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It is essential that you target the suggested guidelines (see: Am H Assoc plus Brit Hyper Soc) of <140/80 in diabetics. HD patients have a similar increased risk of cardiovascular disease to diabetics; hence, 140/80 is an appropriate target P/B. Guidelines for achieving B/P control in HD – ü Have a target weight, then aim to bring your patient to their dry weight by bring their weight down slowly over several dialyses, (e.g., 0.5 – 1 kg/week). ü Minimize symptomatic hypotensive episodes so patients will tolerate weight reduction; also possibly minimize the use of anti-hypertensive drugs, as these may contribute to hypotension on dialysis. ü Educate your patients about the importance of B/P control management. Encourage your patients to restrict weight gains between dialyses to < 2 kg by limiting salt and water intake. ü ACE inhibitors and angiotensin II blockers both can cause dramatic hypotension with volume depletion. Anaphylactic reactions can also occur when ACE inhibitors are used in patients dialyzing on polyacryonitrile (PAN) membranes. These drugs must be used with great care, only when B/P control cannot be achieved by any other means. Conclusion - All nursing staff including the NP should pay close attention to the B/P, fundoscopy findings, and precordial examination. In addition, examine the abdomen for bruits and palpable renal masses. Also, important would be the visual extremity examination for edema, and the probability of neurologic presences of asterixis (i.e., muscle weakness and/or tremor of the wrist when extended). It is essential and through evidence-based investigation that the nursing teams work together, to slow down the progression of chronic renal disease (CRD) only complicated through abnormal metabolic syndrome X.
Short Bio of Dr. Gary D. Goldberg, PhD
Over 30 years experience in the Medical field, At UCLA and Pacific Hospital of the Valley, as a Chief Technologist and Analyst, Visiting Professor and Instructor for continuing education at UCLA School of Nursing and Writer/Speaker at the School of Medicine from 1995-2008. From 2003-2008 Dr. Goldberg has collaborated and published through Blackwell Publishing Co. (Medical Division), and Journal of American College of Cardiology plus 15, published abstracts through UCLA Dept. of Internal Medicine and the Dept. of Cardiology. Current title: Clinical Professor of Medical Education with Angeles College of Nursing, in Los Angeles, CA. Funded through the State Dept. of California for Continuing Nursing Education. Dr. Goldberg has written two major academic course textbooks for Angele College of Nursing and has represented advanced nursing education course curriculum approved by the ANA for CEU(s) and the AMA CMU Level 1 Credit for physicians. To reach Dr. Gary D. Goldberg, for comments and/or consultation, please use e-mail address: g.goldberg@live.com or cell phone contact: 818-610-9017. [1] U.S. Renal Data System. USRDS 2010, Annual Data Report. Atlas of end-stage renal disease in the United States. Bethesda MD: National Institute of Health, National Institute of Diabetes and Digestive and Kidney Diseases; 2007. Available from URL: http://www.usrds.org/atlas 2010.htm. [2] Schrier RW, Masoum A, Elhassan E. Clin J Am Soc Nephrol (Jun) 5: 1132-1140, 2010 [3] _____et al: Acute renal failure, in Brenner and Rector’s The Kidney, 6th ed., BM Brenner (ed). Philadelphia, Saunders, 2000, pp.1201-1262. Also, see: Xue JL, Ma JZ, Louis TA, Collins AJ. Forecast of the number of patients with end-stage renal disease in the United States to year 2010. J Am Soc Nephrol (2004) 2:1012-1016 revised March 15, 2004. [4] Star RA: Treatment of acute renal failure. Kidney Int (54): 1817, 1998 review. Cited again in 2000 ed. Management of Ischemic and Nephrotoxic Acute Renal Failure. Brenner and Rector’s The Kidney, 6th ed. Philadelphia, Saunders, 2000. pp 1201-1210. [5] Thadhani R et al: Acute renal failure. N Engl J Med (334): 1448, 1996. [6] Kaplan N: Systemic hypertension: Mechanisms and diagnosis, in Heart Disease, 6th ed. E. Braunwald et al (eds.). Philadelphia, WB Saunders, 2001.
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