Professional Documents
Culture Documents
A. Definitions
1. Hyperphosphatemia
4. Bone Evaluation
a. Severe secondary hyperparathyroidism can
lead to osteoporosis
b. Some patients will require
parathyroidectomy to help prevent this
c. Unclear when bone densitometry should be
done on patients with CRF
Pre-Dialysis Treatment
Pre-
1. Maintain normal electrolytes
a. Potassium, calcium, phosphate are major
electrolytes affected in CRF
b. ACE inhibitors may be acceptable in many
patients with creatinine >3.0mg/dL
c. ACE inhibitors may slow the progression of
diabetic and non-
non-diabetic renal disease [[13
13]]
d. Reduce or discontinue other renal toxins
(including NSAIDS)
e. Diuretics (eg. furosemide) may help maintain
potassium in normal range
f. Renal diet including high calcium and low
phosphate
1. Reduce protein intake to <0.6gm/kg body weight
a. Appears to slow progression of diabetic and non-non-
diabetic kideny disease
b. In type 1 diabetes mellitus, protein restriction
reduced levels of albuminuria
c. Low protein diet did not slow progression in
children with CRF
1. Underlying Disease
H. Hemodialysis
1. Indications
a. Uremia - azotemia with symptoms and/or signs
b. Severe Hyperkalemia
c. Volume Overload - usually with congestive heart
failure (pulmonary edema)
d. Toxin Removal - ethylene glycol poisoning,
theophylline overdose, etc.
e. An arterio-
arterio-venous fistula in the arm is created
surgically
1. Procedure for Chronic Hemodialysis
a. Blood is run through a semi-
semi-
permeable filter membrane bathed in
dialysate
b. Composition of the dialysate is altered
to adjust electrolyte parameters
c. Electrolytes and some toxins pass
through filter
d. By controlling flow rates (pressures),
patient's intravascular volume can be
reduced
e. Most chronic hemodialysis patients
receive 3 hours dialysis 3 days per
week
1. Efficacy
a. Some acids, BUN and creatinine are reduced
b. Phosphate is dialyzed, but quickly released from
bone
c. Very effective at reducing intravascular
volume/potassium
d. Once dialysis is initiated, kidney function is often
reduced
e. Not all uremic toxins are removed and patients
generally do not feel "normal"
f. Response of anemia to erythropoietin is often
suboptimal with hemodialysis
1. Chronic Hemodialysis Medications
a. Anti--hypertensives - labetolol, CCB, ACE
Anti
inhibitors
b. Eythropoietin (Epogen®) for anemia in
~80% dialysis pts
c. Vitamin D Analogs - calcitriol given
intravenously
d. Calcium carbonate or acetate to î
phosphate and PTH
e. RenaGel, a non-
non-adsorbed phosphate
binder, is being developed for
hyperphosphatemia
f. DDAVP may be effective for patients with
symptomatic platelet problems