Outline the pathophysiological changes associated with end-stage kidney disease (dialysis dependent) that may impact on the management of critically ill patients.
• Low/no urine output
Metabolic and Endocrine:
o Abnormal Ca++
Need for dialysis determines fluid prescribing, feeding and any protein restriction
• Hypertension very common
• Atherosclerosis common
• Pericarditis common
• Prone to pulmonary oedema
• Dialysis disequilibrium
Polyneuropathy and myopathy
• Fragile skin
• Platelet dysfunction
• Impaired gastrointestinal motility
• Increased risk of bleeding related to gastric ulceration
• Increased risk of infection
• Altered clearance of medications that have predominant renal excretion
• Fistulas used for dialysis may complicate CVC and arterial access
The college answer to this question is a systematic approach which the clever candidate will model. All one can do is rearrange the college response into a different frame.
B) Respiratory considerations:
C) Cardiovascular considerations:
D) Pharmacokinetics are affected:
Neurological function can be impaired by high urea
E) Electrolyte and acid-base balance will be disturbed:
F) Fluid balance will be disturbed:
G) Nutrition is affected:
H) There may be anaemia due to decreased EPO synthesis.
I) There may be immune dysfunction and increased risk of infection.
Arulkumaran, N., N. M. P. Annear, and M. Singer. "Patients with end-stage renal disease admitted to the intensive care unit: systematic review." British journal of anaesthesia 110.1 (2013): 13-20.
Szamosfalvi, Balazs, and Jerry Yee. "Considerations in the critically ill ESRD patient." Advances in chronic kidney disease 20.1 (2013): 102-109.