Download Project-worksheet for Dialysis for Kidney Failure

Worksheet - Dialysis for Kidney Failure:
1. Where does the word dialysis come from (Greek meanings of the prefix, root word,
suffix, etc.)?
2. Compare and contrast the two types of dialysis: hemodialysis and peritoneal dialysis.
Your answers should include the following:
a. A diagram/picture of the dialysis machine
b. Can the procedure be performed inpatient, outpatient or at home, etc.?
c. Describe how the dialysis machine works? Does it involve diffusion, filtration,
etc.? Describe the processes involved.
d. Describe the accesses to hemodialysis and peritoneal hemodialysis. Include
pictures/diagrams along with the advantages and disadvantages.
e. What are the advantages of each procedure?
f. What are the disadvantages or complications of each procedure?
g. Describe the contents of the dialysis fluid (AKAS “solution”).
3. How does nutrition affect dialysis (compare and contrast both types) a patient’s kidney
function:
a. Describe why water intake must be regulated during dialysis.
b. Describe why potassium intake must be regulated during dialysis.
c. Describe why phosphorus intake must be regulated during dialysis.
d. How does protein intake change with dialysis?
e. Describe why sodium intake must be regulated during dialysis.
f. Describe why calorie intake must be regulated during dialysis.
g. Describe why vitamins and minerals are sometimes prescribed during dialysis.
4. What are typical medications prescribed for patients on dialysis?
5. What do the blood test results mean?
6. Can a patient exercise on dialysis?
Answers to Worksheet - Dialysis for Kidney Failure:
1. Dialysis (from Greek “dialusis”)
“Dia” means through
“Lusis” means loosening
2. 2 Types of dialysis:
1. Hemodialysis (HD)
a.
http://www.answers.com/topic/hemodialysis-schematic-gif-1
b. It can be inpatient or at home
c. The dialysis machine contains a semi-permeable membrane that acts as a filter
(dialyzer or artificial kidney) and separates the machine into two
compartments. One compartment contains the dialysis solution (dialysate)
and the other compartment contains blood. Blood leaves the patient through
a catheter or fistula and enters the dialysis machine to be filtered. The filtered
blood is returned to the patient via the catheter or fistula. This type of dialysis
involves diffusion of solutes across a semi permeable membrane (dialyzer)
and filtration (removing fluid). It utilizes counter current flow which is the
transfer of a solute from one flowing current of fluid (blood) to another fluid
(dialysate) across a semi permeable membrane (dialyzer).
d. Hemodialysis Accesses:
1. Intravenous catheter:
- Can be tunneled or nontunneled. A tunneled catheter is tunneled
under the skin into the chest until it reaches a large vein (superior
vena cava). A tunneled catheter is usually used when the patient
needs access on a long term basis.
- A plastic catheter with two lumens is inserted into the vena cava (via
the internal jugular vein) or the femoral vein. These veins are
chosen due to a large volume output. This method does not perform
as well as a fistula or graft.
- A risk of stenosis is possible along with scarring.
2. AV fistula:
- A surgeon joins an artery and vein (anastomosis), therefore;
bypassing the capillaries forcing the blood to flow through the
fistula.
- Usually found on the nondominant arm.
- Usually found in the hand (snuffbox fistula), forearm
(radiocephalic fistula) or elbow (brachiocephalic fistula)
- Advantages: lower infection rates and higher blood flow rates
FISTULA
http://www.answers.com/topic/hemodialysis?cat=health
3. AV Graft:
- Similar to the fistula but a tube (artificial vessel) joins the artery and
vein.
- Used when the patient’s vasculature can’t tolerate a fistula.
- Are at a high risk for infection, narrowing, clotting, etc.
GRAFT
e. The major advantage of the HD is minimal participation of the patient since
dialysis is performed in
a treatment center.
www.camsf.com
f. The disadvantages and complications of HD procedure:
Disadvantages include:
1. A stricter diet and fluid intake than PD.
2. Requires the patient to travel to a treatment center multiple times a
week.
Complications include:
1. “Dialysis Hangover” or “Dialysis Washout” – due to the removal of
fluid (through ultrafiltration), which is sometimes too much or too
little, the patient may complain of low blood pressure, fatigue, chest
pains, cramps, nausea, etc.
2. Infection – the circulatory system has been accessed exposing the
body to microbes, etc. To prevent infection it is crucial to use
infection control practices.
3. Heparin allergy – heparin is an anticoagulant used in hemodialysis.
Other alternatives are used if problems occur i.e. bleeding, low platelet
count, etc.
4. First Use Syndrome – severe anaphylactic reaction to the artificial
kidney. Symptoms include sneezing, wheezing, shortness of breath,
chest pain, etc.
g. The dialysis solution is a sterilized solution of mineral ions. Note: the
sodium and chloride are similar to normal plasma to prevent loss.
Bicarbonate is added in a higher concentration than plasma to correct blood
acidity. Glucose is also sometimes added. These levels are adjusted
according to the individual condition.
2. Peritoneal dialysis:
a. There are two types of peritoneal dialysis (Continuous Ambulatory Peritoneal
Dialysis or CAPD and Continuous Cycling Peritoneal Dialysis or CCPD).
The main difference between the two types of peritoneal dialysis is that CAPD
does not require the use of a machine. With CAPD the dialysate enters the
peritoneal region remains there for 4-5 hours then drains out. This process is
referred to as exchange. A CAPD patient will perform 4-5 exchanges per day.
With CCPD, a machine (called a cycler) is used to pump the dialysate into the
peritoneal region. A CCPD patient performs multiple exchanges daily each
lasting 1-1.5 hours and throughout the night.
Continuous Ambulatory Peritoneal
Dialysis (CAPD)
Continuous Cycling Peritoneal Dialysis
(CCPD)
http://www.kidneyurology.org/Library/Treatment_Options/Peritoneal_Dialysis_Dose_and_Adequacy.php
http://www.renalpatients.co.uk/capd.htm
b. The procedure is performed multiple times daily at home or while traveling.
c.
The dialysis solution enters the abdomen via a catheter and forces water, salts
and waste products to move from the blood into the dialysis fluid passing
through the peritoneum. When the solution gets saturated it must be
exchanged. The solution enters via a catheter that was surgically placed in the
abdomen. Usually, 2 liters of fluid enters each time and this is done 4 times
daily. The procedure involves filtration (the patient’s peritoneum acts as a
filter) and diffusion.
d. The access is via the abdomen (peritoneal region). See picture above.
e. Advantages: treatment at home, no needles, patient can travel, lower risk for
infection, better preservation of kidney function, etc.
f. Disadvantages: infection in the peritoneum, exit site infection, membrane
malfunction, etc.
g. Solution (peritoneal dialysis fluid) contains:
1. Glucose – the greater the amount of glucose the greater the water
removal. There are 2 types of glucose solutions that differ in pH so
depending on the patient’s needs a particular glucose solution will be
chosen.
2. Amino Acids – used to improve the patient’s nutrition and reduce the
amount of glucose removed.
3. Icodextrin – removes more water than the glucose which give longer
exchange intervals
3. Nutrition
Nutrition is different for peritoneal dialysis and hemodialysis.
a. Fluid intake for PD and HD: Excess fluid causes an increase in blood pressure
thereby requiring the heart to work harder. Fluid intake is limited for both types of
dialysis and based on the patient’s needs.
Fluid intake for PD: the amount of fluid taken out should be relatively the same as
the fluid put in. For example, if more fluid is removed the patient will need to drink
more water throughout the day. The same principle applies if less fluid is removed
during the filtration process.
Fluid intake for HD: The goal is fluid removal. Ideal fluid gain between treatments
is 1-2 pounds. Fluid intake allowance for HD is based on this equation: urine output
+ 700-1000ml. For example, if you urinate 300 mls then add 700 ml totaling 1000 ml
of fluid intake.
b. Potassium assists in the regulation of one’s heartbeats and must remain at appropriate
levels to prevent excessive strain on the heart’s workload.
Potassium intake for PD: Because the peritoneum acts as a filter (which works
continuously) peritoneal dialysis patients are usually not restricted to potassium
intake. Sometimes potassium must be increased due to excessive loss.
Potassium intake for HD: As opposed to PD, it must be limited.
c. Phosphorus is a mineral that extracts calcium from the bones. If excessive calcium
is extracts from the bones then one is at risk for osteoporosis. Additionally, if one has
excessive phosphorus then one’s skin will itch.
Phosphorus intake for PD and HD: Phosphorus intake must be controlled in both
types of dialysis since it is not removed during the filtration process of either type.
Many times, phosphate binders are prescribed to prevent phosphate from entering the
blood and instead pass via the stool.
d.
Protein intake for PD and HD: Patients on peritoneal dialysis are allowed to
consume more protein than patients on hemodialysis because peritoneal dialysis uses
the peritoneum to filter wastes, etc. rather than the filter in the dialysis machine. With
peritoneal filtration, patients lose proteins rendering the need for additional high
quality protein intake. Proteins assist in repair of the body’s tissues especially when
infection is present.
e. Sodium intake for PD and HD: Sodium intake is the same for both types of dialysis.
A limited sodium intake will decrease thirst (decreasing fluid intake) and decrease
water in the body (decreasing blood pressure).
f. Caloric intake for PD: Patients on peritoneal dialysis must have adequate caloric
intake to allow the utilization of the proteins in the body. Without the appropriate
calories, the body will not assimilate the protein sources to repair the body’s tissues,
etc. However, because of the dextrose in the dialysate many patients gain weight
during dialysis. It is advised these patients reduce their calories by reducing sweets
and fats while including an exercise program.
g. Vitamins and mineral for PD and HD: Since many foods are restricted from the
patient’s diet, vitamins and minerals are many times prescribed. These vitamins must
be prescribed because over the counter vitamins have substances that will harm the
kidney.
4. Common medications prescribed during dialysis:
a.
To prevent anemia: erythropoietin hormone medication (i.e.
Procrit®) and iron supplementation (needed for erythropoietin to work)
b.
To prevent bone disease and calcifications: phosphorus binding
medication, calcium binding medication and the active form of vitamin D
c. To prevent vitamin and mineral loss – B-complex vitamin with folic acid
d. To prevent dry skin and itching – antihistamine and cortisone medication, etc.
e. To prevent cramps – quinine sulfate
f. Others that are related to kidney disease – blood pressure, cholesterol and diabetes
medicines
5. Blood test results and what do they mean:
a. Albumin – low levels suggest you may not be eating enough protein
b. Blood urea nitrogen – high levels suggest the kidneys are not removing urea
effectively
c. Calcium – high levels suggest you may be getting too much calcium or vitamin D via
supplementation or developing bone disease (osteodystrophy), low levels suggest you
may be consuming excessive phosphorus via the diet
d. Creatinine – high levels suggest dialysis is not working effectively or one is not
consuming enough calories
e. Ferritin – high levels suggest inflammation or follow repeated blood transfusions,
low levels suggest one is not absorbing iron
f. Folate – low levels suggest one needs supplementation of folate
g. Glycated hemoglobin – high levels suggest poor blood sugar control
h. Hematocrit – low levels suggest hemoglobin is lost in the blood, iron levels are too
low or erythropoietin medication needs to be adjusted
i. Hemoglobin – low levels suggest hemoglobin is lost in the blood, iron levels are too
low or erythropoietin medication needs to be adjusted
j. Iron – follow repeated blood transfusions, low levels suggest one is not absorbing
iron
k. Parathyroid hormone – high levels suggest phosphorus and calcium need
adjustment or the parathyroid glands may be overactive
l. Phosphorus – high levels suggest one’s diet is too high in potassium, low levels
suggest phosphorus binding medication are too high or one is not consuming enough
calories
m. Potassium – high levels suggest one is consuming too much potassium in one’s diet,
low levels may follow diarrhea or vomiting, phosphorus must be in range or it may
stop one’s heart
n. Sodium – high levels increase thirst (increase fluid consumption) and blood pressure,
low levels suggest one is retaining too much fluid
o. Vitamin B-12 – low levels suggest one needs to absorb more B-12 via the diet or
supplementation
p. Prothrombin time – high levels suggest your blood is too thin, low levels suggest
your blood is too thick
6. A patient should include the following exercise prescription:
a. Cardiovascular (3-5 times/week)– these exercises aid in increasing metabolic rate,
decrease blood pressure and increase the health of one’s heart
b. Strength (3 times/week) - these exercises help to maintain muscle structure and
function
c. Flexibility (daily) – these exercises aid joint movement
References:
http://www.aakp.org/aakp-library/hemodialysis-diet-versus-peritoneal-diet/
http://kidney.niddk.nih.gov/kudiseases/pubs/eatright/index.htm
http://www.kidneyurology.org/Library/Treatment_Options/Peritoneal_Dialysis_Dose_and_Adeq
uacy.php
http://www.answers.com/topic/hemodialysis?cat=health
http://www.davita.com/dialysis/c/469
http://www.mayoclinic.com/health/dialysis/DA00133
http://en.wikipedia.org/wiki/Countercurrent_exchange
http://www.medicinenet.com/dialysis/page4.htm
http://en.wikipedia.org/wiki/Hemodialysis
http://www.hopkinsmedicine.org/Press_releases/2004/02_11_04.html
http://msl1.mit.edu/esd10/kidneys/hndbkhtml/ch4.htm
http://www.renalpatients.co.uk/capd.htm