End-stage renal disease (ESRD), also called end-stage kidney disease or kidney failure, is the final and permanent stage of chronic kidney disease. In this stage, kidneys can no longer function on their own and the patient must receive dialysis or kidney transplantation to survive.
In this article:
- Stages of Chronic Kidney Disease
- Nursing Process
- Nursing Assessment
- Nursing Interventions
- Nursing Care Plans
- Excess Fluid Volume
- Imbalanced Nutrition: Less Than Body Requirements
- Impaired Urinary Elimination
- Ineffective Tissue Perfusion
Stages of Chronic Kidney Disease
Chronic kidney disease is divided into five stages based on the eGFR (estimated glomerular filtration rate), a blood test that measures the kidney’s filtering ability.
- Stage 1 presents as an eGFR of 90 ml/min or higher. This is considered a normal eGFR, and the patient will likely be asymptomatic.
- Stage 2 CKD is an eGFR of 60-89 ml/min. This is mild CKD, and the patient may not notice symptoms, but protein in the urine or other damage will be observable.
- Stage 3a is an eGFR of 45-59 ml/min. Kidney damage is mild to moderate.
- Stage 3b is an eGFR of 30-44 ml/min. Kidney damage is moderate to severe, and symptoms such as fatigue, edema, muscle cramps, and changes in urination occur.
- Stage 4 CKD is an eGFR of 15-29 ml/min. This is the final stage before kidney failure.
- Stage 5 CKD is end-stage renal disease with an eGFR of less than 15 ml/min. Kidneys may not work at all anymore.
Nursing Process
End-stage renal disease is irreversible and has no cure. Nursing care priorities for patients with end-stage renal disease include:
- Prevent and treat complications
- Assist in kidney transplantation or dialysis
- Instruct on the management of chronic conditions
- Implement fluid restrictions and diet recommendations
- Promote physical and psychosocial well-being
- Enhance the patient’s overall quality of life
- Instruct on lifestyle modifications
- Provide support to the patient and family
- Collaborate with the nephrologist and other team members
Nursing Assessment
The first step of nursing care is the nursing assessment, during which the nurse will gather physical, psychosocial, emotional, and diagnostic data. In this section, we will cover subjective and objective data related to end-stage renal disease.
Review of Health History
1. Assess the patient’s general symptoms.
As ESRD progresses, the patient may present with the following signs and symptoms:
- CNS: headaches, altered mentation, insomnia
- Respiratory: dyspnea, chest pain
- GI: nausea, vomiting, loss of appetite, metallic taste in the mouth
- Musculoskeletal: fatigue, muscle weakness, twitches, cramps
- Genitourinary: changes urine amount and characteristics
- Integumentary: swelling of the feet and ankles, persistent itching
2. Identify the patient’s risk factors.
The following factors increase the likelihood that chronic kidney disease will progress to end-stage renal disease faster, including:
- Age (60 years or older)
- Family history of kidney failure
- Race that includes Asian, Pacific Islander, American Indian, Black, or Hispanic heritage
- Obesity
- Tobacco use
3. Record the patient’s medical history.
Kidney damage develops over months or years due to various causes. These conditions include:
- Diabetes with poor glucose control
- Hypertension
- Glomerulonephritis
- Polycystic kidney disease
- Interstitial nephritis
- Urinary tract obstruction (such as kidney stones)
- Vesicoureteral reflux (a condition when urine flows back to the kidneys)
- Pyelonephritis
- Congenital kidney defects
4. Assess for factors that may influence the development of ESRD.
The presence of certain conditions may further damage the kidneys, which can lead to ESRD. These conditions include:
- Systemic hypertension
- Hyperlipidemia
- Uncontrolled diabetes
5. Review the patient’s medication list.
The kidneys process and filter both prescription and over-the-counter drugs. The following medications can further damage the kidneys:
- Cholesterol medications
- Pain medications (NSAIDs)
- Antibiotics
- Antiretrovirals
- Antidiabetic medications
Physical Assessment
1. Assess for ESRD complications.
Complications that occur due to kidney damage include:
- Volume overload resistant to diuretics
- Poorly controlled hypertension
- Anemia
- Electrolyte abnormalities
- Bone deficiencies
- Metabolic abnormalities
- Decreased immune response
2. Assess for the presence of uremic toxicity.
Fluid, electrolyte, hormone, and metabolic abnormalities are characteristics of uremia (waste products in the blood). This is a serious condition that occurs when the kidneys are unable to filter toxins and can cause cognitive impairment, acidosis, and blood vessel calcification.
3. Perform a physical assessment.
ESRD can have detrimental effects on all organ systems. Physical manifestations of ESRD may include:
- General: malnutrition (weight loss, fatigue, muscle weakness)
- CNS: encephalopathy (confusion, irritability, drowsiness)
- Cardiovascular: pericarditis (fever, dyspnea, abnormal heart sounds)
- Gastrointestinal: vomiting, diarrhea
- Genitourinary: erectile dysfunction, amenorrhea, infertility, oliguria or anuria
- Musculoskeletal: peripheral neuropathy, muscle cramps or weakness
- Integumentary: dry skin, pruritus, ecchymosis, edema
- Hematological: platelet dysfunction, anemia
4. Strictly monitor the fluid intake and output.
With ESRD, remain cautious about intake and output. Patients may not tolerate excessive intake due to the kidney’s inability to excrete fluid. Patients may have little to no urine output.
Diagnostic Procedures
1. Determine the eGFR.
The estimated glomerular filtration rate (eGFR) gauges the kidneys’ capacity to filter waste products and classifies chronic kidney disease into five stages. An eGFR below 15 ml/min is stage 5 CKD, also known as ESRD. The kidneys will no longer function at all.
2. Send samples for blood testing.
Perform blood tests to identify the presence of the following:
- Complete blood count: anemia
- Basic metabolic panel (BMP):
- High serum creatinine and blood urea nitrogen (BUN) levels
- High potassium levels (hyperkalemia)
- Low bicarbonate levels
- Low serum albumin levels (malnutrition)
- Serum phosphate
- Vitamin D
- Lipid profile
3. Examine urine samples.
Urinalysis determines the solutes in the urine, which can describe the filtering capability of the kidneys.
- Urine protein/creatinine ratio: albumin in the urine (albuminuria); severe renal impairment = greater than 300 mg/g
- 24-hour urine protein: greater than 3.5 g = nephrotic range proteinuria
4. Prepare the patient for imaging scans.
Imaging scans visualize the status of the kidneys and surrounding organs. The healthcare provider may choose from the following:
- Kidney ultrasound: checks for the presence of swelling of the kidneys (hydronephrosis) or structural abnormalities
- Retrograde pyelogram: diagnoses obstruction or renal stones
- Computed tomography (CT) scan: visualizes kidney masses, cysts, and stones
- Magnetic resonance angiography (MRA): used to diagnose renal artery stenosis
5. Consider kidney biopsy.
When renal impairment and/or proteinuria approaching the nephrotic range are present, but the diagnosis is unclear after regular workup, a biopsy is indicated.
Nursing Interventions
Nursing interventions and care are essential for the patients recovery. In the following section, you will learn more about possible nursing interventions for a patient with end-stage renal disease.
Delay Progression of Kidney Disease
1. Manage blood pressure.
A blood pressure of 130/80 mmHg or less is recommended. If the patient is not receiving dialysis, a target goal of less than 120 mmHg systolic is advised.
2. Control the blood glucose level.
Control of blood sugar is essential. Advise the patient to maintain a hemoglobin A1C level under 7% to avoid or delay complications. In people with type 2 diabetes mellitus, treatment with sodium-glucose transporter 2 (SGLT-2) inhibitors (such as canagliflozin, dapagliflozin, and empagliflozin) may lessen eGFR decline.
3. Correct metabolic acidosis.
Bicarbonate supplementation used to treat chronic metabolic acidosis may also decrease the progression to ESRD.
4. Manage dyslipidemia.
Lipid panels should be monitored early in the disease, and cholesterol-lowering medications such as HMG-CoA reductase inhibitors (statins) should be started for adults over age 50 with an eGFR of less than 60 mL/min/1.73 m2. Patients receiving dialysis should discontinue statin therapy.
5. Control the fluid volume.
Loop diuretics or ultrafiltration should be used to treat volume overload or pulmonary edema.
6. Manage complications of ESRD.
ESRD affects fluid and electrolyte balance as well as the production of red blood cells. It is essential to treat the following complications of kidney disease:
- Anemia: Administer erythropoiesis-stimulating agents (ESAs) when hemoglobin levels drop below 10 g/dL.
- Hyperphosphatemia: Give phosphate binders (such as calcium acetate, sevelamer carbonate, or lanthanum carbonate) and restrict phosphate in the diet.
- Hypocalcemia: Administer calcium supplements with calcitriol.
- Hyperparathyroidism: Give calcitriol, vitamin D analogs, or calcimimetics
7. Assist the patient in creating their meal plan.
Promote adherence to a renal diet (avoiding foods high in phosphorus and potassium), low salt intake (less than 2 g/day), and a daily protein limit of 0.8 g per kg body weight.
8. Encourage lifestyle modifications.
Promote physical activities and smoking cessation. Advise the patient to maintain an ideal weight. Aerobic exercise has been shown to have the greatest benefit in improving strength, fitness, and quality of life in patients receiving dialysis.
9. Restrict fluids.
Kidneys that are no longer functioning cannot excrete fluids adequately, causing fluid overload. Each patient may have a different fluid restriction. Patients receiving dialysis are restricted to 32 ounces per day.
Plan for Long-Term Renal Replacement Therapy
1. Encourage treatment adherence.
When the kidneys no longer function on their own, dialysis is required to filter the blood and remove toxins. Dialysis requires a commitment to either learning to perform treatments at home or attending an outpatient dialysis clinic multiple days per week. The following renal replacement therapy options should be discussed with the patient:
- Hemodialysis
- Peritoneal dialysis
- Kidney transplantation
2. Educate the patient about their prognosis and treatment options.
Early patient education should begin with discussing kidney transplantation, various dialysis modalities, and natural disease progression. This discussion will help the patient accept the diagnosis and prepare for the future.
3. Discuss vascular access options.
An arteriovenous (AV) fistula is the best long-term option for vascular access as it has a lower risk of clotting or infection. AV fistulas take months to mature and may not be feasible if the patient needs dialysis immediately. AV grafts are another option that uses a synthetic catheter to connect an artery to a vein and can be used within days to weeks.
4. Instruct on peritoneal dialysis.
If the patient is capable of performing dialysis on their own, the nurse can instruct the patient on how to perform dialysis in their home. The patient must be able to keep their PD catheter free from infection and monitor for complications like peritonitis.
5. Prepare for a kidney transplant.
Dialysis is not a cure for ESRD but it can help patients live for years. A kidney transplant is the only way to replace the diseased organ. Living with only one kidney is possible. Patients with the following conditions may not be eligible for a kidney transplant:
- Older age
- Severe heart disease
- Active or recent cancer
- Dementia
- Severe obesity
- Poor medication adherence
- Current drug or alcohol use
- Limited or no health insurance
6. Discuss palliative and end-of-life care.
Palliative care services are beneficial for patients with ESRD for pain and symptom management. If transplantation is not an option and dialysis is no longer effective, the nurse can discuss hospice and end-of-life care.
Nursing Care Plans
Once the nurse identifies nursing diagnoses for end-stage renal disease, nursing care plans help prioritize assessments and interventions for both short and long-term goals of care. In the following section, you will find nursing care plan examples for end-stage renal disease.
Deficient Knowledge
Deficient knowledge related to end-stage renal disease can be caused by misinformation, leading to further complications and poor outcomes.
Nursing Diagnosis: Deficient Knowledge
Related to:
- Misinformation about ESRD and its management
- Inadequate access to resources
- Inadequate commitment to learning
- Inadequate information about ESRD
- Inadequate interest in learning
- Inadequate participation in care planning
- Misconceptions about ESRD treatment
As evidenced by:
- Inquiries about ESRD
- Inaccurate follow-through of instructions
- Expressed myths about ESRD
- Nonparticipation in care
- Nonadherence to treatment
- Development of complications
Expected outcomes:
- Patient will verbalize understanding of ESRD, its symptoms, and its management.
- Patient will adhere to the treatment plan as evidenced by lab values within the expected ranges.
- Patient will not develop complications from ESRD.
Assessment:
1. Assess the patient’s current knowledge about ESRD.
Ask the patient what they know about ESRD. From there, the nurse can tailor the patient’s health teaching plan.
2. Determine the patient’s willingness and motivation to learn.
Patients with ESRD may feel powerless over this progressive disease, affecting their motivation to learn and adhere to the treatment regimen.
3. Check the patient’s health literacy.
Health literacy can affect health outcomes and treatment compliance. ESRD requires a commitment to a complicated treatment regimen. Myths and misinformation can affect the receipt of accurate information about ESRD and its management.
Interventions:
1. Instruct the patient on lifestyle modifications.
Arm the patient with information so they can make informed decisions. Instruct patients that simple changes such as exercise, quitting smoking, and adhering to their medication regimen can preserve kidney function.
2. Allow inquiries about dialysis and kidney transplant.
Remain approachable, so the patient feels at ease asking questions. Dialysis and kidney transplants require life-long maintenance, and support from nurses can enhance adherence.
3. Instruct on appropriate diets.
Adhering to a kidney-friendly diet can be difficult. The patient may need to limit salt, potassium, and fluids. Provide easy-to-understand written instructions on foods the patient should limit.
4. Have the patient verbalize symptoms of concern.
Teach the patient about the signs of developing complications from ESRD. Dyspnea, confusion, changes in urination, weight gain, high blood pressure, and muscle cramps require immediate assessment.
5. Educate on fistula care.
A fistula is created to allow for vascular access with dialysis. Complications such as infection or bleeding can occur as it heals. Instruct on proper care and when to alert the healthcare provider if concerns arise.
Excess Fluid Volume
Excess fluid volume related to end-stage renal disease can be caused by kidneys losing their ability to remove excess fluid leading to fluid overload (hypervolemia).
Nursing Diagnosis: Excess Fluid Volume
Related to:
- Sodium retention
- Imbalanced electrolytes
- Uncontrolled hypertension
- Loss of kidney function
- Decreasing filtering capability of the kidney (glomerular infiltration rate)
- Inappropriate diet
- Nonadherence to fluid restriction
- Comorbidities like heart failure
As evidenced by:
- Edema
- Altered blood pressure
- Altered urine specific gravity
- Intake exceeds output
- Oliguria
- Pulmonary congestion
- Altered mental status
- Hypoalbuminemia
- Electrolyte imbalances
Expected outcomes:
- Patient will achieve an acceptable fluid balance as evidenced by intake and output documentation.
- Patient will remain free from symptoms of excess fluid like edema and dyspnea.
- Patient will display electrolytes within an acceptable range.
Assessment:
1. Weigh the patient daily.
Weigh the patient daily using the same scale at the same time. Sudden weight gain can indicate ESRD complications like fluid retention.
2. Monitor the patient’s intake and output.
The kidneys are in charge of eliminating extra fluid from the body. Fluid can accumulate when the kidneys are not functioning correctly. Accurate intake and output measurements are essential when monitoring patients with ESRD.
3. Check the electrolytes.
Fluid volume is associated with electrolyte balances. Hyperphosphatemia, hyperkalemia, and hypocalcemia are common findings.
4. Obtain urine samples for testing.
The protein albumin in the urine is measured through urine tests. Albumin maintains colloid osmotic pressure, which regulates fluid circulating throughout the body. Hypoalbuminemia is common in ESRD.
5. Monitor for respiratory distress and changes in mentation.
Signs and symptoms of pulmonary congestion and fluid overload must be recognized early to prevent further worsening of the patient’s condition.
Interventions:
1. Administer albumin as indicated.
Patients with ESRD often have low albumin (hypoalbuminemia). Albumin is a plasma protein that maintains intravascular oncotic pressure, preventing fluid from leaking out of the blood vessels and into the extravascular space.
2. Promote diuresis.
Loop diuretics (such as furosemide) are the drug of choice for ESRD to excrete the extra fluid out of the body to relieve edema and pulmonary congestion.
3. Limit sodium intake.
Because the kidneys cannot effectively remove extra sodium and fluid from the body, sodium and fluid build up in the tissues and circulation. Sodium will be restricted in the diet.
4. Elevate edematous extremities.
Elevating edematous extremities promotes venous return and reduces edema.
5. Restrict fluids as ordered.
Maintaining proper fluid balance is crucial since regular hydration can lead to harmful fluid buildup in ESRD. Ensure adherence to daily fluid restrictions.
6. Regulate the blood pressure.
Too much fluid in the blood arteries can elevate the blood pressure and further damage the kidneys. Renal artery stenosis is when the kidneys’ blood vessels constrict and cause high blood pressure.
Imbalanced Nutrition: Less Than Body Requirements
Patients with end-stage renal disease are at risk for developing imbalanced nutrition, which often manifests as micronutrient deficiencies and protein-energy wasting.
Nursing Diagnosis: Imbalanced Nutrition: Less Than Body Requirements
Related to:
- Disease process
- Chronic inflammation
- Uremic toxins
- Metabolic acidosis
- Food aversion
As evidenced by:
- Fluid and electrolyte imbalances
- Constipation
- Diarrhea
- Nausea
- Vomiting
- Weight loss
- Anorexia
- Lethargy
Expected outcomes:
- Patient will report receiving the recommended intake of protein, potassium, sodium, and phosphorus.
- Patient will remain free from fluid and electrolyte imbalances.
Assessment:
1. Assess the patient’s nutritional status and nutrient deficits.
Understanding the patient’s nutritional status, food choices, and symptoms can help determine appropriate interventions to help correct imbalanced nutrition in patients with ESRD and guide proper meal planning.
2. Assess weight loss associated with end-stage renal disease.
As ESRD worsens, it can cause various symptoms, including nausea, vomiting, weight loss, mental status changes, and fatigue, impacting the patient’s nutritional intake. Closely monitor weight, BMI, and mid-arm circumference.
3. Assess the patient’s serum albumin, red blood cell count, and electrolyte levels.
In ESRD, low serum albumin is associated with poor protein intake, protein loss, and inflammation. Albumin is an important protein as it helps fluid move more easily from tissues into the blood for removal through dialysis. Patients with ESRD are at risk for increased potassium and phosphorus as well as low red blood cells, causing anemia.
Interventions:
1. Encourage strict fluid management.
As CKD progresses to ESRD, fluid elimination becomes impaired, and edema occurs along with elevated blood pressure and an increased risk for congestive heart failure. For patients who are on dialysis, it is recommended to limit fluid intake to 32 ounces per day.
2. Encourage adequate protein intake.
A low-protein diet can delay the progression of kidney disease and prevent complications. However, ESRD patients on dialysis will need more protein in their diet, with recommendations of at least 1.2 grams/kg of body weight for those on hemodialysis and slightly more for patients on peritoneal dialysis.
3. Instruct the patient to limit foods high in potassium, sodium, and phosphorus.
Patients diagnosed with ESRD have difficulty regulating potassium, sodium, and phosphorus. It is recommended to avoid eating foods like dried fruits, bananas, processed cheese, nuts, potatoes, organ and processed meats, and beans. High phosphorus levels negatively impact calcium and bone strength and may be treated with phosphate binders to absorb phosphorus before the body does.
4. Instruct on supplements as prescribed.
Patients with ESRD are often deficient in most vitamins and may not be able to receive them through their restricted diet. Patients may be prescribed vitamins D, C, and E, B complex, L-carnitine, iron, and calcium to improve nutrition and anemia.
5. Provide nutritional counseling.
Patients should receive individualized nutritional counseling based on their lab results, weight, subjective symptoms, and socioeconomic status (access to food and income). Nurses can request patients keep a nutritional log to closely monitor if the patient demonstrates understanding and improvement in their diet compared to objective findings.
6. Encourage exercise as tolerated.
Exercise can help positively influence nutritional status, manage weight, improve blood pressure, and improve the general well-being of patients with ESRD. Aerobic exercise for 30 minutes several days a week can benefit ESRD patients on hemodialysis.
Impaired Urinary Elimination
Impaired urinary elimination related to end-stage renal disease can be caused by loss of kidney function to filter and eliminate toxic wastes from the body through urine.
Nursing Diagnosis: Impaired Urinary Elimination
Related to:
- Disease process
- Loss of nephrons
- Decreasing filtering capability of the kidney (glomerular infiltration rate)
- Urinary tract obstruction
- Inflamed urinary tract
- Kidney infection
As evidenced by:
- Decreased urine output (oliguria)
- Painful urination (dysuria)
- Absence of urine output (anuria)
- Urinary retention
- Difficulty in starting urination (urinary hesitancy)
- Increased urge to urinate (urinary urgency)
- Increased urination at night (nocturia)
- Urinary incontinence
Expected outcomes:
- Patient will manifest improved urine output within the target limit set by the healthcare provider.
- Patient will participate in dialysis treatments as prescribed.
Assessment:
1. Assess the patient’s urinary elimination status.
ESRD often occurs when chronic renal failure has advanced to the point where kidney function is less than 10% of the maximum. The body can no longer generate urine normally or at all.
2. Observe the patient’s urine characteristics.
More frequent urination (urinary urgency) or the presence of blood can happen when the kidneys are not working correctly. Also, frothy or bubbly urine could be an early sign of protein entering the urine due to damaged kidneys.
3. Know the patient’s eGFR.
Perform a blood test to establish the glomerular filtration rate. The eGFR calculates the number of milliliters (mL/min) of blood the kidneys can filter each minute. The kidney function decreases as the GFR does. Renal failure is diagnosed when the GFR falls below 15 ml/min.
4. Obtain blood samples for creatinine and BUN.
The kidneys also filter creatinine, a waste product from the muscles. Like BUN, high creatinine levels may indicate that the kidneys cannot filter waste. In ESRD, serum creatinine and blood urea nitrogen (BUN) levels are increased.
5. Palpate the bladder.
A palpable bladder can indicate a dilated urinary collection system or urinary system blockage, which can result in renal failure and kidney damage.
6. Check for costovertebral angle tenderness.
Costovertebral angle (located at the back and bottom of the ribcage) tenderness is associated with a kidney infection (pyelonephritis) and kidney stones. These are possible causative factors of ESRD.
Interventions:
1. Closely monitor the patient’s intake and output.
The patient’s fluid volume is compromised in ESRD. It is vital to monitor the intake and output closely. As kidney failure progresses, renal perfusion and function decline, as does urine production. As ESRD worsens, the patient may be anuric.
2. Explain the importance of dialysis.
Dialysis is a necessary treatment for ESRD to survive. Since the kidneys are no longer functioning, a dialysis machine acts as the kidneys to filter blood and remove fluid.
3. Anticipate a possible kidney transplant.
A kidney transplant surgically implants a donor kidney to help the body regain proper excretion of waste through urine. The healthcare team will discuss options with the patient and prepare them for receiving the organ.
4. Refer to a dietitian.
A dietitian can create a kidney-friendly diet as part of the kidney disease treatment. Proper diet adherence is essential to preserve kidney function.
Ineffective Tissue Perfusion
Adequate renal perfusion is essential in removing fluid and toxic waste from the body. Kidneys that no longer filter adequately negatively impact all other organ systems.
Nursing Diagnosis: Ineffective Tissue Perfusion
Related to:
- Disease process
- Chronic inflammation
- Compromised kidney function
- Hypervolemia
- Hypertension
- Nephrotoxic medications
- Uncontrolled diabetes
As evidenced by:
- Anuria
- Oliguria
- Edema
- Itchy skin
- Fatigue
- Muscle cramps
- Mental status changes
- Decreased eGFR
Expected outcomes:
- Patient will be free from complications of poor renal perfusion causing other organ dysfunction, such as congestive heart failure or encephalopathy.
- Patient will adhere to dialysis treatments.
Assessment:
1. Note intake and output and urine characteristics.
As the kidneys continue to deteriorate, they will excrete less urine. It is expected for patients with ESRD to excrete little to no urine. Monitor urine color and specific gravity.
2. Assess the patient’s diagnostic studies.
Renal ultrasound and CT scan are indicated to evaluate kidney health and visualize causes of poor perfusion such as masses, calculi, or obstruction.
3. Assess for symptoms of worsening perfusion.
Poor renal perfusion can lead to organ dysfunction as toxic waste builds up in the body. The patient may experience confusion, irritability, or reduced LOC if encephalopathy occurs. Poor fluid balance may cause edema, hypertension, and congestive heart failure.
4. Monitor lab values.
Patients with ESRD will demonstrate an eGFR of < 15 mL/min. The nurse should also monitor the protein/creatinine ratio, BUN, and electrolyte levels.
Interventions:
1. Prepare the patient for dialysis.
Dialysis is indicated for patients with ESRD whose uremia no longer responds to conservative medical management. The patient may undergo peritoneal dialysis or hemodialysis to remove waste products and correct fluid and electrolyte imbalances.
2. Assist in conducting a kidney biopsy.
A kidney biopsy may be indicated to help determine the type of kidney disease and the extent of kidney damage. This procedure involves retrieving a kidney tissue sample for analysis.
3. Instruct the patient to avoid IV contrast and other nephrotoxic medications.
Nephrotoxic medications, including IV contrast, must be avoided or used with caution in patients with ESRD as this can further damage the kidneys.
4. Assist and prepare the patient for a kidney transplant.
A renal transplant is the only treatment to cure kidney disease. Evaluation and preparation for a kidney transplant are essential as not every patient is a candidate. The nurse is vital in helping the patient adhere to their treatment regimen to maintain the highest level of health prior to transplant. The patient will then require close monitoring post-transplant for complications and medication adherence to prevent organ rejection.
References
- Arora, P. (2023, May 26). Chronic kidney disease (CKD): Practice essentials, pathophysiology, etiology. Diseases & Conditions – Medscape Reference. Retrieved September 2023, from https://emedicine.medscape.com/article/238798-overview?icd=login_success_gg_mismatch_norm#a1
- Burns, S. (2014). AACN essentials of critical care nursing (3rd ed.). McGraw-Hill Education / Medical.
- Burns, J. (2023, January). Patient education: Dialysis or kidney transplantation — which is right for me? UpToDate. https://www.uptodate.com/contents/dialysis-or-kidney-transplantation-which-is-right-for-me-beyond-the-basics
- Centers for Disease Control and Prevention. (2022, February 28). Chronic kidney disease basics. Retrieved September 2023, from https://www.cdc.gov/kidneydisease/basics.html
- Cleveland Clinic. (2020, November 13). End-stage renal (Kidney) disease: What is it, causes, dialysis & more. Retrieved February 2023, from https://my.clevelandclinic.org/health/diseases/16243-end-stage-renal-kidney-disease
- Cleveland Clinic. (2020, November 13). End-stage renal (Kidney) disease: What is it, causes, dialysis & more. Retrieved September 2023, from https://my.clevelandclinic.org/health/diseases/16243-end-stage-renal-kidney-disease
- DaVita Kidney Care. (n.d.). Fluid control for kidney disease patients on dialysis. Kidney disease and dialysis information. Retrieved September 2023, from https://www.davita.com/diet-nutrition/articles/basics/fluid-control-for-kidney-disease-patients-on-dialysis
- Hashmi, M. F., Benjamin, O., & Lappin, S. L. (2023, February 19). End-stage renal disease – StatPearls – NCBI bookshelf. National Center for Biotechnology Information. Retrieved September 2023, from https://www.ncbi.nlm.nih.gov/books/NBK499861/
- Mayo Clinic. (2021, October 12). End-stage renal disease – Symptoms and causes. Retrieved February 2023, from https://www.mayoclinic.org/diseases-conditions/end-stage-renal-disease/symptoms-causes/syc-20354532
- Mayo Clinic. (2021, October 12). End-stage renal disease – Diagnosis and treatment – Mayo Clinic. Retrieved September 2023, from https://www.mayoclinic.org/diseases-conditions/end-stage-renal-disease/diagnosis-treatment/drc-20354538
- National Center for Biotechnology Information. (2021, September 16). End-stage renal disease – StatPearls – NCBI bookshelf. Retrieved February 2023, from https://www.ncbi.nlm.nih.gov/books/NBK499861/
- National Kidney Foundation. (2021, December 21). 5 drugs you may need to avoid or adjust if you have kidney disease. Retrieved September 2023, from https://www.kidney.org/atoz/content/5-drugs-you-may-need-to-avoid-or-adjust-if-you-have-kidney-disease
- Zemaitis, M. R., Foris, L. A., Katta, S., & Bashir, K. (2022, April 29). Uremia – StatPearls – NCBI bookshelf. National Center for Biotechnology Information. Retrieved September 2023, from https://www.ncbi.nlm.nih.gov/books/NBK441859/
