Kidney Disease Concepts
27-29%of exam
Hemodialysis
51-53%of exam
Peritoneal Dialysis
15-17%of exam
Transplant + Acute Therapies
4-5%of exam
ImmunosuppressantsRejectionCRRTTransplant Basics
Quick Facts
- Exam
- CDN
- Credential
- Dialysis Nurse
- Items
- 150 MCQ
- Time
- 3 hours
- Pass
- Score 95 (~70%)
- Fee
- $350 ($300 ANNA)
- Valid
- 3 years
- Body
- NNCC via PSI
CKD GFR Stages
90 60 30 15 under 15
Stage 1: 90+Stage 2: 60-89Stage 3: 30-59Stage 4: 15-29Stage 5: under 15
CKD vs AKI
CKD
- Months years
- Irreversible loss
- Staged GFR
AKI
- Hours days
- Often reversible
- Rapid rise Cr
Chronic vs acute
CKD Stages
- Stage 1
- GFR 90+ damage
- Stage 2
- GFR 60-89 mild
- Stage 3
- GFR 30-59 moderate
- Stage 4
- GFR 15-29 severe
- Stage 5
- GFR under 15 ESRD
- AKI
- Sudden function loss
- ESRD
- Permanent kidney failure
- Nephron
- Functional kidney unit
CKD Electrolyte Triad
High K PO4 low Ca
K+: hyperkalemia riskPO4: binders neededCa: low with high PTH
Electrolytes
- Hyperkalemia
- High serum K+
- Hypocalcemia
- Low serum Ca++
- Hyperphosphatemia
- High serum PO4
- Hyponatremia
- Low serum Na+
- Phosphate binder
- Binds dietary PO4
- Kayexalate
- K+ exchange resin
- Calcitriol
- Active vitamin D
- Fluid overload
- Excess volume retention
Acid-Base
- Met acidosis
- Low HCO3 low pH
- Resp alkalosis
- Low CO2 high pH
- Anion gap
- Unmeasured anions
- Bicarbonate
- Primary buffer base
- pH 7.35
- Lower acidosis limit
- pH 7.45
- Upper alkalosis limit
- Kussmaul
- Deep rapid breathing
- Uremic frost
- Skin urea crystals
Anemia + Bone
- EPO
- Stimulates RBC production
- ESA
- Erythropoiesis-stimulating agent
- Iron sucrose
- IV iron replacement
- Ferritin
- Iron storage marker
- Renal osteodystrophy
- CKD bone disease
- PTH
- Parathyroid hormone
- Cinacalcet
- Lowers PTH Ca
- Albumin
- Nutrition marker
HD Hypotension
Fast UF dry weight vasodilate
Fast UF: volume shiftBelow dry weightVasodilator medsAutonomic neuropathy
AVF vs AVG
AVF
- Native vein
- Lower infection
- Longer maturation
AVG
- Synthetic tube
- Faster use
- Higher thrombosis
Native vs synthetic
Symptom Picker
- BP drop dizzy→Slow UF(Hypotension)
- Leg cramps→Saline bolus(Volume shift)
- Chest pain→Stop UF O2(Ischemia)
- Fever chills→Culture access(Infection)
- Headache nausea→Lower UF rate(Disequilibrium)
- Bleeding site→Reduce heparin(Anticoagulation)
- No thrill→Assess clot(Access failure)
- Air in line→Clamp clamp off(Embolism risk)
HD Principles
- Diffusion
- Solute gradient clearance
- Ultrafiltration
- Pressure water removal
- Dialysate
- Treatment bath fluid
- Blood flow
- 300-500 mL/min
- Dialysate flow
- 500-800 mL/min
- Kt/V
- Adequacy dose marker
- URR
- Urea reduction ratio
- Recirculation
- Blood short-circuit
HD vs PD
HD
- In-center machine
- Vascular access
- Rapid UF
PD
- Home peritoneum
- Catheter access
- Gentle daily
Machine vs peritoneum
Access Picker
- Long-term HD→AVF(Preferred)
- Veins poor→AVG(Synthetic)
- Urgent start→CVC(Temporary)
- Steal symptoms→Surgeon consult(Ischemia)
- New fistula→Wait maturation(6-8 weeks)
- Infection fever→Blood cultures(Bacteremia)
- High recirc→Reposition needles(Low clearance)
- Buttonhole site→Same track(Reduced pain)
Vascular Access
- AVF
- Gold standard access
- AVG
- Synthetic conduit access
- CVC
- Temporary central catheter
- Steal syndrome
- Distal ischemia
- Maturation
- Fistula vein enlargement
- Thrill/bruit
- Normal access sounds
- Buttonhole
- Constant-site cannulation
- ROPE
- Cannulation mapping
Diffusion vs UF
Diffusion
- Solute clearance
- Concentration gradient
- Small molecules
UF
- Water removal
- Pressure gradient
- Volume control
Solute vs water
HD Complications
- Hypotension
- Intradialytic BP drop
- Muscle cramps
- Fluid sodium issue
- Air embolism
- Venous air entry
- Bleeding
- Heparin anticoagulation risk
- Chest pain
- Ischemia or hypoxemia
- Fever
- Pyrogen or infection
- Disequilibrium
- Rapid solute shift
- Clotting
- Circuit access thrombosis
Water Treatment
- RO
- Reverse osmosis purification
- Chloramine
- Must be removed
- Bacteria
- Under 1 CFU/mL
- Endotoxin
- Under 0.25 EU/mL
- Conductivity
- Dialysate purity check
- Hardness
- Ca/Mg ion level
- pH monitor
- Dialysate acid-base
- Loop system
- Recirculating water design
Cloudy PD Effluent
Cloudy pain fever culture
Cloudy: peritonitis signPain: abdominalFever: systemicCulture: guide ABX
Peritonitis vs Exit-Site
Peritonitis
- Cloudy effluent
- Abdominal pain
- Intraperitoneal
Exit-site
- Local redness
- Drainage only
- Catheter surface
Inside vs outside
PD Modalities
- CAPD
- Manual bag exchanges
- APD
- Cycler overnight cycles
- PD catheter
- Tenckhoff peritoneal tube
- Dwell time
- Fluid in peritoneum
- Exchange
- Drain fill cycle
- Icodextrin
- Long-dwell osmotic agent
- Ultrafiltration
- PD fluid removal
- Clearance
- Creatinine urea removal
CAPD vs APD
CAPD
- Manual exchanges
- Daytime dwells
- No machine
APD
- Cycler machine
- Night cycles
- Dry day option
Manual vs cycler
PD Infections
- Peritonitis
- Cloudy dialysate pain
- Exit-site
- Redness drainage
- Tunnel infection
- Subcutaneous tract
- Gram stain
- Initial organism guide
- Culture
- Definitive antibiotic choice
- Mupirocin
- Exit-site prophylaxis
- Aseptic technique
- Hand mask drape
- Catheter secure
- Prevent trauma pull
Transplant + Acute
- Tacrolimus
- Calcineurin inhibitor
- Mycophenolate
- Antiproliferative agent
- Prednisone
- Corticosteroid suppressant
- Rejection
- Immune graft attack
- CRRT
- Slow continuous replacement
- Hemofiltration
- Convection clearance
- Living donor
- Preferred transplant source
- Contraindications
- Active infection cancer
Common Traps
AVF vs CVC
AVF long-term ≠ CVC temporary urgent
Diffusion vs UF
Diffusion clears solutes ≠ UF removes water
CKD vs AKI
CKD progressive ≠ AKI often reversible
Peritonitis vs exit
Peritonitis cloudy effluent ≠ Exit-site local only
Kt/V vs URR
Kt/V dose adequacy ≠ URR percent reduction
ESA vs iron
ESA stimulates RBCs ≠ Iron replaces stores
Last Minute
- 1.Weights: 28 / 52 / 16 / 4
- 2.HD = largest domain
- 3.AVF = preferred access
- 4.CVC = temporary only
- 5.HyperK = kayexalate insulin
- 6.Hypotension = slow UF saline
- 7.Cloudy PD = peritonitis culture
- 8.Kt/V = adequacy marker
- 9.RO water = chloramine out
- 10.Pass = score 95 (~70%)
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