S T.

PAU L U N I V E R S I T Y I L O I L O

Kidney
Kidney Service
Service
Unit
Unit

PRESENTED BY:

LAGAMO | MALAYAN | MARTINEZ | PALMARES

 Kidney Service Unit
St. Paul’s Hospital Iloilo has a dedicated Kidney Center—its KSU—that
provides comprehensive renal care, including nephrology, dialysis, and
kidney transplantation services. It's the first and only facility outside Metro
Manila in the region accredited to perform kidney transplants and offers the
most extensive hospital-based kidney services in Iloilo.

Core Services:
✓ Hemodialysis and Peritoneal Dialysis
✓ Kidney transplantation (first private hospital regionally to offer this)
✓ Nephrology consultations, renal biopsies, and general renal disease
management
✓ Part of the St. Paul Integrated Centre of Expertise (SPICE), connecting kidney
care with related specialties like urology
 THE KIDNEY SERVICE UNIT TEAM
Doctors: Head Nurse: Clerks:
1. Dr. Hazel Oro 1. Dorothy Moneva

2. Dr. Marie Hazel Ivy Mueño 2. Jodie Lyn Malifero

Michelle Zamora, R.N.
3. Dr. Ethel Cordero 3. Shane Efundo

4. Dr. Annia Rae Ni colasora

5. Dr. Josefa Belita

Staff Nurses: Charge Nurses: Nursing Aides:

1. Marian Beth Antonino, R.N. 1. Honey Hope Ceralbo, R.N. 1. Mico Gen Gustilo

2. Pamela Reign Lucas, R.N. 2. Retchel Losaria, R.N. 2. Rosmar Marañon

3. Meryl Beñabon, R.N. 3. Lara Mae Abadillo, R.N. 3. Jerriel Marie Bordon

4. Adam Groune, R.N. 4. Manilyn Mondejar, R.N. 4. Keziah Espina

5. Dianne Therese Suresca, R.N. 5. Karren Faith Canja, R.N. 5. Genie Marie Tabiosas

6. Fatima Jawad, R.N.

7. Ryssa Marie Pelobello, R.N.

8. Kristel Ann Coo, R.N. Renal Technicians: Orderly:

9. Marine Jeil Barro, R.N.

10. German Jr. Memorial, R.N. 1. Ryan Canaya

1. Nelmar Toria

2. Paul Eric Laguna 2. Evon Rey Abutal

 Hemodialysis
Machine

Automated Continuous Ambulatory

Peritoneal Dialysis Peritoneal Dialysis
 Abbreviations & Terms
Abbreviation Meaning Abbreviation Meaning Abbreviation Meaning

AP Arterial Pressure AKI Acute Kidney Injury SC Subcutaneous

VP Venous Pressure HTN Hypertension IJ Intrajugular

TMP Transmembrane Pressure DM Diabetes Mellitus UF Goal Ultrafiltration Goal

BFR Blood Flow Rate Hgb/Hct Hemoglobin/Hematocrit C&S Culture & Sensitivity

DFR Dialysate Flow Rate BUN Blood Urea Nitrogen eGFR Estimated Glomerular Filtration Rate

UFR Ultrafiltration Rate Cr Creatinine CBG Capillary Blood Glucose

Heparin Anticoagulant AVF Arteriovenous Fistula EPO Epoetin Alfa (e.g., Eposino, Recormon)

CKD Chronic Kidney Disease AVG Arteriovenous Graft OPD Out-Patient Department

ESRD End Stage Renal Disease CVC Central Venous Catheter KSU Kidney Service Unit
Hemodialysis vs Peritoneal Dialysis

Hemodialysis is a treatment that filters blood using a

machine outside the body, typically done in a dialysis
center or hospital three times a week. It requires access
through a fistula, graft, or catheter. While effective, it
may cause low blood pressure, cramps, and fatigue.
Peritoneal Dialysis uses the lining of the abdomen to
clean the blood inside the body. It’s usually done at home
either manually (CAPD) or with a machine at night (APD). It
offers more flexibility but carries risks like peritonitis,
bloating, and weight gain.
 Aspect Hemodialysis (HD) Peritoneal Dialysis (PD)

A treatment for kidney failure that removes waste, fluids, and chemicals A treatment that uses the lining of the abdomen (peritoneum) to remove
Definition
from the blood when kidneys can no longer do so. waste and fluid from the blood.

Usually in dialysis centers or hospitals; can also be done at home with

Where it’s done? Mainly at home, can also be done at work, school, or while traveling.
training.

Access Site Arteriovenous fistula (AVF), graft, or central venous catheter. A soft catheter is placed in the abdomen to fill and drain dialysate.

Blood is drawn through a needle, cleaned in a dialyzer, and returned to CAPD (Continuous Ambulatory Peritoneal Dialysis)
Process
the body. APD (Automated Peritoneal Dialysis)

Frequency 3 times/week, ~4 hours/session Daily: CAPD ~4x/day, APD nightly

Equipment Needed Dialysis machine, dialyzer Dialysate, catheter, manual or automated cycler

Low blood pressure (hypotension)

Peritonitis (abdominal infection)
Muscle cramps
Catheter site infection
Fatigue
Bloating or abdominal discomfort
Side Effects Nausea, headache
Weight gain (from glucose in dialysate)
Itchy skin
Hernia risk
Infection or clotting at access site
Incomplete waste removal if exchanges aren’t done properly
Dizziness after treatment
Hemodialysis PROS & CONS + COST
HEMODIALYSIS

ADVANTAGES DISADVANTAGES COST

Requires frequent travel to a clinic.

A single session can cost Php 2,000 to
Medical staff supervise treatments in a Less flexible treatment times.
Php 7,000 or more.
clinic. Strict diet and fluid restrictions.
PhilHealth covers up to Php 6,350 per
Fixed schedule 2-3 times a week, Can cause side effects like fatigue, low
session, for up to 156 sessions annually
predictable. blood pressure.
(nearly Php 1 million).
No need to store equipment at home. Needs a surgical access point (fistula,
Some out-of-pocket costs and
Opportunity for social interaction. graft, or catheter) with infection risks.
professional fees may apply.
Needles inserted at each session.
PERITONEAL dialysis PROS & CONS + COST
PERITONEAL DIALYSIS

ADVANTAGES DISADVANTAGES COST

Requires daily exchanges.

Can be done at home, work, or while A catheter is permanently in the
traveling, offering flexibility. abdomen. PhilHealth's Z Benefit package covers
Fewer strict diet and fluid restrictions. Risk of peritonitis (abdominal infection), adult patients for Php 389,640 to Php
No needles for daily treatments once a serious complication. 510,140 annually.
catheter is placed. Requires significant storage space for For children, coverage ranges from Php
May help preserve remaining kidney supplies at home. 510,000 to Php 1.2 million, depending on
function longer. Potential for weight gain from absorbed the type of PD.
Gentler on the heart due to continuous sugar in the solution. This package generally includes solutions,
process. Risk of hernias. supplies, professional fees, infection care,
Flexible schedule (manual or automated Effectiveness might decrease over time. catheter insertion, and related tests/drugs.
overnight). Requires thorough training for patient or
caregiver.
Pre-Procedural Essentials for Hemodialysis
Why
Why are
are these
these procedures
procedures essential?
essential?

Removes waste, toxins, and excess fluids that the kidneys can no longer filter

Helps maintain electrolyte and acid-base balance

Prevents life-threatening complications like fluid overload, high potassium, and

uremia

Improves quality of life and extends survival in end-stage renal disease (ESRD)

What
What are
are some
some preparations
preparations done
done prior
prior to
to the
the What
What are
are some
some special
special considerations?
considerations?
procedure?
procedure?
Monitor for hypotension during and after the
Check vital signs (BP, HR, temp, RR)
procedure

Weigh the patient to assess fluid removal goal

Do not use or take BP on the arm with a fistula or graft

Inspect the access site (fistula/graft/catheter)

Maintain aseptic technique to prevent infection

for signs of infection or malfunction Assess for bruit and thrill at the access site (to

Withhold certain medications that may lower BP confirm patency)

Watch for signs of complications: dizziness, cramping,

or be dialyzed out (e.g., antihypertensives)

bleeding, or clotting
Ensure adequate hydration unless restricted
Provide psychosocial support, especially for long-

Educate the patient and confirm consent

term patients
 Pre-Procedural Essentials for
Peritoneal Dialysis
Why
Why are
are these
these procedures
procedures essential?
essential?

Removing waste, excess fluids, and toxins using the peritoneal membrane

Offering a home-based, flexible alternative to hemodialysis

Allowing better blood pressure control and gentler fluid shifts

Supporting independence and improved lifestyle for many patients

What
What are
are some
some preparations
preparations done
done prior
prior to
to the
the What
What are
are some
some special
special considerations?
considerations?
procedure?
procedure?
Strict aseptic technique is critical to prevent
Ensure the peritoneal catheter is properly placed and

peritonitis
healed before starting

Monitor for signs of infection: cloudy effluent,

Educate the patient on sterile technique to prevent

fever, abdominal pain

infection

Assess for leakage, hernias, or bloating

Prepare a clean and safe environment at home for

Track daily weights and fluid balance

exchanges

Encourage dietary compliance (especially sodium,

Review dialysate types and storage

Check vital signs and weight to monitor fluid status fluid, and protein)

Ensure the patient or caregiver is trained and confident Support emotional readiness for self-care or long-

in performing the procedure term home management

 hemodialysis flow of procedure
Before
Before the
the Procedure
Procedure

1. Patient arrives at the Kidney Center.

2. Receptionist will prepare the charge slip of the patients. During

During the
the Procedure
Procedure
3. Triage nursing aide/nurse will check patients’ vital signs

1. the nurse will prepare the dialysis machine and

and distribute the charge slip, assist in signing of

connect the patient to the machine via the

consent and weigh the patients.

arteriovenous fistula, graft, or catheter.

4. Folks/Patient will proceed to the SPICE cashier for

2. blood will be pumped from the patient's body through

payment.

5. ONCE PAID, present the official receipt to the

the dialyzer (artificial kidney) where waste products

receptionist/nurse/nursing aide. and excess fluids are removed.

6. Dialysis nurse will call the patient in first come first 3. cleaned blood will be returned to the patient's body.

serve basis once the machine is ready. 4. the nurse will monitor the patient's vital signs (blood

7. Triage nurse will assist the patient to proceed to the pressure, heart rate, oxygen saturation) and the

designated machine to be catered. dialysis machine parameters throughout the

procedure.

After
After the
the Procedure
Procedure 5. the nurse will address any complications or

discomforts the patient may experience during the

1. The nurse will assist the patient in termination.

dialysis session.

2. The nurse will get the vital signs of the patient and
6. the dialysis session will continue for a prescribed

inject the Eposino/Recormon.

duration, typically 4 hours, depending on the

3. Folks or patient goes to the reception area for

patient's needs.

scheduling of next hemodialysis session.

4. The nursing aide will assist weigh the patient post

dialysis.
 peritoneal dialysis flow of procedure
Before
Before the
the Procedure
Procedure

1. Patient empties bladder and bowels if needed, then

washes hands thoroughly.

2. Gather all necessary supplies: PD solution bags,

During
During the
the Procedure
Procedure
transfer set, mask, sterile gloves, antiseptic, and

prepare a clean workspace. 1. Connect the transfer set to the peritoneal catheter.

3. Wash hands again and put on a mask. 2. Drain the old dialysis solution from the belly into a

4. Set up a clean, dry, well-lit area for the procedure. drainage bag.

5. If instructed, warm the PD solution to body temperature. 3. (Optional) Briefly flush with a small amount of new

6. Check solution bags for leaks, cloudiness, or expiry

solution and drain it.

date.
4. Infuse the fresh dialysis solution from the bag into

the belly.

5. Allow the new solution to "dwell" in the belly for the

After
After the
the Procedure
Procedure
prescribed time.

6. Disconnect the empty solution bag and cap the

1. Dispose of used solution bags and supplies properly.

catheter.
2. Observe the drained solution for clarity, color, and

volume; report any issues.

3. Record details of the exchange (time, volumes,

observations).

4. Perform catheter site care as instructed.

5. Prepare for the next scheduled exchange.

MEDICATIONS
Heparin
DRUG CLASS: ANti-coagulant

Indication mechanism of action contraindication side/adverse effects nursing responsibilities

Used to prevent blood Enhances the activity of - Active bleeding (e.g., - Bleeding or bruising - Monitor for signs of
clots during hemodialysis antithrombin III, which GI bleed) - Low platelet count (HIT) bleeding (gums, stool,
by keeping the blood inactivates clotting - Severe low platelet - Allergic reactions urine)
from clotting in the factors like thrombin and count - Osteoporosis (with long- - Check platelet count
dialysis circuit. factor Xa, slowing down (thrombocytopenia) term use) regularly
the clotting process. - History of heparin- - Elevated liver enzymes - Ensure correct dosing
induced during dialysis (bolus or
thrombocytopenia (HIT) continuous)
- Hypersensitivity to - Watch for signs of HIT
heparin (drop in platelets, new
clots)
- Educate patient to
report unusual bleeding
or bruising
Eposino (epoetin alfa)
Drug class: Hematopoietic agent

Indication mechanism of action contraindication side/adverse effects nursing responsibilities

Treatment of anemia Stimulates - Uncontrolled - Hypertension - Monitor hemoglobin

associated with chronic erythropoiesis by acting hypertension - Thromboembolic events (Hgb) levels (do not
kidney disease (CKD), on erythroid progenitor - Hypersensitivity to - Seizures exceed 11 g/dL)
especially in hemodialysis cells in bone marrow, epoetin alfa or albumin - Pure red cell aplasia - Monitor blood
patients. mimicking the action of - Pure red cell aplasia - Headache pressure regularly
endogenous after prior use - Injection site reactions - Assess for signs of
erythropoietin. thrombosis
- Educate patient on
purpose and potential
side effects
RENOGEN
Drug class: Erythropoiesis-Stimulating Agent (ESA)

Indication mechanism of action contraindication side/adverse effects nursing responsibilities

Used to treat anemia Stimulates the bone - Uncontrolled - Hypertension - Monitor hemoglobin
associated with chronic marrow to produce red hypertension - Headache, joint or muscle levels regularly
kidney disease (CKD) in blood cells by mimicking - Known hypersensitivity pain - Monitor BP before and
dialysis and non-dialysis erythropoietin, a to erythropoietin - Thromboembolic events during therapy
patients. hormone normally products (e.g., stroke, DVT) - Assess for signs of
produced by the kidneys. - Iron deficiency if not thrombosis
supplemented - Ensure adequate iron
- Rare: seizures, allergic stores
reactions - Administer after
dialysis (if applicable)
- Educate patient about
the purpose of the drug
and potential side
effects
- Rotate injection sites if
given subcutaneously
GENTAMICIN
Drug class: Aminoglycoside Antibiotic

Indication mechanism of action contraindication side/adverse effects nursing responsibilities

Used to treat gram- Inhibits bacterial protein - Hypersensitivity to - Nephrotoxicity (kidney - Monitor drug levels to
negative bacterial synthesis by binding to aminoglycosides damage) prevent toxicity
infections, often in the 30S ribosomal - Pre-existing hearing - Ototoxicity (hearing or - Monitor renal function
dialysis patients with subunit, leading to loss balance issues) (BUN, creatinine)
catheter-related bacterial cell death. - Severe kidney - Dizziness, rash - Assess
infections or sepsis. impairment without - Neuromuscular blockade hearing/balance
monitoring (rare) regularly
- Administer after
dialysis to avoid drug
removal
- Watch for signs of
toxicity: tinnitus,
decreased urine output
 Laboratories
Tests Normal Value Indications

Serum Creatinine 0.6 - 1.2 mg/dL A key indicator of kidney function.

Blood Urea Nitrogen (BUN) 7 - 20 mg/dL Measures the amount of urea nitrogen in the blood.

Estimated Glomerular Filtration Rate

>90 mL/min/1.73 m² Measures the kidneys’ ability to filter toxins from the blood.
(eGFR)

Electrolytes
Sodium 135 - 145 mEq/L Fluid balance, blood pressure, and nerve function.
Potassium 3.5 - 5.0 mEq/L Nerve and muscle function, especially heart rhythm.
Phosphorus 2.5 - 4.5 mg/dL Bone health and mineral metabolism.

Bicarbonate (HCO₃⁻) 22 - 29 mEq/L Assess the body's acid-base balance and electrolyte levels.

Complete Blood Count

Hemoglobin F: 12.0 - 15.5 g/dL; M: 13.5 - 17.5 mg/dL Level of oxygen-carrying red blood cells.
Hematocrit F: 36 - 48%; M: 40 - 54% Percentage of RBCs in the blood.
WBC 4,500 - 11,000/mm³ Body’s ability to fight infection.
Platelets 150,000 - 450,000/mm³ Ability to form blood clots.
 Health Teachings
D Diet Control (low sodium, potassium, & phosphorus)

I Infection Prevention

A Access Site Care

L Limit Fluids

Y “Your Meds” (take it properly)

S Schedule Adherence

I Identify Warning Signs

S Support System & Self-Care

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S T. PAU L U N I V E R S I T Y I L O I L O

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You!