Chronic Renal Failure - College of Pharmacy-Handout2012

Dwell times vary as do the number of treatments per

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Dwell times vary as do the number of treatments per day or week May be performed at home or at a health care setting Treatment may be automated or manual Treatment may be continuous or intermittent Complications include: Infection, dehydration, hyperglycemia, hypoalbuminemia, poor appetite and hernia
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Hemo- vs Peritoneal Dialysis Mortality data similar between treatments Patient preference Independence, comfort level Aversion to blood sticks Controlled environment at dialysis center Geographic Access issues Costs Time
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Transplantation Improved success has made this the treatment of choice for most patients Donor availability has limited number performed Sources include: cadavers and live donors in equal amounts One year survival is 95-98% and 5 year survival is 65-80% Survival depends on organ type, compatibility, organ preservation, immunosuppression and patients health
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Kidney Transplant
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Transplantation Rejection is most difficult obstacle to success Mediated by both B and T cell response Immunosuppression can control but not yet eliminate rejection Complications include: Infection Cancers Graft failure Primary cause of death today is cardiovascular disease
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Patient Case #1 What long term treatment options should we start to consider for AK? What are the risks and benefits of each of these options?
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Patient Case #1 Prolong her current renal function as long as possible Decide which treatment option is best for her both medically and personally Prepare her for dialysis thru insertion of either a HD graft or a PD catheter OR initiate work-up for a kidney transplant
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Questions?
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Patient Case #2 FJ is a 65 yo BM with a long hx of poorly controlled IDDM and HTN. SrCr last year was 2.7. His urine is + for protein and he has 2+ pitting edema. He also gets SOB after walking 1 set of stairs. Came to ER today with a hip fracture. Ht 6’0” Wt 175# BP 180/110 HR 95 Cr=4.5 K=5.9
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Patient Case #2 Calculate the patients CrCl 18 ml/min What is the etiology of his declining renal function? Diabetes and HTN What are his symptoms? Edema, SOB, protein in urine, hip fracture
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Patient Case #2 What other labs should we check? Electrolytes, PTH, Hg/Hct, albumin, Ca, Mg, Phos, vitamin D, cholesterol, glucose, HgA1c What stage of CKD? Stage 4
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