divya esrd

End-Stage Renal Disease: 

End-Stage Renal Disease Presented by- Divya Pathak M.Pharm -1 st yr Pharmacology

Introduction: 

Introduction End –stage renal disease is complete or almost complete failure of the kidney to work. The kidneys remove waste and excess water from body. In this condition kidneys cannot effectively concentrate or dilute the urine ,it is also called “Final stage renal failure” occurs when about 90% of nephron have been lost.

PowerPoint Presentation: 

At this stage GFR diminishes to 10-15% of normal , oliguria is present and blood level of nitrogen containing wastes and creatinine increase further.

Causes-: 

Causes- ESRD is when the kidney are no longer able to work at a level needed for day- to-day life. The most common causes of ESRD in the u.s are diabetes and high blood pressure. These conditions can affect your kidneys. ESRD almost always comes after “chronic kidney disease". The kidneys may slowly stop working End-stage disease result.

Symptoms-: 

Symptoms- Symptoms may include: General ill feeling and fatigue Itching ( pruritus ) and dry skin Headaches Weight loss without trying Loss of appetite Nausea Other symptoms may include: Abnormally dark or light skin Nail changes Bone pain Drowsiness and confusion Problems concentrating or thinking Numbness in the hands, feet, or other areas

PowerPoint Presentation: 

Muscle twitching or cramps Breath odor Easy bruising, nosebleeds, or blood in the stool Excessive thirst Frequent hiccups Low level of sexual interest and impotence Menstrual periods stop ( amenorrhea ) Sleep problems, such as insomnia , restless leg syndrome , or obstructive sleep apnea Swelling of the feet and hands ( edema ) Vomiting , especially in the morning

Treatment: 

Treatment Dialysis or kidney transplantation is the only treatment for this condition. Changing the patient diet to achieve clinical goal. Intensive glucose control. Antihypertensive therapy . Metabolic acidosis.

Dialysis: 

Dialysis

PowerPoint Presentation: 

9 Dialysis is used to remove fluid and waste products from the body when the kidneys cannot do so. May also be used for oedema hepatic coma, hyperkalemia, hypercalcemia, hypertension uremia

PowerPoint Presentation: 

10 Dialyzer – serves as a synthetic semipermeable membrane replacing renal glomeruli and tubules. Treatement for 3 – 4 hours 3 – 4 times a week Or – short daily haemodialysis

How does dialysis work ?: 

11 How does dialysis work ? Dialysis works on the principle of diffusion of solutes across a semipermeable membrane - osmosis Smaller solutes pass through the membrane. The concentrations of undesired solutes (for example potassium, urea, and phosphorus) are high in the blood, but low or absent in the dialysis solution. The dialysis solution is isotonic for sodium and chloride. For bicarbonate, dialysis solution level is set at a slightly higher level than in normal blood, to encourage diffusion of bicarbonate into the blood, to neutralise the acidosis that is often present in these patients.

Indications: 

12 Indications i . volume overload ii. electrolyte imbalance iii. contraindications to peritoneal dialysis iv. uremic symptons

PowerPoint Presentation: 

13 Contraindications/disadvantages i. Hemodynamic instability ii. vascular access problems v. hepatitis vi. muscle cramping vii. bleeding tendencies due to anticoagulant used

PowerPoint Presentation: 

14 Types of vascular access: i. Temporary double or single lumen catheters ii. AV fistulas iii. grafts (Gortex) iv. shunts (Scribner)

PowerPoint Presentation: 

15

Vascular Access: 

16 Vascular Access Subclavian, internal jugular, and femoral catheters Double or multilumen catheters Fistula – AV fistula – created by surgery – between the cephalic vein and the radial artery – fistula takes 4 – 6 weeks to mature The rate of flow : 200 to 800 ml / mt.

Vascular Access: 

17 Vascular Access

Graft: 

18 Graft An arteriovenous graft created – synthetic graft made of PTFE = polytetrafluoroethylene Fore arm, upper arm, upper thigh For patients who don’t have suitable vessels Complications – infection, thrombosis

Vascular Access - graft: 

19 Vascular Access - graft

Complications and problems during dialysis: 

20 Complications and problems during dialysis Fluid overload Heart failure, CAD, anginal pain Stroke Anemia and fatigue Gastric ulcers – due to physiological stress Renal osteodystrophy that produces bone pain and fractures Malnutrition Infection Neuropathy and pruritus Disturbances of lipid metabolism

PowerPoint Presentation: 

21 Hypotension Painful muscle cramping Exsanguination accidental Dysrhythmias Air embolism Chest pain

PowerPoint Presentation: 

22

Peritoneal Dialysis: 

23 Peritoneal Dialysis Indications : Those who are unwilling to undergo haemodialysis Diabetes mellitus Cardiovascular disease Elderly patients Risk of heparin Severe hypertension Heart failure Pulmonary oedema

Peritoneal - approaches: 

24 Peritoneal - approaches Acute intermittent peritoneal dialysis Continuous ambulatoryperitoneal dialysis (CAPD) Continuous cyclic peritoneal dialysis (CCPD)

PowerPoint Presentation: 

25

PowerPoint Presentation: 

26

Underlying principles: 

27 Underlying principles Peritoneum – a serous membrane – used as the semipermeable membrane – 22000 cm 2 Sterile dialysate introduced into the peritoneal cavity at intervals through an abdominal catheter at intervals Urea and creatinine and other metabolic end products normally excreted by the kidneys are cleared from the blood by diffusion and osmosis

Procedure : 

28 Procedure Explain Record baseline vital signs, weight, electrolytes level Empty bladder and bowel to avoid injury Prophylactic antibiotics

Preparing the equipment: 

29 Preparing the equipment Assemble the equipment Decide concentration of the dialysate Antibiotics and heparin added Aseptic precautions Warm up the solution Avoid air in the tubing

Inserting the catheter: 

30 Inserting the catheter At OT – preferable A rigid stylet catheter for acute dialysis only Skin painted with antiseptics Local anaesthesia Stab wound 3 – 5 cm below the umbilicus Trocar inserted, catheter inserted, trocar removed and catheter is secured to the abdominal wall by a purse string suture. Catheter – silicone – radio-opaque

PowerPoint Presentation: 

31

Performing the exchange: 

32 Performing the exchange A series of exchanges or cycles – infusion, dwell and drainage Infused by gravity 2 litres over 5 - 10 mts Dwell time varies – 1 to 3 hours

Complications of peritoneal dialysis: 

33 Complications of peritoneal dialysis Immediate complications Peritonitis Leakage Bleeding Long term complications Hypertriglyceridemia Abdominal hernias Low back pain Clots in the peritoneal catheter Constipation