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CKD Stages

Stage 1: minimal kidney damage, GFR is greater than 90
Stage 2: minor kidney damage, GFR is between 60-89
Stage 3: moderate kidney damage, GFR is between 30-59
Stage 4: severe kidney damage, GFR is between 15-29
Stage 5: kidney failure and end stage kidney disease with little or no GFR (less than 15 mL/min)


CKD Health Promotion and Disease Prevention

-limit alcohol intake
-NO smoking
-drink at least 2 L of water daily. consult w/provider about any restrictions
-diet and exercise to manage weight and prevent or control DM and HTN
-adhere to medication prescription guidelines to prevent kidney damage
-test for albumin in the urine yearly (PT's who have DM or HTN)
-take ALL antibiotics until completed
-limit OTC NSAIDs


Risk factors for CKD

-acute kidney injury
-nephrotoxic medications (gentamicin, NSAIDs, or chemicals like contrast dye for tests)
-autoimmune disorders (systemic lupus erythematosus)
-renal artery sensosi
-recurrent severe infections
-chronic glomerulonephritis


CKD Clinical Manifestations general

Nausea, fatigue, lethargy, involuntary movement of legs, depression, intractable hiccups.
In most cases, findings of CKD are related to FV overload.


CKD Neuro manifestations

lethargy, decreased attention span, slurred speech, tremors or jerky movements, ataxia, seizures, coma


CKD cardiovascular manifestations

fluid overload (JVD, sacrum, ocular, or peripheral edema), HTN, dysrhythmias, HF, orthostatic hypo, peaked T waves on ECG (hyperkalemia)


CKD Respiratory manifestations

uremic halitosis with deep sighing, yawning, SOB, tachypnea, hyperpnea, Kussmaul respirations, crackles, pleural friction rub, frothy pink sputum


CKD hematologic manifestations

anemia (pallor, weakness, dizziness, ecchymoses, petechiae, melena)


CKD GI manifestations

ulcers in mouth and threat, foul breath, blood in stools, vomiting


CKD Musculoskeletal manifestations

osteodystrophy (thin fragile bones)


CKD renal manifestations

urine contains protein, blood, particles, change in the amount, color, concentration


CKD skin manifestations

decreased skin turgor, yellow cast to skin, dry, pruritus, urea crystal on skin (uremic frost)


CKD reproductive manifestations



Lab tests for CKD

Urinalysis: hematuria, proteinuria, and decrease in specific gravity

Serum Creatinine: gradual increase over mo. to years for CKD exceeding 4 mg/dL

BUN: gradual increase with elevated serum creatinine over months to years for CKD

Serum Electrolytes: DECREASED sodium (dilutional) and calcium; INCREASED potassium, phosphorus, and magnesium

CBC: decreased HGB and HCT from anemia, secondary to the loss of erythropoietin in CKD


Nursing Care for CKD

Report and monitor irregular findings:
-urinary elimination patterns: amount, color, odor, consistency
-vital signs: BP may be increased or decreased
-weight: 1 kg (2.2 lb) daily weight increase is approximately 1 L of fluid retained

-assess and monitor vascular access or peritoneal dialysis insertion site
-obtain a detailed medication and herb history to determine the PT's risk for continued kidney injury
-control protein intake based on the client's stage of CKD and type of dialysis prescribed
-monitor for weight gain trends
-restrict Intake of fluids (based on urinary output)
-protect PT from injury
-provide emotional support to the PT and family
-encourage the PT to ask questions and discuss fears
-administer meds as prescribed
-provide skin care in order to increase comfort and prevent breakdown
-balance the PT's activity and rest
-adhere to meticulous cleaning of areas on skin not intact and access sites to control infections


Goals for CKD nutritional therapy

-slow the progression of CKD
-control blood glucose and HTN
-help preserve remaining kidney function by limiting the intake of protein and phosphorus

-restricting phosphorus intake slows the progression of kidney disease. high levels of phosphorus contribute to calcium and phosphorus deposits in the kidneys
-Protein restriction is essential for PT's who have stage 1-4 CKD b/c it helps slow progression of kidney disease and too little protein results in the breakdown of body protein. Carefully determine protein intake


CKD dietary recommendations

-RESTRICT sodium intake to maintain BP
-RESTRICT K+ intake to prevent HYPERkalemia
-The recommended daily protein intake is 0.8 to 1.0 g/kg/day of ideal body weight.
-High biological value proteins are recommended for PT's who have CKD to prevent catabolism of muscle tissue. These proteins include eggs, meats, poultry, game, fish, soy, and dairy products
-limit meat intake to 5-6 oz/day for most men and 4 oz/day for most women
-limit dairy products to 1/2 cup per day
-limit high phosphorus foods (peanut butter, dried peas and beans, bran, cola, chocolate, beer, some whole grains) to one serving or less per day.
-Avoid high protein sports drinks, energy drinks, or meal supplements.
-Avoid herbal supplements that can affect bleeding time and BP.

-Provide a diet that is high in carbs and moderate in fats


End Stage Kidney disease Nutrition

-Protein restrictions are decreased as the disease progresses to ESKD, and to decrease the workload on the kidneys.
-Protein needs increase once dialysis has begun as protein and amino acids are lost in the dialysate
-a high-protein, low phosphorus, low potassium, low sodium (2 to 4 g/day), fluid restricted diet is recommended


Foods high in phosphorus

milk products, beef liver, chocolate, nuts, and legumes