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Ilyn Mendoza

NUTR 409
September 14, 2014

Case Study #18: Chronic Kidney Disease Treated with Dialysis

1. The physiological function of the kidneys is to maintain fluid, electrolyte and solute balance
while filtering blood and producing ultrafiltrate (which is a substance that is eventually
converted to urine). Other functions of the kidneys include controlling blood pressure,
eliminating waste, producing EPO and regulating water homeostasis.

2. Two diseases and conditions that can lead to chronic kidney disease are diabetes and
hypertension. Diabetes (which is the leading risk factor for chronic kidney disease) is related to
CKD because when one is diabetic, blood glucose levels are higher. Elevated blood glucose
levels will cause the kidneys to filter more, which can eventually overwork the kidneys and can
result in chronic kidney disease if the diabetes is not properly monitored or .

3. There are five stages of chronic kidney disease. Stage 1 of CKD is described as kidney
damage with normal to increased kidney function and an eGFR (estimated glomerular filtration
rate) of 90-130 mL/min. Stage 2 of CKD is described as mild decrease in kidney function with
an eGFR of 60-89 mL/min. Stage 3 of CKD is a moderate decrease in kidney function with an
eGFR of 30-59 mL/min. Stage 4 of CKD is a severe decrease in kidney function with an eGFR
of 15-29 mL/min. Stage 5 of CKD, or end-stage renal disease, is kidney failure with necessary
treatment and a eGFR of less than 15 mL/min. Since CKD is a slow and progressive disease, the
more severe signs and symptoms usually take time to show up and when they do, they will show
up during the later stages of CKD. Signs and symptoms include poor appetite, swollen ankles
and feet, puffy eyes, frequent urination, and high blood pressure.

5. Treatment options for Stage 5 CKD include dialysis or transplantation. Hemodialysis requires
access to the blood stream (typically in the arm), a dialysis machine and an artificial kidney. The
process takes 3-5 hours and is done three times a week. Peritoneal dialysis requires access to

blood vessels in the peritoneal membrane of the abdominal cavity and is done 4-5 times in a 24hour period.

6. 35 kcal/kg (increased kcal) is the required amount of kcals needed for Mrs. Joaquin to allow
protein synthesis and to spare protein for tissue. 1.2 g protein/kg (increased protein) is needed
because dialysis can delete protein from the patients body. 2 g K (decreased potassium) is
needed to control edema and electrolyte balance. 1 g phosphorus (decreased phosphorus) is
needed to prevent the development of renal osteodystrophy. 2 g Na (decreased sodium) is
required in order to control edema and electrolyte balnce. Finally, 1000 mL fluid + urine output
(decreased output) is necessary to control edema.
7. Mrs. Joaquins height and weight: 50, 170 #

60 in x 2.54 cm = 152.4 cm 1.524 m

170# / 2.205# = 77.10 kg

BMI = kg/m2

77.10 kg / 1.542m2
33.19 BMI, Obese.
Edema is capable of affecting BMI since extra weight from excess fluid held in the body
can cause a patients BMI to be higher than it is supposed to be.

8. Edema-free weight is the patients weight excluding weight that may be caused by edema.

Edema-free weight = Body weight + [(Standard Body Weight Body Weight) x 0.25]
= 170# + [(100# - 170#) x 0.25]
152.5 #

12. Patients undergoing predialysis have a protein requirement of 1.2-1.5 g/kg bodyweight with
50% HBV protein. Hemodialysis patients need 1.2 g protein/kg bodyweight. Patients undergoing
peritoneal dialysis need 1-1.2 gprotein/kg bodyweight.

13. Mrs. Joaquin needs to be on a phosphorus restriction because with CKD, a decreased
glomerular filtration rate results in phosphorus retention in plasma. Foods that are high in
phosphorus are also high in protein (such as meats, dairy, nuts, legumes, and processed foods),
so patients need to make sure that they monitor the types of protein they are consuming.

14. Fluid foods include soups and popsicles. Recommendations for Mrs. Joaquin would be to
decrease the amounts of fluid foods; If thirsty, Mrs. Joaquin can decrease her thirst by sucking on
ice chips or cold sliced fruits.

15. Glomerular filtration rate (GFR) measures the rate of waste filtration in the kidneys. While
the normal range for GFR is greater than 90 mL/min, Mrs. Joaquins GFR is 28 mL/min. This
means that she is at the later stages of CKD since her GFR is very low.
16. Mrs. Joaquins low sodium (130 mEq/L), high potassium (5.8 mEq/L), high phosphorous
(9.5 mEq/L), high BUN (69 mg/dL) and high creatinine (12 mg/dL) are all indicators of an
overly stressed kidney due to its inability to properly filter out. Additionally, Mrs. Joaquins high
glucose (280 mEq/L) indicates that her T2DM is the cause of her CKD.

18.

Capoten/captopril: Treats kidney disease caused by diabetes.


Nutritional concerns include an increased potassium and decreased sodium.

Erythropoietin: Helps treat anemia related to kidney failure.


Nutritional concerns include a high iron and heart healthy diet.

Sodium bicarbonate: Helps reduce acidity in the blood and urine.


Nutritional concerns include high sodium levels.

Renal caps: Helps provide water soluble vitamins to kidney failure patients.
Nutritional concerns include the maintenance of a generally healthy diet.

Renvela: Helps decrease phosphorous levels in CKD patients.


Nutritional concerns include a low phosphorus diet.

Hectorol: Helps decrease parathyroid hormone levels.


Nutritional concerns include a low phosphorous diet.

Glucophage: Helps control blood glucose levels.


Nutritional concerns include the maintenance of a generally healthy diet with the addition
of exercise.

19. According to the National Institute of Diabetes and Digestive and Kidney Diseases, 50% of
Pima Indians have diabetes and 95% of those with diabetes are overweight or obese. The thrifty
gene is a theory that many Pima Indians are overweight, obese, and have diabetes because hey
are genetically predisposed to store more fat than others. As a result, Pima Indians are at a higher
risk for diabetes complications, especially if proper measures arent taken to control the diabetes.

22. It is recommended for CKD patients to have at least 50% of their protein from high
biological value sources in order to ensure that they are consuming enough essential amino acids.