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?
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).
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.
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).
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.
- Every little bit helps!
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!
Aucella, F., Gesuete, A., & Battaglia, Y. (2014). A “nephrological” approach to physical activity. Kidney & Blood Pressure Research, 39(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.