Question

Question 1: Create a table for the different stages of chronic kidney disease and the signs and/or symptoms for each stage.

Question 2: When doing a vital signs assessment on your patient with a fistula in their right arm, which arm would you put the blood pressure cuff on? Why?

Question 3: Is there anything in particular you need to assess with someone who has a fistula?

Answer 1

Chronic kidney disease (CKD) refers to all five stages of kidney damage, from very mild damage in stage 1 to complete kidney failure in stage 5. The stages of kidney disease are based on how well the kidneys can filter waste and extra fluid out of the blood. In the early stages of kidney disease, your kidneys are still able to filter out waste from your blood. In the later stages, your kidneys must work harder to get rid of waste and may stop working altogether.

The way doctors measure how well your kidneys filter waste from your blood is by the estimated glomerular filtration rate, or eGFR. Your eGFR is a number based on your blood test for creatinine, a waste product in your blood.

The stages of kidney disease are based on the eGFR number.

• Stage 1 CKD: eGFR 90 or Greater
• Stage 2 CKD: eGFR Between 60 and 89
• Stage 3 CKD: eGFR Between 30 and 59
• Stage 4 CKD: eGFR Between 15 and 29
• Stage 5 CKD: eGFR Less than 15

Stage 1 CKD: eGFR 90 or Greater

Stage 1 CKD means you have mild kidney damage and an eGFR of 90 or greater.

Most of the time, an eGFR of 90 or greater means your kidneys are healthy and working well, but you have other signs of kidney damage. Signs of kidney damage could be protein in your urine (pee) or physical damage to your kidneys. Here are some ways to help slow down the damage to your kidneys in Stage 1 kidney disease:

• Control your blood sugar if you have diabetes
• Control your blood pressure
• Eat a healthy diet
• Do not smoke or use tobacco
• Be active 30 minutes a day, 5 days a week
• Stay at a healthy weight
• Ask your doctor if there are medicines you can take to help protect your kidneys
• Make an appointment to see a nephrologist (kidney doctor) even if you already have a general doctor

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Stage 2 CKD: eGFR Between 60 and 89

Stage 2 CKD means you have mild kidney damage and an eGFR between 60 and 89.

Most of the time, an eGFR between 60 and 89 means your kidneys are healthy and working well. But if you have Stage 2 kidney disease, this means you have other signs of kidney damage even though your eGFR is normal. Signs of kidney damage could be protein in your urine (pee) or physical damage to your kidneys. Here are some ways to help slow down the damage to your kidneys in Stage 2 kidney disease:

• Control your blood sugar if you have diabetes
• Control your blood pressure
• Eat a healthy diet
• Do not smoke or use tobacco
• Be active 30 minutes a day, 5 days a week
• Stay at a healthy weight
• Ask your doctor if there are medicines to protect your kidneys
• Make an appointment to see a nephrologist (kidney doctor) even if you already have a general doctor

Stage 3 CKD: eGFR Between 30 and 59

Stage 3 CKD means you have an eGFR between 30 and 59.

An eGFR between 30 and 59 means that there is some damage to your kidneys and they are not working as well as they should.

Stage 3 is separated into two stages:

• Stage 3a means you have an eGFR between 45 and 59
• Stage 3b means you have an eGFR between 30 and 44

Many people with Stage 3 kidney disease do not have any symptoms. But if there are symptoms, there may be:

• Swelling in your hands and feet
• Back pain
• Urinating (peeing) more or less than normal

At this stage, you are also more likely to have health complications as waste builds up in your body and your kidneys are not working well, such as:

• High blood pressure
• Anemia (a low number of red blood cells)
• Bone disease

To keep your Stage 3 kidney disease from getting worse, you can:

• Control your blood sugar if you have diabetes
• Control your blood pressure
• Do not smoke or use tobacco
• Eat a healthy diet
• Be active 30 minutes a day, 5 days a week
• Stay at a healthy weight
• Visit a nephrologist (kidney doctor), who will make a treatment plan that is right for you and tell you how often you will need to have your kidneys checked
• Meet with a dietitian, who will help you follow a healthy diet
• Ask your doctor about blood pressure medicines called ACE inhibitors and ARBs if you have diabetes or high blood pressure. Sometimes, these medicines can help keep kidney disease from getting worse

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Stage 4 CKD: eGFR Between 15 and 29

Stage 4 CKD means you have an eGFR between 15 and 29.

An eGFR between 15 and 30 means your kidneys are moderately or severely damaged and are not working as they should. Stage 4 kidney disease should be taken very seriously – it is the last stage before kidney failure.

At Stage 4 kidney disease, many people have symptoms such as:

• Swelling in your hands and feet
• Back pain
• Urinating (peeing) more or less than normal

At Stage 4, you will likely also have health complications as waste builds up in your body and your kidneys are not working well, such as:

• High blood pressure
• Anemia (a low number of red blood cells)
• Bone disease

To keep kidney disease from getting worse at this stage, your doctor will recommend that you:

• Have regular appointments with a nephrologist (kidney doctor), who will make a treatment plan that is right for you and tell you how often you will need to have your kidneys checked
• Meet with a dietitian, who will help you follow a healthy diet
• Take special blood pressure medicines like ACE inhibitors and ARBs if your doctor says you should. If you have diabetes or high blood pressure, sometimes these medicines can help keep kidney disease from getting worse.

At Stage 4 kidney disease, this is the time to start talking with your nephrologist about how to prepare for kidney failure. Once your kidneys have failed, you will need to start dialysis or have a kidney transplant to live.

• Preparing for dialysis: Dialysis helps clean your blood when your kidneys have failed. There are several things to think about, such as the type of dialysis, how to plan your treatments and how they will affect your daily life. Learn more about hemodialysis and peritoneal dialysis.
• Preparing for a transplant: A kidney transplant is a surgery to give you a healthy kidney from someone else’s body. If you can find a living kidney donor, you may not need to start dialysis at all. It is possible to have a transplant when your kidneys are getting close to failure. Learn more about kidney transplants.

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Stage 5 CKD: eGFR Less than 15

Stage 5 CKD means you have an eGFR less than 15.

An eGFR less than 15 means the kidneys are getting very close to failure or have completely failed. If your kidneys fail, waste builds up in your blood, which makes you very sick.

Some of the symptoms of kidney failure are:

• Itching
• Muscle cramps
• Feeling sick and throwing up
• Not feeling hungry
• Swelling in your hands and feet
• Back pain
• Urinating (peeing) more or less than normal
• Trouble breathing
• Trouble sleeping

Once your kidneys have failed, you will need to start dialysis or have a kidney transplant to live.

• Preparing for dialysis: Dialysis helps clean your blood when your kidneys have failed. There are several things to think about, such as the type of dialysis, how to plan your treatments and how they will affect your daily life. Learn more about hemodialysis and peritoneal dialysis.
• Preparing for a transplant: A kidney transplant is a surgery to give you a healthy kidney from someone else’s body. If you can find a living kidney donor, you may not need to start dialysis at all. It is possible to have a transplant when your kidneys are getting close to failure. Learn more about kidney transplants.

2. The cuff should be placed in the arm where there is no fistula

Measuring your blood pressure in the fistula arm with a blood pressure meter, as inflating the cuff induces a compression of the blood vessels. Drawing blood or injections, as afterwards haemostasis has to be performed. In addition, unqualified personnel could potentially damage the fistula.