Tracy Morrill MSN, RN, CLN

Kathleen Conway MSN, APRN

» Thirteen percent of Americans now have
chronic kidney disease, up 3% over the last
decade, mostly due to higher rates of diabetes
and high blood pressure.
» Kidney disease ranks low on America's radar
screen. But it's a major killer. While many
patients with chronic kidney disease go on to
die of kidney failure, many more of these
patients die of heart disease.
» Kidneys are the dynamic duo of filtration of the
blood.
» The 1 million nephrons in each kidney filter the
blood, form urine and excrete toxins and waste.
» Damage to the nephrons decreases their
filtration capabilities thereby allowing the build
up of toxins and waste which damage blood
vessels and organs.
» Describe the structures of the kidney
» Outline the role of the kidneys
» Verbalize understanding of terminology
» Describe types of dialysis including rationales
» Kidneys are paired retroperitoneal structures
that are located betweeen the transverse
processes of T12 to L3.
» They receive approximately 20% of the cardiac
output (the amount of blood pumped by the
heart averages 4-8 LPM)
» The nephron is the functional unit of the kidney
&there is approximately 1-1.25 million in each
kidney
» The glomerulus is a cluster of vessels that acts
as a filter and is connected to a tubule (each
pair makes a nephron)
» The membrane is semi-permeable which
allows waste products and water to pass into
the tubule while retaining RBCs and proteins in
the blood
» Glomerular Filtration Rate (GFR) – volume of plasma from the
glomerulus into the Bowman’s capsule each minute (ml/min)
» Diffusion – movement of particles from an area of higher
concentration to an area of lesser concentration. Diffusion stops
when equilibrium occurs.
» Osmosis- movement of water across a semipermeable membrane
from an area of lower concentration of solutes to an area of higher
concentration of solutes. Osmosis stops when equilibrium occurs.
» Hydrostatic Pressure – the pressure a solution exerts against the
wall of its container. If the container is permeable, filtration
occurs.
» Isotonic solution – a solution with concentration the same as body
fluid (such as NSS and LR)
» Hypertonic solution – a solution where concentration is greater
than what it is compared to, thereby drawing and retaining water
in the circulation increasing blood volume (such as D5W with
0.45NS, D10, D5NS)
» Hypotonic solution – a solution where the concentration is less
than that with which it is compared. This allows water to shift out
of the capillaries into the tissues, resulting in decreased blood
volume (such as 0.45NS)
» Osmolality – is a term that reflects the number of particles (such as
electrolytes) dissolved in the urine. (dehydration – high osmolality,
volume excess – low osmolality)
» Specific gravity – 1.015-1.025 (lower end dilution, higher end
concentration)
» Creatinine – is an endogenous waste product of skeletal muscle
that is excreted by glomerular filtration and is not appreciably
reabsorbed or secreted by the renal tubules.
» Renin is secreted by the juxtaglomerular cells when
BP decreases.
» An enzyme converts the renin to angiotensin I then
to angiotensin II.
» In return this causes the blood pressure to increase.
» Aldosterone is secreted by the adrenals which
increases NA and water (by releasing ACTH –
adrenocorticotropic hormone) which increase
extracellular volume thereby increasing BP.
» Functions:
˃ Filtration & excretion of metabolic wastes
˃ Regulation of electrolytes
˃ Acid/Base balance
˃ Regulation of blood pressure
˃ Controlling reabsorption of water & maintaining
intravascular volume
˃ Reabsorption of glucose & amino acids
˃ Hormonal function via erythropoetin, calcitrol and
vitamin D activation
» Definition:
˃ Irreversible decline in a person’s kidney
function that is severe enough that without
dialysis or a transplant the patient will die
˃ It is measured by the GFR (the average
glomerular filtration rate is 90-120 ml/min)
˃ GFR below 15ml/min is a sign of renal failure
» Affects more than 1500 people per million in countries
with high prevalence such as US and Japan
» 2/3 receive hemodialysis, ¼ receive transplants, 1/10
receive peritoneal dialysis
» Risk factors include:
˃ Advanced age
˃ Diabetes
˃ HTN
˃ Obesity
˃ HX of renal disease
˃ Smoking
˃ Drug use
˃ Analgesic use
» The leading cause of mortality in
ESRD is cardiovascular disease
» The prognosis is poor for these
patients
» Hemodialysis
˃ This type of dialysis uses a special dialyzer thast acts as an artificial
kidney to clean the blood
˃ The machine pulls blood through diffeerent types of “baths” and
then returns it to the patient
˃ Some patients need fluid removed during the treatment but
others may just need to be “even”
˃ Patient NEEDS a special central line in order to do this type of
dialysis, such as the Quinton or Vaxcell catheters
˃ Instead, a patient may have an AV fistula that will need at least 6-8
weeks to mature once it is surgically created
˃ There is an arterial & venous port for blood to be to pulled from
and returned to the patient
˃ The procedure takes approximately 3-4 hours
˃ The patient needs to go to a facility for treatment on average 3
times a week
˃ It can be exhausting and time consuming
» Peritoneal Dialysis
˃ A catheter is placed in the peritoneal membrane
˃ Fluid is instilled and allowed to dwell then emptied
˃ The procedure is repeated every 4-6 hours per the
provider’s orders
˃ The process of peritoneal dialysis is based on
diffusion and osmosis
˃ CCPD (continuous cycling peritoneal dialysis) is
performed on a machine continuously at night while
the patient sleeps
˃ CAPD (continuous ambulatory peritoneal dialysis) is
performed without the use of the machine
» You will begin to learn about CAPD (continuous
ambulatory peritoneal dialysis)and the role and
responsibilities of the nurse. This portion of your
training will include viewing four videos that will
give you a base of knowledge for your training.
» The videos have sound so please ensure that you
are using a desk top computer that allows for
sound.
» You may want to use head phones and a computer
in one of the Education computer rooms on the
second floor.
» Please view the following videos in sequence:
A prompt will appear asking if you want to “Open” (yes) or “Save”
(no). You will also need to close each video at the end.

» Introduction-to-Peritoneal-Dialysis video #1 of 4 Time 23:41

» Damage-to-PD-Catheter video #2 of 4 Time 13:07
» Ultra-Bag-Solution-Delivery-system video #3 of 4 Time 11:53
» Transfer-Set-Change-Procedure video #4 of 4 Time 6:27

These videos can also be found on the hospital Intranet, in the

Education and Organization Development site within the Training
Video Library.
REMEMBER:
» You will attend a class that will continue your CAPD
learning.
» The third and final component to your independent
management of CAPD for your patients is a skills
validation by a mentor. Details will be provided to
you during the class.
» All three segments of the training must be
completed.

» Please direct your questions to:

Education Department
Kathleen Conway X 7618