Chapter 63: Concepts of Care for Patients With Acute Kidney Injury and Chronic Kidney Disease

Acute kidney injury represents a sudden decline in kidney filtration capacity that may be reversible with appropriate intervention, while chronic kidney disease involves progressive and irreversible loss of renal function staged from mild impairment through end-stage kidney disease. The chapter establishes that chronic kidney disease progresses through five clinical stages, with stage five representing complete kidney failure requiring renal replacement therapy. Understanding the pathophysiology of fluid and electrolyte imbalances is essential, as retained fluids and electrolytes create systemic complications including hypertension, cardiac dysfunction, and pulmonary edema. The syndrome of uremia encompasses the constellation of clinical manifestations resulting from accumulated uremic toxins, presenting with symptoms such as pruritus, gastrointestinal disturbance, fatigue, and altered mental status. Long-term consequences of chronic kidney disease include renal osteodystrophy, a metabolic bone disease developing from calcium and phosphorus dysregulation, which increases fracture risk and necessitates fall prevention protocols. The chapter details renal replacement therapy modalities including hemodialysis and peritoneal dialysis, addressing critical nursing competencies in vascular access management, anticoagulation protocols, infection prevention through sterile technique, and hemodynamic monitoring. Patient education encompasses daily weight monitoring as an indicator of fluid status, blood pressure management to slow disease progression, dietary modifications including protein restriction in advanced disease stages, phosphorus and potassium limitation, and protective skin care measures to prevent pressure injuries and infection. Nursing interventions focus on preventing complications, supporting medication adherence, facilitating interdisciplinary care coordination, and promoting patient adaptation to lifestyle changes and potential renal transplantation or permanent dialysis therapy.