OT, dialysis, acute care

Renal failure, dialysis, and OT in acute care

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Kidney and dialysis FAQs: What the OT needs to remember…

  • Kidneys produce urine and eliminate waste from the body. “Waste” is created by metabolic processes in the body.
  • A decrease in the body’s ability to get rid of waste negatively impacts other bodily functions. However a person can live with as much as 75% loss of kidney function.
  • The OT should monitor for physical or cognitive changes in clients who have kidney problems and those that are on dialysis.
  • IN ACUTE CARE, WHAT AN OT SHOULD LOOK OUT FOR:
    • High BP (check vitals before and after intervention)
    • Blood in urine (OT should check during ADL/foley care and report if detected)
    • Elevated creatinine levels (OT should review chart –  high levels may cause fatigue, confusion, edema, shortness of breath)
    • Glomerular Filtration rate  will indicate severity of kidney disease
    • Clients may need to urinate frequently (plan toilet breaks before/after sessions)
    • Edema in hands/feet – this is systemic and cannot be managed with traditional interventions for edema.

What are common kidney conditions that an OT will treat?

Acute Renal Failure: 

Kidney function decreases over hours to days. The body retains the waste products. **Lab indicator of acute renal failure-increased serum creatinine levels

What OT can do:

  • Be mindful of signs of uremia: nausea, vomiting, malaise, altered sensory system (adjust sessions as needed).
  • Educate client on diet adherence (monitor fluids and electrolytes).

Chronic Renal Disease & Chronic Renal Failure:

Decline in kidney function may be due to several factors: severe hypertension, diabetes, glomerulopathies, obstructive uropathy, and hereditary renal diseases.  **This condition is typically irreversible and function gradually continues to decline.

What OT can do:

  • Test client knowledge of understanding of diet guidelines; educate client on diet adherence- LOW SALT, LOW FAT diet, high protein.
  • Practice meal planning (test cognitive ability for meal planning, assess caregiver ability to follow diet).
  • Perform kitchen activities – assess whether client has needed motor and sensory skills to cut and prepare food safely.
  • Test safety in the kitchen – the Kettle Test (find it here).
  • Emphasize that chronic renal disease is often asymptomatic but affects all other systems of the body.

End-Stage Renal Disease(ESRD):

Kidneys fail to work and the body cannot get rid of waste. **most common cause is diabetes

Be aware of the symptoms of ESRD that will impact OT intervention:

  • Changes in mental state.
  • Impaired sensation in hands/feet (assess safety in kitchen and overall mobility; safety in grooming and hygiene and educate on signs of skin issues).
  • Nausea/vomiting (postpone OT?).
  • Headache (monitor for tolerance of OT sessions).
  • Easy bruising (avoid strong hand-holds or wrapping theraband around extremity).
  • Fatigue,

Dialysis: What should the OT know?

  • 3 types of dialysis:
    • Hemodialysis– blood passed through machine where wastes are cleared.
    • Peritoneal Dialysis– dialysate, a fluid that absorbs wastes, is injected into abdomen through a tube. This type needs to be done 4 times a day.
    • Continuous Renal Replacement Therapy- used in clients with acute renal failure or in ICU. Blood is removed through catheter, cleaned, and returned at bedside. Can be done 24 hours a day, if needed.
  • A number of recent studies suggest that physical activity can be beneficial in clients with ESRD (Aucella, Gesuete, & Battaglia, 2014). In addition, even those on CRRT can benefit from mobility (Toonstra et al., 2016) – talk with nursing and PT to arrange mobility with patients, even if just to the edge of bed to complete some light ADLs or cognitive tasks.
    • Every little bit helps!
      • Increase energy and strength.
      • Improve mood and quality of life.
      • Reduce stress and improve sleep.
      • Help regulate BP.
      • Improve efficiency of dialysis.

Final Considerations for OT working with clients with kidney disease:

  • Intervention sessions may need to be shortened d/t declines in physical or cognitive status.
  • Sessions should include education on energy conservation.
  • Always check physician’s orders for activity for clients on dialysis (use current evidence to support mobility with patients on CRRT).
  • Note that dialysis can increase fatigue so OT should aim to schedule treatment on non-dialysis day and monitor client’s closely (vital signs!).
  • Check diet orders before therapy session; check in client chart or with nursing staff.

Acknowledgement: This blog post would not be possible without the help of Andrea Matanovic, a student in the MOT program at CSU when this was written. She has a passion for acute care and hopes to be working in an acute care setting soon!

References

Aucella, F., Gesuete, A., & Battaglia, Y. (2014). A “nephrological” approach to physical activity. Kidney & Blood Pressure Research39(2-3), 189-196. doi:10.1159/000355796

Smith-Gabai, H. (ed.) (2011). Occupational Therapy in Acute Care. Rockville, MD:  American Occupational Therapy Association.

Toonstra, A., Zanni, J. M., Sperati, C. J., Nelliot, A., Mantheiy, E., Skinner, E. H., & Needham, D. M. (2016).  Feasibility and safety of physical therapy during continous renal replacement therapy in the intensive care unit.  Annals of the ATS, 13(5), 699-704.

 

2 comments on “Renal failure, dialysis, and OT in acute care”

  1. Excellent article – just what I need! The language is comprehensible but not reivialisinf – just the right level and volune to avoid swanoinf and inevitable ’switch-off’. Well done and keep up the brilliant work!

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