Kidney disease, chronic hemodialysis

Sevelamer For control of serum phosphorus in patients with chronic kidney disease and hemodialysis... 

The client diagnosed with chronic kidney disease on hemodialysis is prescribed lanthanum (Eosrenol), an electrolyte- and water-balancing agent. Which laboratory data indicates the medication is effective ... 

The client diagnosed with chronic kidney disease on hemodialysis is prescribed... 

HIV infection1 12 13 CD4+T lymphocyte count Diabetes, heart disease, chronic pulmonary disease, chronic alcoholism Asplenia12 (Including elective splenectomy and terminal complement component deficiencies) Chronic liver disease Kidney failure, end-stage renal disease, receipt of hemodialysis... 

FIGURE 76-5. Guidelines for iron therapy in the management of the anemia of chronic kidney disease (CKD). (CHr, content of hemoglobin in the reticulocytes ESA, erythropoietic-stimulating agent Hb, hemoglobin HD, hemodialysis PD, peritoneal dialysis TSat transferrin saturation.)... 

Kidney Failure, Chronic An irreversible and usually progressive reduction in renal function in which both kidneys have been damaged by a variety of diseases to the extent that they are unable to adequately remove the metabolic products from the blood and regulate the body s electrolyte composition and acid-base balance. Chronic kidney failure requires hemodialysis or surgery, usually kidney transplantation. [NIH]... 

Iron deficiency anemia is treated with oral or parenteral iron preparations. Oral iron corrects the anemia just as rapidly and completely as parenteral iron in most cases if iron absorption from the gastrointestinal tract is normal. An exception is the high requirement for iron of patients with advanced chronic kidney disease who are undergoing hemodialysis and treatment with erythropoietin for these patients, parenteral iron administration is preferred. 

Kolf s early devices were used for patients who had suffered acute kidney failure as a result of trauma or poisoning and needed dialysis only a few times. Such emergency treatment was the main application of hemodialysis until the early 1960s, because patients suffering from chronic kidney disease require dialysis two to three times per week for several years, which was not practical with these early devices. However, application of hemodialysis to this class of patient was made possible by improvements in the dialyzer design in the 1960s. The development of a plastic shunt that could be permanently fitted to the patient to allow easy access to their blood supply was also important. This shunt, developed by Scribner et al. [6], allowed dialysis without the need for surgery to connect the patient s blood vessels to the dialysis machine for each treatment. 

TABLE 76-4 Dosing Recommendations for Vitamin D in Patients with Stage 5 Chronic Kidney Disease and Those on Hemodialysis ... 

Altmann P, Barnett ME, Finn WE SPD405-307 Lanthanum Carbonate Study Group. Cognitive function in Stage 5 chronic kidney disease patients on hemodialysis noadverseeffectsoflanthanumcarbonatecompared with standard phosphate-bindertherapy. Kidney Int 2007 71 252-259. 

Patients with anemia secondary to chronic kidney disease are ideal candidates for epoetin alfa therapy. The response in predialysis, peritoneal dialysis, and hemodialysis patients is dependent on the severity of renal failure, erythropoietin dose and route of administration, and iron availability. The subcutaneous route of administration is preferred to the intravenous route because absorption is slower and the amount of drug required is reduced by 20 to 40%. 

Sevelamer hydrochloride is a phosphate binder, which decreases intestinal phosphate absorption by binding to phosphate in the GI tract. It is indicated in the reduction of serum phosphorus in patients with chronic kidney disease who are on hemodialysis. 

The kidneys act to filter toxins out of the blood for excretion in the urine. There are complex mechanisms to recover electrolytes, carbohydrates, and amino acids. The kidney is also an endocrine organ, regulating vitamin D metabolism and signaling red blood cell proliferation through erythropoietin. While each of these unique roles is not specifically tied to an inborn error of metabolism, the kidneys are affected by several disorders and may be the source of chronic complications of disease. Symptoms of chronic kidney disease include osteoporosis, hypertension, anemia, and electrolyte abnormalities with the primary means of therapy being hemodialysis or transplant (Box 4.5). 

M. V. Rocco, More frequent hemodialysis back to the future in Advances in Chronic Kidney Disease, Volume 14, pp. 1-9 (2007). 

Altmann, P. Barnett, M. E. et al. (2007). "Cognitive function in Stage 5 chronic kidney disease patients on hemodialysis no adverse effects of lanthanum carbonate compared with standard phosphate-binder therapy." Kidney Int, 71(3), 252-9. 

A major physiological function of the kidney is to remove toxic metabolic wastes and excess fluids from the blood stream. This function may be impaired through chronic degeneration or as a result of injury. Hemodialysis is the most commonly prescribed means of blood purification for end-stage renal disease. The worldwide dialysis patient population approached 1 million at the end of the 20th century. 

Key M male F female DM diabetes mellltus HTN hypertension CAD coronary artery disease COPD chronic obstructive pulmonary disease CHF congestive heart failure ESRD end stage renal disease OSPS oral sodium phosphate solution PEG polyethylene glycol AKI acute kidney Injury na not available HD hemodialysis. 

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