OVERVIEW

CKD (Chronic Kidney Disease) with Hyperkalemia

Definition

CKD - Chronic kidney disease (CKD) is a long-term condition where the

kidneys don't work as well as they should. It's a common condition often
associated with getting older. It can affect anyone, but it's more common
in people who are black or of south Asian origin.

Hyperkalemia - Hyperkalemia is the medical term that describes a

potassium level in your blood that's higher than normal.Your blood
potassium level is normally 3.6 to 5.2 millimoles per liter (mmol/L).
Having a blood potassium level higher than 6.0 mmol/L can be dangerous
and usually requires immediate treatment.

Signs and Symptoms

CKD

Symptoms can include:

 weight loss and poor appetite
 swollen ankles, feet or hands – as a result of water retention (oedema)
 shortness of breath
 Tiredness
 blood in your pee (urine)

Hyperkalemia

Symptoms can include:

 Heart palpitations or arrhythmia (irregular, fast or fluttering
heartbeat).
 Muscle weakness or numbness in limbs.
 Chest pain

Causes or Risk Factors

CKD
CKD can be caused by:
 high blood pressure – over time, this can put strain on the small blood
vessels in the kidneys and stop the kidneys working properly
 diabetes – too much glucose in your blood can damage the tiny filters
in the kidneys
 high cholesterol – this can cause a build-up of fatty deposits in the
blood vessels supplying your kidneys, which can make it harder for
them to work properly

Risk factors of CKD

Factors that may increase your risk of chronic kidney disease include:

 Diabetes
 High blood pressure
 Being African-American, Native American or Asian-American
 Older age
 Family history of CKD

Causes of Hyperkalemia

 A high-potassium diet, which can result from potassium supplements

and salt substitutes.
 Medications that contain potassium, such as certain high blood
pressure medicines.

Risk Factors of Hyperkalemia

 Renal failure
 Diabetes

DIAGNOSTIC TOOL

CKD
For kidney disease diagnosis, you may also need certain tests and
procedures, such as:

 Blood tests - Kidney function tests look for the level of waste
products, such as creatinine and urea, in your blood.
 Urine tests - Analyzing a sample of your urine may reveal
abnormalities that point to chronic kidney failure and help identify the
cause of chronic kidney disease.
 Imaging tests - Your doctor may use ultrasound to assess your
kidneys' structure and size. Other imaging tests may be used in some
cases.
 Removing a sample of kidney tissue for testing - Your doctor may
recommend a kidney biopsy to remove a sample of kidney tissue.
Kidney biopsy is often done with local anesthesia using a long, thin
needle that's inserted through your skin and into your kidney. The
biopsy sample is sent to a lab for testing to help determine what's
causing your kidney problem.

Hyperkalemia

For hyperkalemia diagnosis, you may also need certain tests and
procedures, such as:

 Electrocardiogram, called an ECG or EKG - maybe done to check

for problems with your heart rhythm. This test records your heart's
electrical activity.
 Potassium blood test - is used to detect abnormal potassium levels. It
is often used as part of an electrolyte panel or basic metabolic panel
for a routine health exam.
 Potassium urine test - check your potassium levels if you’ve been
vomiting, had diarrhea for several hours or days, or shown signs of
dehydration. It is also done to verify a high or low blood potassium
test result.

TREATMENT

CKD
 High blood pressure medications - High blood pressure medications
can initially decrease kidney function and change electrolyte levels,
so you may need frequent blood tests to monitor your condition. Your
doctor will likely also recommend a water pill (diuretic) and a low-
salt diet.
 Medications to lower cholesterol levels - Your doctor may
recommend medications called statins to lower your cholesterol.
People with chronic kidney disease often experience high levels of
bad cholesterol, which can increase the risk of heart disease.
 Medications to treat anemia - Erythropoietin supplements aid in
production of more red blood cells, which may relieve fatigue and
weakness associated with anemia.
 Medications to relieve swelling - People with chronic kidney disease
may retain fluids. This can lead to swelling in the legs, as well as high
blood pressure. Medications called diuretics can help maintain the
balance of fluids in your body.
 A lower protein diet to minimize waste products in your blood -
As your body processes protein from foods, it creates waste products
that your kidneys must filter from your blood. To reduce the amount
of work your kidneys must do, your doctor may recommend eating
less protein. Your doctor may also ask you to meet with a dietitian
who can suggest ways to lower your protein intake while still eating a
healthy diet.
 Dialysis - Dialysis artificially removes waste products and extra fluid
from your blood when your kidneys can no longer do this. In
hemodialysis, a machine filters waste and excess fluids from your
blood.

Hyperkalemia
 Insulin - Insulin accelerates the intracellular movement of potassium
into muscle cells by binding to its receptor on skeletal muscle.
 Diuretics - The use of loop diuretics in combination with saline
infusion to ensure delivery of sodium to the distal nephron can
promote renal potassium excretion in patients with normal kidney
functions.
 Dialysis - Hemodialysis is the method of choice for removal of
potassium when pharmacologic therapies fail to adequately lower and
eliminate potassium.
 Low Potassium Diet - A nutritionist will take a close look at what
you normally eat and drink and recommend a low-potassium meal
plan filled with the nutrients you need.

NSG MANAGEMENT ( HYGIENE, EXERCISE)

HYGIENE
 Assist client to go to bathroom to take a bath with toiletries, a
clean towel and change of clothes/gown, if client can’t or doesn’t
want to walk, do bed bath with client. Bathing keeps the skin
healthy and can help prevent infections. It's a good time to check the
skin to look for sores or rashes.
 Keep a sanitary environment to promote hygiene and to prevent
diseases and other consequences of ill-health relating to
environmental factors.
 When washing hands, observe the WHO’s 11 handwashing steps.
Washing your hands properly with soap and water can help prevent
the spread of the germs (like bacteria and viruses) that cause these
diseases.

EXERCISE

 Patient can ambulate only with assistance of watcher. This is

necessary since it was stated in the case scenario that the patient is
experiencing weakness and fatigue.
 Walking is the simplest way of exercise and is a good choice.
Canes, crutches, and any walking aids can help.
 If client still can’t walk, do range of motion exercises such as
rotation, abduction, adduction, flexion and extension of
shoulders, dorsiflexion, and plantar flexion. Active range of motion
exercises help improve joint function. These exercises help you move
each joint through its full range of motion. Movement can help keep
your joints flexible, reduce pain, and improve balance and strength.
 If client has other exercises that she wants to try or do, talk to the
doctor before starting a new routine.