Management of Fluid Overload in Chronic Renal Failure

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Management of Fluid overload in Chronic Renal Failure (CRF)

Chronic Renal Failure is a long term serious irreversible condition, described as the gradual loss of kidney function (McCarthy, et al 2009). The number of patients suffering from CRF in United Kingdom (UK) is rising rapidly. Ferenbach and Wood (2005, p.16) state that in UK, about 6000 people are commencing dialysis treatment per year. Fluid overload is a frequently observed finding in renal failure patients. About one third of the patients receiving dialysis for Chronic Renal Failure have fluid overload despite advice to restrict their oral fluid intake (Roderick, et al 2004). This assignment will examine the clinical effectiveness of the management of fluid overload in patients with chronic renal failure undergoing continuous haemodialysis. It also focuses on the consequences associated with fluid overload in such patients. In addition, I will critically analyse my experience on nursing a patient with fluid overload suffering from End Stage Renal Failure (ESRD). The physiology by which fluid overload contribute to the progression of the disease is also been examined. Rationale for selection of topic

Recent research (National Kidney Federation (NKF), 2006 suggests that 1 in 10 people have CRF. Compared to young adults, 1 out of 2 in those aged over 75 years are suspected to have Kidney failure . Jassal (2009) also supports that chronic renal failure is increasingly being recognized in elderly individuals’ globally. In UK, between 2 and 3% of the National Health Service budget is spent on dialysis and transplantation and in many cases the patients are elderly (Black, et al 2010, p.25). The concern with fluid overload in haemodialysis patients is not a new problem and hence it has been considered as a challenge for the health professionals especially when the patients are non-compliant. Therefore this particular topic seems to be so important that it would be worth examining in detail. I will critically discuss the recent evidence that support effective care and reveal an understanding of the current issues involved in the topic.

Pathophysiology
As kidney fails, the body becomes unable to excrete waste products, excess fluids and salts. The extracellular fluid sodium concentration and osmolality are being maintained by the kidneys in normal cases. From the fluid in the tubules, the chemicals such as potassium, sodium and bicarbonate and water are either added or removed according to the body’s needs. Inspite of the gradual destruction of nephrons, the kidney has an inherent capability to maintain glomerular filtration rate (GFR) by hyper filtration. This flexibility helps to eliminate plasma solutes so that substances such as protein, urea and creatinine show considerable increase in plasma levels once the total GFR has decreased to half (Arora and Batuman, 2001). Numerous studies have shown a correlation between the degree of proteinuria and rate of progression of renal failure (Black, et al 2010). This has led to the assumption that proteinuria is an important indicator of glomerular dysfunction (Abbate, et al 2008). But the mechanisms by which the presence of proteins in tubular fluid promotes the progression of CRF are not yet determined. However the increased glomerular capillary pressure, which damages the capillaries, leading to glomerulosclerosis has been determined (Walls, 2001). An increase in plasma creatinine from a baseline value of 0.6 mg/dL to 1.2 mg/dL also represents a destruction of half of the functioning nephron mass (Adamczak and Ritz, 2008). A normal level of GFR is 80-120ml/min/1.73m2, but it is normal to fall GFR with age (Ferenbach and Wood, 2005, p.16). Patient Profile

I will refer to the patient as Mr. Frank to maintain the patient’s confidentiality in accordance with the Nursing and Midwifery Council Code of Professional Conduct (NMC, 2004 and 2010). Mr. Frank was referred to the dialysis unit due to high uremic...
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