Friday, October 07, 2011

Renal Replacement Therapy

Dealing with a 76 year old gentleman who comes for THR, who has limited mobility,is hypertensive (controlled) has ischaemic heart disease intermittent Angina (no echo since more than 10 years), is a vasculopath post CABG and Aorto- femoral surgery
has urea 26 mmol/l and creatinine of 189 mmol/l. K 5.5

A few important questions I had to find an answer to......

When to refer a CRF patient to nephrologist who comes for Preop Asessment?

Renal Replacement Therapy (Please cllick on the link )

We recommend that most patients with CKD stage 4-5(eGFR <30ml/min/1.73m2) or with CKD stage 3 and rapidly deteriorating renal function should be referred for assessment by a nephrologist (1B)
When should the patient receive RRT ?
We suggest that serious consideration should be given to starting renal replacement therapy in patients with an eGFR < 6ml/min/1.73m2, even if the patient is asymptomatic (2C)

When Could my patient develop Uremic encephalopathy?
It develops in patients with acute or chronic renal failure, usually when creatinine clearance (CrCl) levels fall and remain below 15 mL/min

What is the risk of death in this patient?
Having both heart and kidney disease can cause 20 times the risk of death from heart problems than either problem alone
Ref:Damman K, Navis G, Voors AA, Asselbergs FW, Smilde TD, Cleland JG, van Veldhuisen DJ, Hillege HL. Worsening renal function and prognosis in heart failure: systematic review and meta-analysis. J Card Fail. 2007 Oct;13(8):599–608