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Aubreyann Veyveris Nutr.

409 4 November 2013 Case Study #18- Chronic Kidney Disease Treated with Dialysis 1. Physiological functions of the kidneys include the removal of organic wastes from the body via excretion, homeostatic regulation of blood volume and blood pressure, regulating plasma concentrations of sodium, potassium, chloride and other ions, stabilizing blood pH by controlling the loss of hydrogen and bicarbonate ions, assisting the liver in detoxifying poisons, and producing enzymes and hormones. 2. Some diseases and conditions that can lead to CKD are diabetes, high blood pressure, cardiovascular disease, congestive heart failure, lung disease, peripheral vascular disease, neurological problems, and malnutrition. Diabetes causes high blood sugar, which can damage small blood vessels, including the blood vessels in your kidneys that are used to help your kidney function properly. Diabetes can also damage nerves in your body and affect the functions of the kidney. 3. Stages of CKD- Stage 1= kidney damage with normal or increased GFR. Stage 2- mild kidney damage with a GFR of 60-89 mL/min/1.73 m2 with evidence of structural abnormal kidneys such as reflux nephropathy or renal dysgenesis. Stage 3- more kidney damage than stage 2 with a GFR of 45-59 (3A) or 30-44 (3B). Creatinine and GFR in patients are usually quite stable. Identify individuals at risk of progressive renal disease, and reduce associated like risk of cardiovascular events and death by the presence of CKD. Some patients need further investigation where there are indications that progression to end stage renal failure may be likely. Pointers to progression of renal disease are proteinuria and haematuria. Stage 4 CKD is severely reduced kidney function, GFR 15-29ml/min/1.73m2. Stage 5 CKD is very severely reduced kidney function endstage or ESRF/ESRD, GFR less than 15 ml/min and the kidney is basically shutting down and either dialysis or kidney transplantation needs to be done or death will occur. 5. Stage 5 CKD treatment options include dialysis or kidney transplantation. Hemodialysis occurs in a dialysis center with a permanent access site in the forearm for the blood to pass through. Peritoneal Dialysis is usually done at home with a catheter and is continuously done throughout the day. 6. 35 kcal/kg- Provide adequate nutrients to the body, prevent malnutrition 1.2 g PRO/kg- Increased needs because of need to maintain a positive nitrogen balance and to prevent malnourishment 2 g K- prevent hyperkalemia 1 g Phosphorus- prevent hyperphosphatemia

2 g Na- prevent too much fluid retention 1000 mL fluid + urine output- to help control edema, prevent fluid overload that can cause shortness of breath, congested heart failure, and hypertension 7. 50 170 lbs 77.1 kg 152.4 cm 77.1/ 1.522 = 33. 4 kg/m2 According to the BMI she is obese but this number could be slightly altered based on the fact that she has edema. It should really be lower. 8. Edema- free weight is the weight of a patient with added weight for retained fluids, but the weight of the fluids is factored out of the total body weight. Mrs. Joaquins edema- free weight is aBWef=165+[(65-165)x 0.25] =165 + [(-100) x 0.25] =165 +(-25) =140 lbs or 63.6 kg

12. Predialysis- 0.6- 1.0 g/ kg IBW, Hemodialysis- 1.2 g/kg IBW, Peritoneal Dialysis- 1.2-1.5 g/kg IBW 13. Mrs. Joaquin has a phosphorus restriction because serum phosphorus levels elevate at the same rate as GFR decreases. Phosphorus reduction can help delay hyperparathyroidism and bone disease. Foods high in phosphorus include cheese, fish (salmon), pork, beef, low-fat dairy, beans and lentils. 14. Foods are considered fluids when they are liquid at room temperature. Yes she is on a fluid restriction diet. In order to help reduce her thirst she can limit her salt intake, suck on a few ice chips, eat cold sliced fruit, or use artificial saliva. 15. Glomerular Filtration Rate is a calculation that determines how well the blood is filtered by the kidneys. A normal GFR is anything over 60 mL/min and anything less is an indication of kidney disease and the lower the number the worse the disease. Mrs. Joaquin has a GFR of 28 mL/min, which means she has moderate to severe kidney disease and her kidney function is limited. 16. The labs that support the diagnosis of Stage 5 CKD are her sodium levels being low and her potassium levels being high. She has high BUN, creatinine, glucose, and phosphate lab values. She also has a high amount of protein and WBCs in her urine and the pH is higher than normal.

18. Capoten/Captopril- treats hypertension and congestive heart failure. Nutritional concernsavoid salt substitutes, alcohol, caffeine, arginine, lots of different herbs. Erythropoietin- hormone that stimulates the production of RBC in bone marrow. Nutritional concerns- adequate iron and protein intake and b12 and folate supplementation Sodium Bicarbonate- antacid that relieves heart burn and acid indigestion. Nutritional concernsdo not use on a salt restricted diet, decrease the effectiveness of certain drugs that require stomach acid to work Renal caps- combination of B vitamins to treat or prevent vitamin deficiency. NC- falsely alter lab results, may interact with other medications Renvela- lowers the level of phosphorus. NC- do not take with alcohol, interacts with many other drugs, can cause N/V, loss of appetite, and stomach pain Hectorol- used for the treatment of hyperparathyroidism. NC- drug works most effectively on a low phosphate diet Glucophage- used to treat Type II Diabetes. NC- mild nausea, vomiting, diarrhea, given with meals 19. Health problems that have been identified in the Pima Indians include diabetes, hypertension, and high rates of obesity. The thrifty gene theory states that for thousands of years populations who relied on farming, hunting and fishing for food, such as the Pima Indians, experienced alternating periods of feast and famine. To adapt to these extreme changes in caloric needs, these people developed a thrifty gene that allowed them to store fat during times of plenty so that they would not starve during times of famine. Yes they are at higher risk for complications of diabetes because they are less likely to take action and correctly treat their diabetes, so their conditions worsen. 22. To allow for optimal protein use, 50% of protein should come from sources that have a high biological value or complete protein foods such as animal protein because they can be absorbed better by the body and CKD patients require more protein than normal so it is important that all protein consumed be easily absorbed by the body.