This eBook from Blue Heron Health NewsBack in the spring of 2008, Christian Goodman put together a group of like-minded people – natural researchers who want to help humanity gain optimum health with the help of cures that nature has provided. He gathered people who already know much about natural medicine and setup blueheronhealthnews.com. Today, Blue Heron Health News provides a variety of remedies for different kinds of illnesses. All of their remedies are natural and safe, so they can be used by anyone regardless of their health condition. Countless articles and eBooks are available on their website from Christian himself and other natural health enthusiasts, such as Julissa Clay , Shelly Manning , Jodi Knapp and Scott Davis. |
Managing acute complications of CKD in the hospital
Management of Chronic Kidney Disease (CKD) Acute Complications within the Hospital
Chronic Kidney Disease (CKD) patients are at higher risk of the occurrence of acute complications, particularly when hospitalized. They may be supplemented by underlying renal impairment, comorbidities (e.g., diabetes mellitus, hypertension, or cardiac disease), and the acute insult of illness or surgery. Successful management of the complications requires close monitoring, prompt intervention, and coordination among various healthcare teams. The following are some of the common acute complications of CKD and how to manage them in the hospital setting.
1. Acute Kidney Injury (AKI)
AKI is a common and serious complication in hospitalized patients with CKD. AKI can be due to dehydration, infection, drug toxicity, or deterioration of CKD. AKI should be identified and treated early to prevent further kidney damage.
Management:
Regular Monitoring of Kidney Function: Regularly check serum creatinine, glomerular filtration rate (GFR), and urine output. A sudden increase in creatinine or decrease in urine output can indicate AKI.
Fluid Management: Ensure proper hydration without fluid overload, especially in patients with severe CKD or heart failure. Use prudent intravenous (IV) fluids based on volume status.
Reduce Nephrotoxic Drugs: Avoid or minimize nephrotoxic drugs (e.g., NSAIDs, certain antibiotics, contrast media) in patients with CKD. Use decreased dosing of drugs based on renal function when feasible.
Dialysis: In case AKI progresses to acute renal failure, start dialysis. This is either hemodialysis or peritoneal dialysis, as per the specific patient’s requirement and prevailing dialysis modalities.
2. Electrolyte Imbalance (Hyperkalemia and Hyponatremia)
Patients with CKD are at higher risk of developing electrolyte imbalance due to the impaired renal function, thus impairing the kidneys’ ability to excrete or regulate electrolytes.
Hyperkalemia (Increased Potassium):
Monitor Serum Potassium: Monitor potassium levels in CKD patients regularly, especially if they are on medications like ACE inhibitors, potassium-sparing diuretics, or other medications that could raise potassium.
Treat Hyperkalemia: If hyperkalemia is detected (serum potassium >5.5 mEq/L), immediate treatment must be administered:
Calcium Gluconate: Administer calcium gluconate to stabilize the cardiac muscle.
Insulin and Glucose: Administer insulin (to shift potassium into cells) with glucose to prevent hypoglycemia.
Sodium Bicarbonate: Sodium bicarbonate in acidosis will decrease potassium.
Dialysis: In severe situations, dialysis may be done to remove excess potassium.
Hyponatremia (Low Sodium):
Monitoring Sodium Levels: Check sodium on a regular basis, especially if the patient is fluid-imbalanced or receiving IV fluids.
Fluid Restriction: Fluid restriction will control dilutional hyponatremia.
Hypertonic Saline: In severe situations, a small bolus of hypertonic saline (3% NaCl) may be given under strict observation.
3. Pulmonary Edema and Fluid Overload
Fluid overload, in turn, poses a risk to CKD patients, especially advanced-stage or on dialysis, with pulmonary edema, or fluid accumulation in the lungs.
Management:
Daily Weights and Fluid Balance: Daily weigh and closely monitor input/output charts. Unexplained weight gain often indicates fluid retention.
Diuretics: Use diuretics (e.g., furosemide) to help with fluid removal but with caution, since overdiuresis leads to dehydration and worsens kidney function.
Dialysis: For diuretic ineffectiveness or extensive fluid overload, dialysis can be employed to remove excess fluid and restore electrolyte balance to normal.
Oxygen Support: Use oxygen therapy to manage hypoxia secondary to pulmonary edema.
4. Hypertension and Hypotension
Control of blood pressure is necessary in CKD patients. They may develop secondary hypertension due to fluid overload, or secondary hypotension due to infection, blood loss, or the effect of certain drugs.
Management:
Monitor Blood Pressure: Regular blood pressure monitoring. Hypertension can exacerbate kidney damage, and hypotension can reduce kidney perfusion.
Blood Pressure Medications: Titrate antihypertensive drugs according to the renal function of the patient. ACE inhibitors, ARBs, or calcium channel blockers are usually used in CKD patients to manage blood pressure. Dosing, however, may need to be adjusted according to renal function.
Prevent Hypotension: If hypotension occurs, administer sufficient IV fluid resuscitation and titrate drugs accordingly. In certain cases, vasopressors might be required to support blood pressure.
Targeted Dialysis: If blood pressure remains difficult to control, dialysis can help remove excess fluid that is also contributing to high blood pressure.
5. Infections
CKD patients are more susceptible to infections, particularly urinary tract infections (UTIs), respiratory infections, and dialysis-related infections.
Management:
Early Detection: Monitor for signs of infection like fever, chills, elevated white blood cell count, and changed urine output or quality.
Antibiotic Therapy: Start broad-spectrum antibiotics early and then tailor based on culture and renal function. Always consider renal dosing when prescribing antibiotics, as impaired renal function can affect drug clearance.
Dialysis Access Site Infection: In patients on dialysis, carefully monitor dialysis access sites for signs of infection (redness, swelling, or discharge). Use sterile techniques to prevent infections.
Preventative Measures: Follow appropriate infection control practices, like immunization against influenza and pneumonia, as infections have more serious effects in CKD patients.
6. Metabolic Acidosis
Metabolic acidosis can occur in patients with CKD as the kidneys are unable to effectively remove acid. The disease can also progress to further impair kidney function and lead to systemic complications.
Management:
Monitor Arterial Blood Gases (ABGs): Regular monitoring for acidosis, especially if the patient is in a critical condition.
Sodium Bicarbonate: Administer sodium bicarbonate orally or intravenously to correct acidosis.
Dialysis: Dialysis may be required in severe cases to help correct metabolic acidosis by removing excessive acid from the body.
7. Nutritional Support
CKD patients often suffer from malnutrition or protein-energy wasting as a result of loss of appetite, increased metabolic requirements, and dietary restriction.
Management:
Nutritional Assessment: Conduct continuous assessment to establish the nutritional status of the patient. Refer to a dietitian.
Protein Nutrition: Adjust the patient’s protein nutrition based on the CKD stage. Dialysis patients may need higher protein nutrition due to dialysis loss.
Micronutrient Surveillance: Check for adequate ingestion of vitamins and minerals, particularly vitamin D, calcium, and iron, as deficiency may occur in CKD.
Conclusion
Management of acute CKD complications in the hospital environment requires a multidisciplinary approach, close monitoring, and expedient intervention. Fluid and electrolyte management, infection prevention, renal function monitoring, and medication modification are important to prevent further kidney injury and improve the patient outcome. Because of the complexity of CKD and its acute complications, it is essential that health care providers plan together so as to maximize treatment and minimize the risk of progression to end-stage renal disease.
CKD and Surgical Risk
CKD imparts a significant impact on the body to heal from surgery as it alters the kidneys’ filtering function, fluid handling, and electrolyte balance. The patient with CKD thus bears increased surgical risk prior to, during, and after surgery. The risk is especially increased in patients with advanced CKD (Stages 3–5) or end-stage kidney disease (ESKD), particularly on dialysis.
1. Effect of CKD on Surgical Risk
CKD can affect outcomes of surgery in several ways, and the risk severity is mostly reliant on CKD stage and whether comorbidities such as cardiovascular disease and diabetes are present:
???? Compromised Renal Function
The kidneys might not eliminate anesthesia and drugs administered during surgery properly, which can result in drug toxicity and metabolic derangement.
Electrolyte imbalance and fluid overload are common, and under anesthesia, they can be potentiated with risk of complications such as hyperkalemia (high potassium), hyponatremia (low sodium), or fluid overload.
???? Cardiovascular Complications
CKD also has a very strong association with heart disease, and cardiovascular complications during or after surgery are a major concern. CKD patients are at risk for more heart attacks, arrhythmias, and heart failure during the perioperative period.
CKD patients are also at a higher risk of developing venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE), that can complicate the perioperative recovery process.
???? Increased Risk of Infection
CKD patients, particularly dialysis patients, may also have an impaired immune system, which puts them at a higher risk of infection after surgery.
Dialysis access sites like fistulas or catheters are prone to infection, which can cause complications such as sepsis, making post-surgical mortality more likely.
2. Surgical Risk Determinants in CKD Patients
The following factors, among others, play a role in surgical risk:
Stages of CKD
Stage 1–2 CKD (incipient kidney disease) neither has any effect on the surgical outcome, although risks exist due to associated conditions such as diabetes and hypertension.
Stage 3 CKD possesses moderate risk, where kidneys lose their filtering capacity, and fluid and electrolyte imbalance become a greater threat.
Stage 4–5 CKD (advanced CKD and end-stage renal disease) is at high risk for surgery due to the very impaired function of the kidneys, dependence on dialysis, and comorbidities such as cardiovascular disease, diabetes, and anemia.
???? Comorbidities
The presence of cardiovascular disease (e.g., coronary artery disease, hypertension) in patients with CKD greatly enhances the risk of perioperative cardiac complications.
Diabetes also complicates surgery by increasing the risk of wound infections and impairing blood glucose control.
Anemia, which is common in CKD, can contribute to intraoperative blood loss with subsequent need for blood transfusion and delayed recovery.
???? Dialysis Dependence
Dialysis-dependent patients carry higher risks due to the potential for dialysis-related complications, such as infection (peritonitis in peritoneal dialysis and bacteremia in hemodialysis), and the difficulty of fluid management.
Electrolyte abnormalities will be exacerbated by the perioperative period and will require close monitoring.
3. Perioperative Management of CKD Patients
Special attention must be given in the perioperative period (preoperative, intraoperative, and postoperative) to address the hazards of CKD:
???? Preoperative Assessment
Renal function (quantitated by serum creatinine and glomerular filtration rate (GFR)) must be evaluated to grade the CKD and prepare for potential surgical issues.
Evaluation of comorbid illnesses (cardiovascular, diabetes) is important to assess the risks of surgery.
Electrolyte balance and fluid status should be optimized before surgery. Correction of abnormalities (e.g., potassium correction or dehydration) can improve outcomes.
???? Considerations in Anesthesia
General anesthetic and local anesthetic agents must be chosen cautiously because clearance of anesthetic drugs may be impaired in CKD.
Kidney function and drug elimination must be watched carefully because many of the anesthetic drugs are cleared through the kidneys.
Regional anesthesia (e.g., spinal, epidural) may be employed in some cases, but drug accumulation can still be expected in patients with reduced renal function.
???? Fluid and Electrolyte Management
Fluid management must be handled carefully to avoid fluid overload, which is characteristic in CKD patients and can exacerbate heart failure and pulmonary edema.
Patients on dialysis may require their dialysis regimen to be optimized to ensure maximum fluid status before surgery.
???? Infection Prevention
Prophylactic antibiotics can be administered to prevent infection, particularly in dialysis access patients.
The catheters and fistulas must be monitored well during the perioperative period in order to avoid infection at these locations.
???? Postoperative Care
Tight monitoring of renal function, fluid balance, and electrolytes must be performed during the early postoperative period. CKD patients are at a higher risk of AKI occurring as a result of the stress of surgery, blood loss, or the use of drugs.
Cardiac monitoring must be performed since the cardiovascular event following surgery is likely to occur.
Nutritional support is required, especially if the patient is dialysis-dependent or has compromised kidney function, to allow healing and provide optimal nutrient levels.
4. Reducing Surgical Risk in CKD Patients
???? Optimize Preoperative Kidney Function:
Whenever possible, stabilize renal function prior to surgery, especially for patients with end-stage CKD or dialysis-dependent patients.
Preoperative dialysis can be necessary to clear toxins and improve fluid status.
???? Reduce Cardiovascular Risk:
Regulate blood pressure, regulate blood glucose levels, and optimize cardiac function prior to surgery to avoid heart attacks or arrhythmias during the peripartum period.
???? Postoperative Monitoring and Care:
Close monitoring on a high-dependency unit or intensive care unit (ICU) may be required for high-risk CKD patients after major surgery, particularly those with ESKD.
5. Conclusion
CKD significantly raises the risk of surgery due to impaired renal function, co-morbidities, and risk of complications like infections, cardiovascular complications, and electrolyte imbalance. Preoperative assessment, renal function optimization, and periprocedure care are the pillars of improving outcomes in CKD patients who are facing surgery.
Do you have specific concerns about a type of surgery or treatment choices for CKD patients?
The Chronic Kidney Disease Solution™ By Shelly Manning It is an eBook that includes the most popular methods to care and manage kidney diseases by following the information provided in it. This easily readable eBook covers up various important topics like what is chronic kidney disease, how it is caused, how it can be diagnosed, tissue damages caused by chronic inflammation, how your condition is affected by gut biome, choices for powerful lifestyle and chronic kidney disease with natural tools etc.
Blue Heron Health News
Back in the spring of 2008, Christian Goodman put together a group of like-minded people – natural researchers who want to help humanity gain optimum health with the help of cures that nature has provided. He gathered people who already know much about natural medicine and setup blueheronhealthnews.com.
Today, Blue Heron Health News provides a variety of remedies for different kinds of illnesses. All of their remedies are natural and safe, so they can be used by anyone regardless of their health condition. Countless articles and eBooks are available on their website from Christian himself and other natural health enthusiasts, such as Shelly Manning Jodi Knapp and Scott Davis.
About Christian Goodman
Christian Goodman is the CEO of Blue Heron Health News. He was born and raised in Iceland, and challenges have always been a part of the way he lived. Combining this passion for challenge and his obsession for natural health research, he has found a lot of solutions to different health problems that are rampant in modern society. He is also naturally into helping humanity, which drives him to educate the public on the benefits and effectiveness of his natural health methods.