Page 403 - Critical Care Nursing Demystified

388 CRITICAL CARE NURSING DeMYSTIFIED

Chronic Renal Failure (CRF)

What Went Wrong?
5 Chronic renal failure (CRF) is a progressively worsening, irreversible loss of
kidney function. Although CRF is irreversible, it can be slowed by medications
and diet. In CRF, the kidneys lose their ability to maintain homeostasis with
fluid balance and waste accumulation leading to end-stage renal disease (ESRD)
and the need for dialysis. CRF is identified by glomerular filtration rate (GFR)
and is divided into three stages: reduced renal reserve, renal insufficiency, and
end-stage renal disease (ESRD; see Table 8–8).
CRF can be caused by all the processes outlined for ARF; however, the
patients with the highest risk of developing CRF are those with diabetes mel-
litus (DM). Around 30% of patients treated with dialysis have DM. The second
largest group is patients with hypertension.

Prognosis
The prognosis for patients with CRF provides hope. There are almost a half
million patients in the United States being treated for CRF. Well more than half
are maintained on hemodialysis and the next largest number, around 28%, have Downloaded by [ Faculty of Nursing, Chiangmai University 5.62.158.117] at [07/18/16]. Copyright © McGraw-Hill Global Education Holdings, LLC. Not to be redistributed or modified in any way without permission.
received kidney transplants. Five percent are treated with PD. The cause of
death in most CRF patients is cardiovascular disease.

2 TABLE 8–8 Stages of CRF
Stages GFR Signs/Symptoms
Reduced renal 40%–70% decrease in GFR Asymptomatic; observe BUN,
reserve creatinine, and GFR
Renal insufficiency 75% decrease in GFR BUN, creatinine elevated
Anemia
Electrolyte imbalances
Nocturia; polyuria (with
inability to concentrate
urine)
End-stage renal 90% reduction in GFR Oliguria <500 mL/day
disease (ESRD)
Uremic toxins (uremia)
elevate, creating severe fluid
and electrolyte imbalances in
all body systems