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Chronic Renal Failure - College of Pharmacy-Handout2012

Replacement of substances can be added to dialysate

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Unformatted text preview: Replacement of substances can be added to dialysate • During the dwell solutes and fluid diffuse into the dialysate • Dialysate is drained and replaced or capped until next treatment • Variety of solutions are available to titrate to individual patient needs Peritoneal Dialysis • 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 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 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 Kidney Transplant 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 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? 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 Questions? 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 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 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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Replacement of substances can be added to dialysate •...

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