Patients receiving hemodialysis are at risk for amyloidosis, which is characterized by joint pain. With amyloidosis, a waxy amyloid protein builds up in bones, joints, and other soft tissues. Proteins are normally soluble in water, but amyloid proteins are not, so they deposit in tissues. Dialysis-associated amyloidosis usually occurs after five years of hemodialysis, and the risk increases with years of hemodialysis. Common complications include carpal tunnel syndrome, pain in the shoulders, and joint damage. Amyloidosis may cause skeletal deformities and fractures.
Erythropoietin, which is produced by the kidneys in response to decreasing oxygen in the blood, directs the bone marrow to produce more red blood cells (because red blood cells contain hemoglobin, which carries oxygen). With kidney failure, production of erythropoietin is impaired, so patients do not produce enough red blood cells, and the red blood cells they do have live shorter than normal lives, so virtually all patients on dialysis are anemic to some degree.
A patient beginning hemodialysis usually has a hemoglobin test every one to two weeks. Once the patient's condition is stabilized, this is usually decreased to every two to four weeks. Hemoglobin is the oxygen-carrying component of the red blood cells. Hemoglobin levels may be low if the patient isn't producing enough red blood cells, is losing red blood cells because the cells burst (hemolysis), or is bleeding/ Additionally, hemoglobin may be high if the patient is dehydrated, has received too much erythropoietin-stimulating agent, or has chronic lung disease.
As part of anemia management for patients receiving hemodialysis, the technician should rinse back as much blood as possible. Longer treatments pose less risk of anemia than shorter treatments. High-calorie snacks are usually high in carbohydrates or fats rather than protein. Whether or not a patient is to receive oral protein supplements during hemodialysis depends on the nephrologist’s assessment and orders. Severe anemia may be treated with an erythropoiesis-stimulating agent to increase the production of red blood cells.
Low levels of calcium (hypocalcemia) may result in numbness, tremors, muscle spasms, and muscle pain. Calcium is an electrolyte that is primarily found in the bones and teeth, but it also has an essential role in the control of blood clotting, enzymes, hormones, nerves, and muscles. Calcium levels can fall if phosphorus levels are too high because calcium binds to phosphorus. Calcium levels may also fall if it cannot be adequately absorbed through the intestines.
The most common treatment for patients with end-stage kidney disease in the United States is standard daytime in-center hemodialysis, usually four-hour treatments three times a week, although three times a week is not optimal because the two consecutive days without treatment stress the system. For patients who have nocturnal hemodialysis available, it is usually carried out for seven to eight hours three times per week, so patients receive more total dialysis time.
Blood urea nitrogen (BUN) testing is often done before and after hemodialysis to measure the effectiveness of dialysis in removing waste products from the body. If the BUN level remains elevated after dialysis, then dialysis may not have been adequate. If the BUN level is lower than normal after dialysis, then some kidney function may remain, or the patient's diet may be deficient in protein, resulting in the breakdown of muscle.
If a patient becomes short of breath when lying flat after treatment, this could mean that he or she is retaining fluid in the lungs. However, because the dry weight was achieved without removing all of the fluid, then it's possible that the patient is losing actual weight because of losing fat and/or muscle mass. Other indications include continued swelling of the feet and ankles and shortness of breath even when upright. If the patient has lost real weight, then the dry weight may need to be adjusted and dietary counseling provided.
Polycystic kidney disease (PKD) is a genetic (inherited) disorder that can lead to kidney failure. With PKD multiple cysts form in the kidneys (and sometimes other organs, such as the liver). These cysts fill with fluid and can compress and damage kidney tissue. Additionally, the cysts can rupture and cause severe bleeding. Hypertension is a common result of PKD. One form of PKD has an onset in childhood, whereas another form has an onset in adulthood.
Normal saline has a sodium chloride concentration of 0.9%. Normal saline is an isotonic solution, which means it has the same sodium concentration as the blood, so the administration of normal saline doesn't alter the sodium balance. A hypertonic solution has more sodium than the blood, and a hypotonic solution has less sodium than the blood. These same terms (isotonic, hypertonic, hypotonic) may be applied to other types of solutions, such as those containing glucose.
The plan-do-check-act cycle used for continuous quality improvement refers to the following steps:
*Plan: Outline a plan to deal with a specific problem including methods, task lists, and target.
*Do: Carry out the action plan on a trial basis or in a limited manner to determine if it is workable and meets needs.
*Check: Evaluate the plan and make necessary modifications based on the results of the assessment.
*Act: Use the action plan and continue to reassess periodically.
