CDN cheat sheet

KDIGO defines CKD as decreased kidney function (GFR <60 mL/min/1.73 m²) or markers of kidney damage (albuminuria, hematuria, structural abnormality) present more than 3 months.

GFR stages: G1 ≥90, G2 60–89, G3a 45–59, G3b 30–44, G4 15–29, G5 <15 mL/min/1.73 m²; albuminuria stages A1 <30, A2 30–300, A3 >300 mg/g creatinine.

Anemia of CKD is driven mainly by insufficient erythropoietin production; iron status (TSAT >20%, ferritin >100 ng/mL) is assessed before and during ESA therapy.

CKD-mineral bone disease: phosphate retention and low calcitriol lower ionized calcium, raising PTH; phosphate binders are taken with meals, and calcitriol or calcimimetics suppress PTH.

Hyperkalemia ECG progression runs from peaked T waves to widened QRS to sine wave; calcium gluconate stabilizes the myocardium without lowering serum potassium.

Nephrotic syndrome: proteinuria >3.5 g/day, hypoalbuminemia, edema, hyperlipidemia; the largest added risks are thrombosis and infection from urinary immunoglobulin loss.

ACE inhibitors, ARBs, and SGLT2 inhibitors slow CKD progression; a creatinine rise up to about 30% after initiation is acceptable, with potassium monitored closely.

Uremia causes platelet dysfunction with prolonged bleeding time despite a normal platelet count; desmopressin or dialysis temporarily restores hemostasis.

KDIGO AKI staging: stage 1 = creatinine rise ≥0.3 mg/dL within 48 h or urine output <0.5 mL/kg/h for 6–12 h; stage 3 = creatinine ≥3x baseline, creatinine ≥4.0 mg/dL, or anuria ≥12 h.

Clearance rises with blood flow rate, dialysate flow rate, membrane surface area, and membrane porosity; countercurrent dialysate flow preserves the maximal concentration gradient along the fiber.

Adequacy targets for three sessions weekly: Kt/V ≥1.2 per treatment and urea reduction ratio ≥65%.

Rule of 6s for a mature arteriovenous fistula: flow >600 mL/min, diameter >0.6 cm, depth <0.6 cm, and at least 6 weeks since creation.

Rising static venous pressure with falling delivered blood flow suggests outflow stenosis; falling arterial (pre-pump) pressure suggests inflow stenosis or arterial disease.

Access recirculation above roughly 10–15% indicates inadequate access flow, stenosis, or a catheter drawing from a poorly functioning vessel.

Ultrafiltration rate above about 13 mL/kg/h raises the risk of intradialytic hypotension and myocardial stunning; the rate equals fluid to remove divided by treatment time and weight.

Dialysis disequilibrium syndrome follows overly rapid urea removal, creating an osmotic gradient with cerebral edema; prevention uses lower blood flow, shorter first sessions, and higher dialysate sodium.

Air embolism management: stop the pump, clamp the lines, place the patient in left lateral Trendelenburg position, and deliver 100% oxygen.

Dialysate conductivity below range indicates a hypotonic bath and risks hemolysis; signs include cherry-red extracorporeal blood, back or chest pain, and dyspnea, and the blood is not returned.

CAPD typically uses 4 exchanges daily with 4–6 hour dwells; APD/CCPD performs multiple nocturnal cycles with an optional daytime last fill.

Dextrose concentrations of 1.5%, 2.5%, and 4.25% create increasing osmotic ultrafiltration, but higher concentrations also increase glucose absorption and hypertriglyceridemia.

Net ultrafiltration equals drained volume minus instilled volume; a negative value indicates absorption and warrants review of transport status and dwell time.

Peritonitis criteria: cloudy effluent, abdominal pain, and effluent white count >100/µL with >50% neutrophils; culture first, then intraperitoneal antibiotics, considering catheter removal if no response in 48–72 hours.

Peritoneal equilibration test categories are high, high-average, low-average, and low transporter; high transporters absorb glucose quickly and lose ultrafiltration with long dwells, so short dwells or icodextrin are used.

Contraindications include recent major abdominal surgery, uncorrected hernia, severe respiratory compromise, peritoneal membrane failure, and encapsulating peritoneal sclerosis.

Peritoneal protein losses run roughly 5–15 g/day and rise during peritonitis, contributing to hypoalbuminemia and malnutrition.

Exit-site infection shows erythema, tenderness, and purulent drainage; nasal Staphylococcus aureus carriage is treated with mupirocin to reduce exit-site infection and subsequent peritonitis.

Pre-dialysis assessment includes weight, blood pressure, temperature, pulse, lung sounds, edema, access thrill and bruit, symptom review, and medication review.

Vital signs are reassessed at least every 30–60 minutes during treatment and after any intervention or change in ultrafiltration.

Intradialytic hypotension: place supine or Trendelenburg, stop or reduce ultrafiltration, give a saline bolus, then re-evaluate estimated dry weight.

Muscle cramps are linked to rapid fluid removal and electrolyte shifts; treatment is a small saline bolus, reduced ultrafiltration rate, and sodium modeling.

Hemolysis during treatment: stop the pump, do not return the extracorporeal blood, and check dialysate conductivity, water treatment, and chlorine/chloramine levels.

Pyrogenic reactions present with fever, chills, and hypotension during treatment and implicate contaminated dialysate or reprocessed dialyzers; treatment is stopped and cultures obtained.

Arrhythmia risk peaks around the potassium and calcium shifts of dialysis; peaked T waves before treatment and hypokalemia after treatment both warrant ECG attention.

Air embolism signs include sudden dyspnea, chest pain, and cyanosis; response is pump stop, line clamping, left lateral Trendelenburg position, and 100% oxygen.

Access assessment each treatment: palpate thrill, auscultate bruit, inspect for redness, swelling, or drainage, and compare distal pulses and hand temperature with the opposite limb.

Teach-back asks patients to restate instructions in their own words; it detects comprehension gaps more reliably than asking whether they understood.

Typical fluid allowance is 1–1.5 L/day plus urine output, with interdialytic weight gain kept below 2 kg/day and generally below 5 kg between treatments.

Hemodialysis diet targets: protein 1.0–1.2 g/kg/day, sodium about 2 g/day, and potassium and phosphorus restricted according to laboratory values, with phosphate binders taken with meals.

In the United States, Medicare ESRD coverage begins the first day of the month dialysis starts (or of transplant) at any age, with a 30-month coordination period when an employer group health plan is primary.

Depression affects roughly 20–25% of dialysis patients and is associated with missed treatments, poorer quality of life, and higher mortality; the PHQ-9 is a validated screening tool.

Vaccination in kidney failure: higher-dose or additional hepatitis B series with post-vaccination titer checks, annual influenza, pneumococcal, and COVID-19 vaccination.

CDC dialysis core interventions: hand hygiene, catheter hub disinfection with chlorhexidine or alcohol, staff vaccination, avoiding shared supplies between stations, and surveillance for bloodstream infection.

Documented advance directives and palliative care involvement are associated with better symptom control; planned withdrawal from dialysis is a recognized course of care.

Missed or shortened treatments are associated with higher hospitalization and mortality; contributing factors include transportation, cost, depression, and denial.