End-Stage Renal Disease (ESRD)

Definition/Etiology:

• ESRD
  • Causes
    • Pre-rena
    • Intra-renal
    • Post-renal

Pathophysiology:

• Kidneys can no longer effectively remove wastes, salts, and fluid from the body.
• Treatment (for the focus of this lesson)
  • Peritoneal dialysis
  • Hemodialysis

Noticing: Assessment & Recognizing Cues:

• Pre-Dialysis Management
  • Dry weight
  • Blood work (kidney function)
  • Blood pressure
  • Temperature
  • Lung assessment
  • Abdominal assessment (esp. PD)
  • Medications- can I give?
  • assessment of vascular access whether temp or permanent

Interpreting: Analyzing & Planning:

• Medications Removed during Dialysis
  • Excreted in kidneys
  • Blood pressure meds
  • Gabapentin/pregabalin
  • Most antibiotics
  • Anticoagulants
• Generally okay to give:
  • Proton pump inhibitors
  • Statins
  • Corticosteroids
  • Calcium channel blockers
  • Insulin/ oral hypoglycemics
• Medications to avoid/renal dosing for ESRD:
  • NSAIDs
  • Codeine/morphine
  • Antibiotics

Responding: Patient Interventions & Taking Action:

• Post-dialysis management
  • Assessment/ follow-up:
    • Vitals (e.g. BP and temp)
    • Lung assessment
    • Abdominal assessment (esp. PD)
    • Medications (not given)
    • Weight

Reflecting: Evaluating Patient Outcomes:

• ESRD Education
  • Diet
  • Low potassium
  • Low salt
  • Fluid restriction
  • Low protein
  • PD= less restricted
• Supplements/Medications
  • Epogen (Epo)
  • Phosphate binders
  • DM/HTN meds 
• Risks
  • Infection
  • Blood pressure changes
  • Changes to electrolytes
  • Weight gain/fluid overload
  • PD= hernia; ineffective

Linchpins (Key Points):

• Kidneys can no longer effectively remove wastes, salts, and fluid from the body.
• Treatment (for the focus of this lesson)
  • Peritoneal dialysis
  • Hemodialysis