Renal replacement therapy (kuliah S1 perawat).pptx

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Renal replacement therapy

dr. Drajat



Years Until Kidney Failure (GFR < 15 mL/min/1.73 m2)

Based on Level of GFR and Rate of GFR Decline

Level of GFR

(mL/min/1.73 m2)

Rate of GFR Decline (mL/min/1.73 m2 per year)

10 8 6 4 2 1*

90 7.5 9.4 13 19 38 75

80 6.5 8.1 11 16 33 65

70 5.5 6.8 9.2 14 28 55

60 4.5 5.6 7.5 11 23 45

50 3.5 4.4 5.8 8.8 16 35

40 2.5 3.1 4.2 6.3 13 25

30 1.5 1.9 2.5 3.8 7.5 15

20 0.5 0.6 0.8 1.3 2.5 5

• Average age-related GFR decline after age 20-30 year

•MDRD Study: average rate of decline in GFR is 4 ml/min/year. 85% declined,15% stabile or improvement



Attemps to prevent and correct acute decline

on chronic renal failure

• Volume depletion

• IV radiographic contrast

•Antimicrobial agent (aminoglycoside,amphotericine B)

• NSAID (including Cox2)

• ACE/ARB

• Cyclosporine and tacrolimus• Obstruction of the urinary tract



Interventions that have been proven to be effective

Diabetic Kidney

Disease

Non diabetic

Kidney disease

Kidney disease

In the transplant

Strict giycemic

control

Yes * I:80-120

II:100-140

HbA1C(%):<7

NA Not tested

ACE – inhibitors or

angletensin-receptor blockers

Yes Yes

(greater affect in patients withproteinuria)

Not tested

Strict blood pressure

control

Yes

< 125/75 mm

Hg

Yes

<130/80 mm Hg

(greater affect in patients with

proteinuria)

<125/75 mm Hg(greater affect in patients with

proteinuria)

Not tested

* Prevents or delays the onset of diabetic kidney discase.



Should be referred to nephrologist

• Most cases of nonprogressive chronic kidney disease can bemanaged without referral to a nephrologist.

• Referral to a nephrologist is recommended :

- patients with acute kidney failure

- GFR less than 30 mL/min/1.73 m2

- progressive decline of kidney function

- inability to achieve treatment targets

- urine albumin to creatinine ratio greater than 500

mg/24 h)

Guidelines for the management of chronic

kidney disease (Canadian Medical Association)



Late vs early referral



• Pernefri,2005 : KK < 15 ml/min for DM, <10 ml/min for non DM. Earlier if uremicsymptoms persist.

• National Kidney Foundation (2006) estimated GFR ≤ 15.0 ml per minute

and ≥ 15.0 ml per minute when patients have coexisting conditions or

symptoms of uremia

• Canadian Society of Nephrology, 2008 → Patients with an estimated GFR <20 mL/min/m2 may require initiation of renal replacement therapy if any of

clinical indicator are present:

- symptoms of uremia (after excluding other causes)

- refractory metabolic complications (hyperkalemia, acidosis)

- volume overload (manifesting as resistant edema or hypertension)

- decline in nutritional status (as measured by serum albumin, lean

body mass or Subjective Global Assessment) that is refractory to

dietary intervention .

Timing of initiation renal replacement therapy



Level of GFR at initiation of replacement

therapy in US

USRDS,1999

Data 2009 :

- eGFr of ≥15 ml/min/1.73 m2

increased from 4% to 17%

- eGFr of ≥15 ml/min/1.73 m2

increased from 4% to 17%



Modality renal replacement therapy

(for chronic kidney disease)

• Kidney transplant

• Hemodialysis (HD)

•Continuos Ambulatory Peritoneal Dialysis(CAPD)



kidney transplant

Data resipien donor

ABO/Rh o/+ o/+HLA A24(A9),A66/A10(?) A(11)?

Crossmatch ±20%, pasca imuran 2 mg : 20%HBsAg/Anti -/+ -/-

HSV1 IgG+/IgM+ IgG+/IgM-HSV2 IgG+/IgM+ IgG-/IgG-Anti CMV IgG+/IgM- IgG+/IgM-HCV -tive -tiveHIV -tive -tiveVDRL/TPHA -tive/-tive -teve/-tiveHb 9,1 12,3Lekosit 5.7 5.4Trombosit 186 300



Hemodialysis



6

7

8

1



Preparation

of access for

HD



CAPD



Preparation for CAPD



Apa peranan perawat pada

penanganan pasien CKD ?

• Asuhan keperawatan pasien CKD

• Asuhan keperawatan pasien renalreplacement therapy (kidney

transplant,HD,CAPD)• Perawat OK (operasi kidney

transplant,CAPD,akses HD)

• Perawat dialisis : melaksanakan HD, merawatkateter HD dan CAPD

• Edukasi pasien

Renal replacement therapy (kuliah S1 perawat).pptx

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