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Understanding CKD @LWNurses #LearnWithNurses Michaela Nuttall RGN MSc Founder, Learn With Nurses Director, Smart Health Solutions Clinical Advisor for CVD Prevention, Public Health England Associate in Nursing, C3 Collaborating for Health Chair, Health Care Committee HEART UK Member, Nurses Working Party and Guidelines & Information Working Party, British and Irish Hypertension Society Trustee, PoTS UK and Bromley Third Sector Enterprise @ thisismichaelaUsing Medall.orgClosed FB group & PageUnderstanding CKD Prevalence of CKD stage 3–5 (coded and uncoded), by ethnic group in all adults (aged ≥18 years) in Lambeth DataNet. Mariam Molokhia et al. Br J Gen Pract 2020;70:e785-e792 ©2020 by British Journal of General Practice Figure 1 The Lancet 2020 395709-733DOI: (10.1016/S0140-6736(20)30045-3) Copyright © 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access Article under the CC BY 4.0 license. Terms and Conditions Understanding CKD • Kidney function • What and how does the kidney go wrong? • How is it diagnosed • How does CKD impact on kidney function?NICE Baroreceptors • Help the body to adjust to being upright • Keeping us functioning • Stops gravity from pulling fluid into our legs • Keeps us conscious Kidneys do lots of things 1. Balance levels of salt and water 2. Excrete waste from the blood 3. Control blood pressure 4. Make strong bones 5. Boost production of red blood cells Renal Vein Renal Artery Ureter What makes our kidneys sad… CVD Diabetes Structural renal tract disease, renal calculi or prostatic hypertrophy Hypertension Lupus erythematosus / HIV Family history of stage 5 CKD or hereditary kidney disease Toxins Long-term NSAIDs Renal Vein Renal Artery UreterNephron (we’ve got lots and lots)HypertensionHypertensionHypertension Less blood/oxygen to the nephronsDiabetesDiabetesDiabetes Increase pressure, damage those precious nephrons and hyperfiltrationLow eGFR Damage to those precious nephrons Renal Vein Renal Artery UreterUnhappy kidney We can test for an unhappy kidneyeGFR U & E Test Levels Urea Kidney Function 2.0-6.6 mmol/’s Dehydration Sodium Raised – could indicate dehydration, 135-147mmol/l uncontrolled diabetes, Low - secondary to diuretics Heart Failure Potassium Raised - could be due to 3.4-5.6 mmol/l deterioration in Kidney Function or medication eg. ACE inhibitors Low - secondary to medication, excessive sweating, D & V Heart Failure Creatinine Normal Range If blood sample taken fasting, advise patient to drink water normally Men Advise patient not to eat meat for 12 hours 75-125 micromol/L prior to eGFR blood test Women By-product of muscle metabolism that is 60-100 micromol/L excreted unchanged by the kidneys Increase can be marker of kidney damage Can be used to calculate eGFR eGFR • Estimated on: serum Creatinine level, age, sex, and race • It is only an estimate. A significant error is possible. eGFR is most likely to be inaccurate in people at extremes of body type, for example malnourished, amputees, etc. • It is not valid in pregnant women or in children eGFR If eGFR in the first test t <60 ml/min/1.73 m repeat within 14 days (exclude AKI) • To identify progression, take at least 3 eGFRs over at least 90 days • Send urine for albumin:creatinine ratio (ACR) Albumin Creatinine Ratio • Albumin is a healthy protein in the bloodstream • Impaired kidneys allow albumin to leak into urine • The creatinine is a waste product that is excreted by the kidney • Impaired kidneys means some creatinine is not filtered so less in the urine. • Needs to be an early morning sample – so it’s concentrated.NICE Impact of CKD on: • Balance levels of salt and water • Excrete waste from the blood • Control blood pressure • Make strong bones • Boost production of red blood cells Impact of CKD on: Balance levels of salt and water They respond to two hormones – Antidiuretic hormone and aldosterone – Therefore, we monitor sodium which affect the reabsorption of water back into and potassium the body. This maintains healthy plasma levels of salt, particularly sodium and potassium Impact of CKD on: Excrete waste from the blood Therefore, we monitor eGFR and ACR Impact of CKD on: Control blood pressure We measure and control blood pressure Impact of CKD on: Make strong bones So, we check calcium, phosphate and parathyroid hormone levels Impact of CKD on: Boost production of red blood So, we check for anaemia, FBC cells Address makes our kidneys sad… CVD Diabetes Structural renal tract disease, renal calculi or prostatic hypertrophy Hypertension Lupus erythematosus Family history of stage 5 CKD or hereditary kidney disease Toxins Long-term NSAIDs When to look for CKD? • weight loss or poor appetite • swollen ankles, feet or hands • Shortness of breath • tiredness • blood in urine • peeing more than usual, particularly at night In summary Kidneys are precious They have lots of functions If we don’t look after them, they wont function as well