Nutrition is an important part of managing chronic dialysis patients so much so that each unit has a registered dietician. Things that I focus on when rounding on a dialysis patient include: Albumin - Malnutrition and protein energy wasting Potassium Bicarbonate - Acid Base status Vitamins - B complex/ C Diabetes Albumin -
Anemia is an almost universal finding in patients with End Stage Renal Disease requiring dialysis. The following factors contribute: Erythropoietin deficiency: The kidneys normally secrete erythropoietin which stimulates the bone marrow to produce red blood cells. When the kidneys fail, erythropoietin deficiency occurs with resultant anemia. Iron deficiency: Patients on hemodialysis have ongoing
Arteriovenous access is the preferred access for hemodialysis (as opposed to use of a catheter). There are 2 types of arteriovenous access Arteriovenous fistula (AVF) - native artery transposed to native vein. Native vein hypertrophies under increased arterial pressure. This becomes fistula. This is the preferred dialysis access (over both catheters and arteriovenous
Dialysis access is the lifeline for patients on dialysis. The goal is to have a durable arteriovenous access (ideally an arteriovenous fistula). However, this is not always possible. The majority of patients initiate dialysis with a catheter and there may be complications that impair the use of the arteriovenous access in prevalent patients.
How do we decide the treatment time or duration of dialysis? How do we assess if a patient is getting sufficient dialysis? Dialysis adequacy refers to the clearance of uremic toxins. Although we use BUN, creatinine and eGFR to assess the degree of kidney function, we don’t use these parameters to assess the
It has become more common for patients with dialysis requiring acute kidney injury (AKI) to be dialyzed in the outpatient setting. With more medically complex patients and the incentive to decrease length of hospitalizations it is not uncommon for patients with dialysis requiring AKI to be discharged from the hospital prior to recovery
Primer for rounding on dialysis patients in the outpatient clinic. Intended for physician extenders, new fellows, and any other provider who wants to understand the mystery of dialysis. Topics: Acute Kidney Injury without recovery requiring continued outpatient dialysis Adequacy of dialysis Dialysis access Catheter Arteriovenous Access Anemia management Nutrition Mineral Bone Disease HTN/
First of all, what’s the difference between a fistula and a graft? To do dialysis you need to be able to consistently insert two large bore needles, 3 times a week. This is typically done via a fistula or graft. Fistula: An artery is redirected to directly connect to a vein. Over time
