2: eGFR 60-89
- Mild kidney damage
Stage 3: eGFR 30-59
- Moderate kidney damage and a notable decrease in kidney function
- You may experience one or more of the following symptoms:
-
- swelling in hands or feet
- back pain
- more or less frequent urination
- high blood pressure
- anemia
- bone disease
Stage 4: 15-29
- Moderate kidney damage and a notable decrease in kidney function
- You will likely experience one or more of the following symptoms:
-
- swelling in hands or feet
- back pain
- more or less frequent urination
- high blood pressure
- anemia
- bone disease
Stage 5: <15
- Severe kidney damage resulting in kidney failure
- You will likely experience one or more of the following symptoms:
-
- weakness/fatigue
- itchiness
- loss of appetite
- less frequent urination
- swelling in ankles/face/hands
- shortness of breath
- trouble sleeping
What happens when kidneys fail?
Your kidneys maintain homeostasis in your body and are a vital part of keeping you alive. When your kidneys fail you will need to start dialysis.
If someone’s kidneys were to fail, they might experience the following side effects:
-
- weakness/fatigue
- Itchiness
- Loss of appetite
- Less frequent urination
- Swelling in ankles/face
- shortness of breath
What can cause kidney failure?
There are many possible causes of kidney failure including high blood pressure, diabetes, and chronic infections just to name a few. Some are hereditary such as polycystic kidney disease.
VA
VASCULAR ACCESS
In order to perform hemodialysis treatment, a vascular access must be made in your arm or leg. Two needles are inserted into your access – one to draw blood from your body into the dialyzer, and another to return the cleansed blood to your body. These needles are removed after each treatment.
PERMANENT VASCULAR ACCESS
There are two types of permanent vascular access:
- A fistula is the surgical joining of an artery and a vein. When a fistula is installed in your arm, the blood vessels inside that arm enlarge and develop a stronger blood flow. This makes the process of inserting needles into your access much easier for your nurse. In order for your blood vessels to grow, it is important to exercise your access arm regularly. An easy way to do this is to squeeze a rubber ball for about 20 minutes, 4 times a day.
- A graft is an artificial tube that is surgically inserted into your arm to join an artery and a vein. This option is great for any patient whose blood vessels are either too small or damaged too severely by illness to create a fistula. During hemodialysis treatment, needles are inserted into the graft.
Whenever possible, a vascular access is placed in the arm that the patient uses least.
Taking Care of Your Vascular Access
- Whether you have a fistula or a graft, you must take special care of your access arm or leg. Here are a few important things to keep in mind:
- Do not wear tight clothing over the access arm or leg.
- Do not sleep on the side of your body that your access arm or leg is on.
- Do not use your access arm as a headrest.
- Blood pressure cannot be taken using your access arm.
- Blood cannot be drawn from your access arm.
- IVs cannot be started in your access arm.
- During hemodialysis treatment, you may be given a medication called Heparin which prevents your blood from clotting in the dialyzer. This may cause bleeding from your vascular access. If this happens, take the following course of action:
- Apply a clean gauze or a cold washcloth to the area with firm pressure until the bleeding has stopped.
- If bleeding is excessive or continuous, contact your doctor immediately for further instructions.
- If you are unable to contact your doctor, go to the emergency room.
- If you do not notice any bleeding from your vascular access, remove the dressing 4-6 hours after your hemodialysis treatment. Wash your access arm or leg daily with mild soap and water. Remember to keep your access arm or leg clean and dry.
- If you notice any bruising on your access arm or leg after your treatment, apply a warm washcloth to the area for 20 minutes, 2-3 times a day until your next treatment.
- It is important to regularly make sure your access is in excellent working condition. To check on your access, place your hand over your vascular access. If you feel a buzzing vibration, this means your access is working as intended. If the vibration is either minimal or completely absent, call your doctor immediately for further instructions.
TEMPORARY VASCULAR ACCESS
- Sometimes, it may not be possible to use your fistula or graft for hemodialysis. In this situation, a temporary vascular access would be used. Your doctor would care for your temporary vascular access in the dialysis unit using local anesthetic.
- A subclavian catheter is a soft plastic tube that is inserted into a large vein in the upper chest. After the catheter is inserted, you can resume normal activity. Before the catheter is used for the first time, you must have a chest x-ray done to make sure the catheter is installed properly. Your catheter will remain in place until a permanent vascular access is ready for use. After each treatment, your nurse will inject Heparin or Saline into the catheter to prevent blood clots from forming in between treatments. The access area will then be covered with dressing. The insertion of a dialysis catheter is done in the hospital.
- Here are a few important things to keep in mind:
- Do not get the dressing or catheter wet. This means no showers.
- Do not touch or remove the dressing.
- If you notice any bleeding or wetness in the area, apply pressure with a clean gauze. Call your doctor immediately for further instructions. If you are unable to contact your doctor, go to the emergency room immediately.
- If you experience shortness of breath or chest pain, call your doctor and go to the emergency room immediately.
- Here are a few important things to keep in mind:
MEDS
MEDICATION
Dialysis patients take many different medications. Your doctor and primary nurse will explain each one to you in detail. Below, you will find a list of some medications along with their respective purposes, methods of administration, and common side effects.
HEPARIN
- Purpose
- Prevents blood from clotting in the dialyzer during treatment
- Method
- Administered through blood lines on the dialysis machine
- Side Effects
- Bleeding
- Recommendations
- Notify your doctor/medical team if you notice any abnormal bruising, fall and hit your head, or go for dental work.
- Notify your doctor if you notice blood or black/tarry discoloration in your bowel movements.
NOMRAL SALINE
- Purpose
- To prepare the dialyzer for use
- For low blood pressure
- For muscle cramps that may occur during hemodialysis
- To return your blood to your body at the end of hemodialysis
- Method
- Administered through blood lines on the dialysis machine
- Side Effects
- Bloating and increased blood pressure if too much is administered
TYLENOL
- Purpose
- For fever and mild pain
- Method
- Ingested as tablet
- Typically 2 tablets every 4-6 hours
- May vary depending on doctor’s order
- Do not take Aspirin unless specifically instructed to by your doctor.
- Aspirin may cause increased bleeding.
- Do not take any NSAIDs.
- These include the following:
- Ibuprofen
- Naproxen
- Alleve
- Motrin
- Advil
- NSAIDs are harmful to your kidneys if you are on dialysis.
- These include the following:
- Typically 2 tablets every 4-6 hours
- Ingested as tablet
PHOSPHATE BINDERS
- These include the following medications:
- Auryxia
- Fosrenol
- Phoslo
- Phoslyra
- Renagel
- Renvela
- Tums
- Velphoro
- Purpose
- Phosphate binders prevent the buildup of phosphorus in your blood.
- If too much buildup occurs, calcium is removed from your bones to maintain normal phosphorus levels. This will eventually cause your bones to become significantly weaker.
- Phosphate binders prevent the phosphorus in food from being absorbed into your bloodstream. This phosphorus is then excreted in your bowel movements.
- Phosphate binders prevent the buildup of phosphorus in your blood.
- Method
- Ingested as tablet, capsule, or liquid
- Take the ordered amount with food.
- Side Effects
- Constipation
- If constipation occurs, inform your doctor and primary nurse.
- Please only take the prescribed medications.
- Constipation
- Ingested as tablet, capsule, or liquid
ERTHROPOIETIN STIMULATING AGENTS (ESAs)
- Purpose
- People on dialysis often experience anemia because they lack a hormone called erythropoietin. Erythropoietin causes the body to make red blood cells which are necessary for carrying oxygen.
- You can tell if you are experiencing anemia based on 2 lab values – hemoglobin and hematocrit.
- Anemia can reduce your quality of life, cause harm to your heart, increase your risk of death, make you feel tired, and make you think less clearly.
- Method
- ESAs are administered through the dialysis lines directly into the bloodstream during dialysis.
- Side Effects
- Increase in hemoglobin and hematocrit
- Too much hemoglobin and hematocrit can thicken your blood and increase your risk of stroke and heart problems.
- Increase in hemoglobin and hematocrit
- Do Not Take the Following:
- Milk of Magnesia/Citrate of Magnesia
- These laxatives contain magnesium. Your body cannot excrete magnesium, and a buildup of magnesium in your blood can be harmful.
- Fleet’s Enema
- Fleet’s Enema is high in phosphorus content.
- Milk of Magnesia/Citrate of Magnesia
VITAMIN SUPPLEMENTS
- These include the following medications:
- Folic Acid
- Pyridoxine
- Vitamin B
- Vitamin C
- Purposes: All of these medications are from the Vitamin B group – the same group of vitamins that is removed from your blood during dialysis treatment. You may be prescribed one or more of these medications to replace what is lost during dialysis.
Your medications must be reviewed monthly by your doctor/nurse practitioner and primary nurse. The best way to do this is to bring your medication bottles in for review once a month. At some units, a list of medications may be sufficient. If you have any questions about your medications, ask your doctor/nurse practitioner or primary nurse.
TESTS
ROUTINE/EXPECTED TESTS
The following tests are ordered by your physician as required. If you have any testing done outside of the dialysis unit, please bring or send copies of your results to the unit.
- EKG
- This test ensures that your heart is working properly with no irregular beating.
- Chest X-Ray
- This is done to make sure that your lungs are clear of fluids and diseases.
- PPD
- This test is administered via a small injection under the skin of your arm. Its purpose is to check whether or not you have been exposed to tuberculosis. If the test is positive, a chest x-ray will be performed to see if you have tuberculosis.
- Monthly Lab Work
- For lab work, samples of your blood are drawn to check the levels of potassium, BUN, creatinine, and other substances in your blood. Your results help your doctor, nurse, and dietitian make any necessary changes to your dialysis treatments or diet.
- Other Tests
- Various other tests are performed throughout the year to ensure that your dialysis treatments, medications, and diet are working properly for you. Feel free to ask your doctor or primary nurse any questions you may have regarding these tests and what the results mean for you.
IC
INFECTION CONTROL
Here are a few ways to minimize the risk of an infection:
- Hand Washing
- Always remember to wash your hands immediately before and after your treatment.
- Access Care
- Washing your fistula or graft before treatment – Your skin has normal bacteria on the surface which can cause an infection if inserted into your bloodstream. Washing your access decreases these organisms on the skin making them less likely to enter into your bloodstream during needle placement.
- Holding your own needle sites after treatment – You must wear gloves if you are going to hold your needle sites after treatment. While holding your needle sites, you can get blood on your fingers. If you don’t have gloves on, you can bring this blood to the scale button, door knobs, and other areas that other patients have to touch. This is called cross contamination and is a large cause of infections.
- Keeping your catheter dry – Be sure to cover the catheter while bathing or showering. You should refrain from swimming. Ensure that water does not directly wet the dressing.
TO
TREATMENT OPTIONS
What is dialysis?
- Dialysis is a treatment process that is performed for the following purposes:
- Removal of excess fluids (ultrafiltration)
- Removal of toxins (filtration)
Peritoneal Dialysis
- Peritoneal Dialysis is a type of dialysis treatment that requires the placement of a catheter in the patient’s abdomen. Fluid called dialysate flows through the abdominal cavity through the catheter. The dialysate remains in the abdomen for several hours, absorbing some of the excess toxins and fluid from your body through the abdomen’s membrane lining. It is then drained out of the patient’s body and discarded. This procedure is repeated as often as the patient’s doctor deems necessary. Peritoneal dialysis is performed at home by either the patient or a helper. If you are interested in trying peritoneal dialysis, speak with your doctor and primary nurse.
Hemodialysis
- Hemodialysis is a type of dialysis treatment that requires a machine, an artificial kidney, and the placement of a vascular access in your arm. Treatments typically last three to four hours and occur three or more times a week. Hemodialysis can be performed in an outpatient center or at home. If you are interested in trying hemodialysis treatment at home, speak with your doctor and primary nurse.
- What is a dialyzer?
- The dialyzer is the artificial kidney used in hemodialysis treatment. Its hard casing contains two compartments:
- The Blood Compartment: As the name suggests, blood flows through this compartment. The blood compartment is a membrane, similar to cellophane. It is semi-permeable, meaning it has very small holes to allow certain particles and fluid to pass through it in both directions. This compartment also prevents blood and dialysate from mixing together.
- The Dialysate Compartment: This is the compartment through which dialysate flows.
- Each treatment, two needles will be inserted into the patient’s vascular access. These needles are then attached to two separate blood lines. The red blood line draws blood from the patient’s body into the dialyzer, while the blue blood line returns the blood from the dialyzer back into the patient’s body.
Kidney Transplantation
- Kidney transplantation is the process of removing a kidney from a donor and placing it in the recipient’s body, usually in the lower abdomen. The donor could be a living relative of the recipient, an unrelated living donor, or someone who has died. After completion of the procedure, the recipient must take medication for the rest of their life in order to prevent their body from rejecting the transplanted kidney.
- If you would like to be considered for kidney transplantation, inform your doctor and primary nurse. If you are accepted as a candidate for a transplant, an appointment at a transplant center will be made for you. The team at the transplant center will evaluate you and answer any questions you may have about the procedure.
