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CHRONIC KIDNEY DISEASE

WITH HEMODIALYSIS
Danielle Vivarttas-Ahrnsbrak & Rosae Calvo
FSHN468: Case Study
02-20-2014

PT HISTORY

22YOM Malaysian
college student
PMHx:
Mild

HF (chest x-ray)

HTN
CAPD

x 3-mon

HPI:
CAPD

non-compliance

N/V
HF

d/t fluid overload


HD 3x/wk

ASSESSMENT

Anthro

On

admissionN/V, HF
During admission
frequent PDHD 3x/wk,
urine output<200ml/24
hrs

Ht

69 Wt 170-lb
106%IBW 110%UBW 15-lb
gain in 6 mon, BMI 25.1
kg/m2

Biochemical
Lytes,

Ca WNL
CO2 22mEq/L (Low)
Phos 8.4 mg/dL (High)
Alb 3.5 g/dL (Lownormal)
Hgb 9.3 g/dL, Hct 28%,
Ferritin 185 ng/dL (Low)

Clinical

Diet
Refined

CHO, Tea/Soda,
salty/sweet snacks
2493 kcal 110g pro (18%)
98g fat (35%) 303g CHO
(48%)
3.8g K, 1.6g Na, 1.2g
Phos, 14mg Fe
Fluid intake = 1680mL

ESTIMATION OF NEEDS

Energy
2460

kcal (35 kcal/kg UBW)


2540 kcal (35 kcal/kg IBW)
~2500 kcal/d (32 kcal/kg)

Protein
93g

15% total kcal

87g

(1.2 g/kg CBW)


(1.2 g/kg IBW)

14% total kcal

~90g

(1.2 g/kg)

14% total kcal

Fluid
950mL/d

(750mL + urine output)


1200 mL/d (1000mL + urine output)
1200mL/d (16 mL/kg)

CHRONIC KIDNEY DISEASE

NUTRITION PLAN

Dx
NI

3.2 Excessive fluid intake r/t CKD aeb HF and


fluid intake (1680mL) greater than estimated
needs (1200mL).
NB 1.1 Food and nutrition-related knowledge
deficit r/t new start HD aeb recent switch from
PD to HD, and diet hx demonstrating undesirable
food choices.

INTERVENTION

Pt. Education:
Lower

fluid to 1.2 L/ d (goal = gain<4% of body weight


btw dialysis tx)
Maintain low Na intake (87-130 mEq)
Avoid high K foods (handout)
Provide resources to educational/support websites
(National Kidney Foundation- http://www.kidney.org/atoz/pdf/hemodialysis.pdf)

Recommend Alternate Therapy/Supplements:


Recommend

PO4 binders
Recommend H20-soluble multi-renal vitamin w/ 1
mg/d folate, possibly Vit. E
Refer to HD RD to monitor labs

MONITORING

Gain/ loss in weight; edema


Progression of HTN, HF complications
Labs for Lytes, K, PO , Na & H 0-soluble
vitamins
Serum ferritin
4

EVALUATION

Decreased symptoms of fluid overload


Subsided N/V associated with inappropriate
levels of waste products in blood
Improved Quality of Life
Increased pt. awareness of appropriate HD
diet
Compliance to prescribed diet
EPO therapy w/ Fe supplement (correct
anemia)
Hyperparathyroidism-Recommend activated Vit D
to manage

RESEARCH ARTICLES

Changes in
Anthropometry and
Mortality in
Maintenance
Hemodialysis
Patients in the HEMO
Study

http://www.ncbi.nlm.nih.gov.eres
.library.manoa.hawaii.edu/pubme
d/?
term=Changes+in+Anthropometry+
and+Mortality+in+Maintenance+He
modialysis+Patients+in+the+HEMO
+Study

Nervous system
autoantibodies and
vitamin D receptor
gene
polymorphisms in
hemodialysis
patients

http://www.ncbi.nlm.nih.gov
/pmc/articles/PMC3919036/