Oxford Handbook of Dialysis

by Levy, Jeremy; Morgan, Julie; Brown, Edwina

• ISBN13: 9780192631602
• ISBN10: 0192631608
• Format: Nonspecific Binding
• Copyright: 2001-04-26
• Publisher: Oxford University Press

Summary

This handbook is a compact but clear and comprehensive guide to all aspects of dialysis, from preparing patients for dialysis, details of both haemo- and peritoneal dialysis, to continuous haemofiltration techniques and complications of end stage renal disease. It has been thoroughly revisedto include: new best practice guidelines, sections on haemodiafiltration, new intradialytic monitoring techniques, new PD fluids, trials in haemodialysis and peritoneal dialysis, integrated care, care of dying patients, pain control in ESRF, new drugs, new vitamin D analogues and phosphasebinders.

Table of Contents

Preface	v
Abbreviations	xv
Conversion between SI and conventional units	xix
Formula for body surface area (BSA) calculation	xix
Part 1 The new patient with renal failure
Introduction to renal failure	4	(2)
Causes of end-stage renal failure	6	(2)
Causes of acute renal failure	8	(2)
Presentation of renal disease	10	(4)
Investigations for patients with ESRD	14	(2)
Assessment of renal function at/near end stage: serum biochemistry	16	(2)
Assessment of renal function at/near end stage: creatinine clearance	18	(2)
Assessment of renal function at/near end stage: other methods	20	(2)
Complications of renal failure (1) - symptomatic	22	(2)
Complications of renal failure (2) - osteodystrophy and malnutrition	24	(2)
Complications of renal failure (3) - fluid overload and percarditis	26	(2)
Complications of renal failure (4) - metasolic	28	(2)
Conservative management of renal failure: aims	30	(2)
Conservative management of renal failure: blood pressure control	32	(2)
Conservative management of renal failure: slowing the rate of decline	34	(2)
Conservative management of renal failure: lipids and fluid balance	36	(2)
Conservative management of renal failure: treatment of complications	38	(2)
Conservative management of renal failure: prevention of symptoms	40	(2)
Assessment of patients for dialysis: early referral	42	(2)
Assessment of patients for dialysis: factors to be assessed	44	(4)
Assessment of patients for dialysis: when not to dialyse	48	(2)
Checklist for assessing patients in a low clearance clinic	50	(2)
Haemodialysis versus peritoneal dialysis	52	(4)
Choosing which dialysis modality	56	(2)
Choice of dialysis modality: case histories	58	(2)
When to start dialysis in ESRD	60	(2)
Indications for acute dialysis	62	(2)
Psychosocial effects of starting dialysis in ESRD: depression and anxiety	64	(2)
Psychosocial effects of starting dialysis in ESRD: others	66	(2)
Psychosocial effects of dialysis in ARF	68	(2)
Assessment for transplant suitability and transplant work up	70	(4)
Part 2 Haemodialysis
Principles of haemodialysis	74	(2)
Principles of haemodialysis in practice	76	(2)
Factors affecting solute clearance on haemodialysis	78	(2)
Ultrafiltration during haemodialysis	80	(2)
High-efficiency and high-flux haemodialysis	82	(2)
Dialysers	84	(2)
Dialysis membranes	86	(2)
Biocompatibility of membranes	88	(2)
Dialysis machines: key features	90	(2)
Dialysis machines: additional facilities	92	(2)
Dialysis machines: monitors	94	(2)
Dialysate (1)	96	(2)
Dialysate (2)	98	(2)
Water purification	100	(2)
Vascular access: overview	102	(2)
Permanent vascular access	104	(2)
Disadvantages of permanent vascular access	106	(2)
Formation of permanent access	108	(2)
Stenosis and thrombosis of fistulae and grafts	110	(2)
Other complications of fistulae and grafts	112	(2)
Tunnelled cuffed catheters	114	(2)
Temporary vascular access	116	(2)
Insertion of vascular access catheters	118	(2)
Complications of temporary access	120	(2)
Management of access (catheter) infections	122	(2)
Prevention of infection of dialysis access	124	(2)
Screening for AVF/graft stenosis	126	(2)
Arteriovenous shunt (Scribner)	128	(2)
Re-circulation	130	(2)
The first dialysis session in chronic and acute renal failure	132	(4)
Complications during dialysis	136	(2)
Complications during dialysis: hypotension	138	(2)
Complications during dialysis: management and prevention of hypotension	140	(2)
Complications during dialysis: others	142	(2)
Complications during dialysis: dialyser reactions	144	(2)
Blood clotting during haemodialysis	146	(2)
Anticoagulation for haemodialysis: heparin	148	(2)
Regional anticoagulation for haemodialysis	150	(2)
Other methods of anticoagulation in haemodialysis	152	(2)
Dialysis adequacy: overview	154	(2)
Dialysis adequacy: solute clearance	156	(2)
Dialysis adequacy: urea kinetic modelling	158	(2)
Calculation of Kt/V	160	(2)
Dialysis adequacy: other measures of solute clearance	162	(2)
Residual renal function	164	(2)
Other markers of dialysis adequacy	166	(2)
Targets for adequate dialysis	168	(2)
Increasing dialysis dose delivered	170	(2)
Dialysis adequacy in acute renal failure	172	(2)
Prescribing acute haemodialysis	174	(2)
Prescribing chronic haemodialysis	176	(4)
Haemofiltration and haemodiafiltration	180	(2)
Laboratory tests for patients on regular haemodialysis	182	(2)
Dry weight	184	(2)
Novel measures of dry weight	186	(2)
Re-use of dialysers	188	(4)
Home haemodialysis and daily haemodialysis	192	(2)
Haemodialysis and surgery: pre-operative	194	(2)
Haemodialysis and surgery: peri-operative	196	(2)
Haemodialysis and surgery: post-operative	198	(2)
Haemodialysis in transplant recipients	200	(2)
Haemodialysis in terminal care	202	(2)
Haemodialysis and haemoperfusion for poisoning	204	(2)
Drugs and toxins removed by haemodialysis	206	(2)
Drugs and toxins removed by haemoperfusion	208	(2)
Haemodialysis for non-renal disease	210	(2)
Continuous renal-replacement therapy (1): overview	212	(2)
Continuous renal-replacement therapy (2): performance	214	(2)
Continuous renal-replacement therapy (3): technical	216	(2)
Other continuous renal-replacement techniques	218	(2)
Anticoagulation for CRRT: heparin	220	(2)
Anticoagulation for CRRT: heparin-free methods	222	(2)
Complications of CRRT	224	(2)
Part 3 Nursing a haemodialysis patient
Approaching patients on haemodialysis	226	(2)
Nursing care of vascular access	228	(2)
Cannulation of fistulae	230	(2)
Problems with access often recognized by nurses	232	(2)
Grafts and shunts	234	(2)
Percutaneous vascular catheters	236	(2)
Putting patients on dialysis	238	(2)
Initiation of treatment	240	(2)
Taking patients off dialysis	242	(2)
Dialysis machine alarms	244	(2)
Care of dialysis machines	246	(6)
Nursing patients on CRRT	252	(2)
CRRT trouble-shooting guide	254	(2)
The dialysis unit	256	(2)
Infection on the dialysis unit	258	(4)
Part 4 Peritoneal dialysis
Principles of peritoneal dialysis	262	(2)
Factors effecting efficiency of pertioneal dialysis	264	(2)
Modes of peritoneal dialysis: CAPD and IPD	266	(2)
Modes of peritoneal dialysis: APD techniques	268	(2)
CAPD technique and systems	270	(2)
Peritoneal dialysis catheters	272	(2)
Insertion of peritoneal dialysis catheters	274	(2)
Pre-operative preparation for peritoneal catheter insertion	276	(2)
Peritoneal dialysis catheter insertion technique	278	(2)
Laparoscopic peritoneal dialysis catheter insertion	280	(2)
Complications of PD catheter insertion	282	(2)
Malfunctioning catheters	284	(2)
Investigation and management of malfunctioning catheters	286	(2)
Constipation in PD patients	288	(2)
Re-siting PD catheters	290	(2)
Types of peritoneal dialysate: dialysate composition	292	(2)
Types of peritoneal dialysate: ultra filtration	294	(2)
New types of peritoneal dialysate	296	(2)
Prescribing CAPD	298	(2)
Adequacy of peritoneal dialysis	300	(4)
Peritoneal dialysis adequacy: goals	304	(2)
PET testing and modelling	306	(2)
Technique for performing PET test	308	(2)
PET results	310	(2)
Increasing dialysis delivered by CAPD	312	(2)
Examples of alterations in CAPD prescription	314	(2)
Prescribing APD	316	(2)
Increasing delivered dialysis and ultrafiltration in APD	318	(2)
Examples of alterations in APD prescription	320	(2)
Peritoneal dialysis in anuric patients	322	(4)
Peritoneal dialysis in acute renal failure	326	(2)
Prescribing PD in acute renal failure	328	(2)
Exit-site infections	330	(2)
Prevention of exit-site infections	332	(2)
Peritonitis overview	334	(2)
Risk factors and prevention of peritonitis	336	(2)
Clinical features of peritonitis	338	(2)
Diagnosis of peritonitis	340	(2)
Treatment of peritonitis: principles	342	(2)
Treatment of peritonitis: protocol	344	(2)
Treatment of resistant peritonitis	346	(2)
Complications of peritonitis	348	(2)
Hernias, leaks, and other complications	350	(2)
Fluid leaks	352	(2)
Other complications	354	(2)
Peri-operative peritoneal dialysis	356	(2)
Peritoneal dialysis and transplantation	358	(2)
Peritoneal dialysis for poisoning	360	(2)
Part 5 Nursing issues in peritoneal dialysis
Role of the nurse in peritoneal dialysis	362	(2)
Nursing care of peritoneal catheters: exit site	364	(2)
Nursing care of peritoneal catheters: catheters	366	(2)
Training patients for CAPD	368	(2)
Training programme	370	(2)
Training patients for APD	372	(2)
Organizing outpatient care of PD patients	374	(4)
Part 6 Nutrition on dialysis
Malnutrition in ESRD	378	(2)
Nutritional requirements in chronic renal failure (pre-dialysis)	380	(2)
Dietetic treatment plan for pre-dialysis patients	382	(2)
Assessment of nutritional status: clinical	384	(2)
Assessment of nutritional status: food intake	386	(2)
Assessment of nutritional status: biochemical	388	(2)
Nutritional requirements in HD and PD	390	(2)
Strategies for achieving nutritional aims	392	(2)
Dietary problems specific to ethnic minority patients	394	(2)
Supplemental vitamins and trace elements	396	(2)
Use of nutritional supplements	398	(2)
Fluid requirements in renal failure	400	(2)
Nutrition in acute renal failure	402	(2)
Routes for nutritional support in acute renal failure	404	(4)
Part 7 Special situations
Dialysis in the elderly	408	(2)
Managing diabetic patients on dialysis	410	(2)
Problems for diabetic patients on dialysis	412	(2)
Surgery in dialysis patients	414	(2)
Myeloma and renal failure	416	(2)
Myeloma and dialysis	418	(2)
Pregnancy in dialysis patients	420	(2)
Managing pregnancy in dialysis patients	422	(2)
Plasmapheresis	424	(2)
Techniques of plasmapheresis	426	(4)
Complications of plasmapheresis	430	(2)
Specific indications for plasmapheresis	432	(2)
Immunoadsorption techniques	434	(2)
Indications for immunoadsorption	436	(2)
Part 8 Complications of ESRD: anaemia
Causes of anaemia and assessment	438	(2)
Assessment of iron stores	440	(2)
Erythropoietin: administration	442	(2)
Erythropoietin: dosing and side-effects	444	(2)
Target haemoglobin	446	(2)
Iron supplements	448	(6)
Part 9 Complications of ESRD: fluid overload
Part 10 Complications of ESRD: renal bone disease
Renal osteodystrophy	454	(2)
Clinical features of hyperparathyroid bone disease	456	(2)
Biochemical features of hyperparathyroid bone disease	458	(2)
Clinical features of low-turnover bone disease	460	(2)
Biochemical features of low turnover bone disease	462	(2)
Medical management of hyperparathyroid bone disease	464	(4)
Examples of treatment plans for renal bone disease	468	(2)
Parathyroidectomy	470	(4)
Part 11 Complications of ESRD: cardiovascular disease
Ischaemic heart disease	474	(2)
Management of ischaemic heart disease in dialysis patients	476	(2)
Hypertension	478	(2)
Blood pressure control in patients on haemodialysis	480	(2)
Blood pressure control in patients on peritoneal dialysis	482	(2)
Other vascular disease	484	(4)
Part 12 Complications of ESRD: infection
Infection risk in dialysis patients	488	(2)
Non-access related infections in dialysis patients	490	(2)
Resistant organisms: MRSA	492	(2)
Resistant organisms: VISA, VRE and others	494	(2)
Viral infections: HBV and HCV	496	(2)
Viral infection: other viruses	498	(4)
Part 13 Other complications of ESRD
Dialysis amyloid	502	(2)
Dialysis amyloid diagnosis and management	504	(2)
Renal cysts and tumours	506	(2)
Pruritus	508	(2)
Neurological complications	510	(2)
Gastro-intestinal bleeding	512	(2)
Acidosis	514	(2)
Sexual dysfunction	516	(2)
Aluminium toxicity	518	(2)
Blood biochemistry in ESRD	520	(2)
Tumour markers in ESRD	522	(2)
Quality of life	524	(2)
Employment and rehabilitation	526	(4)
Part 14 Death in dialysis patients
Causes of death in patients in dialysis	530	(2)
Management of cardiac arrest during dialysis	532	(2)
Withdrawal of dialysis	534	(2)
Withdrawal of dialysis: case histories	536	(4)
Part 15 Drug prescribing in patients on dialysis
Drug handling in renal failure	540	(2)
Dosing of commonly prescribed drugs	542	(4)
Dosing of antimicrobial drugs	546	(4)
Dosing of antifungal and antiviral drugs	550	(2)
Dosing of antiretroviral drugs	552	(2)
Dosing of antituberculous drugs	554	(2)
Drugs that do not require dosage alteration	556	(2)
Drugs to be avoided	558	(2)
Notes on some specific drugs	560	(4)
Factors affecting drug removal by CRRT	564	(2)
Dosing of drugs commonly used during CRRT	566
Part 16 Standards documents: the UK Renal Association and the US DOQI guidelines
Overview of UK Renal Association standards (1997)	564	(4)
Overview of American DOQI standards (1997)	568	(6)
Overview of American DOQI guidelines for nutrition in CRF (2000)	574	(7)
Appendix: useful web sites	581	(4)
Index	585