Download Renal Nutrition Competency Test for Dietitians

Competency Exercise for Dietitians: Working With Renal Patients
Patient 1
The patient is a 27-year-old developmentally delayed male with a history of bilateral
renal hypoplasia on hemodialysis. He is 5'6" tall and weighs 54 kilograms (kg).
Labs are as follows:
 BUN: 101
 Cr: 11.1
 TP: 7.3
 Alb: 4.1
 K: 4
 PO4: 7
 Ca: 7.7
 Kt/V: 1.1
 iPTH: 500
 Urine output is 500 milliliters (mL)/day
Medications include calcium carbonate, NephroVite®, folic acid, and enalapril. You know
he was on a renal diet before, but the dietitian who knows him is on vacation and you
need to recommend a diet for him while he is in the hospital.
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What diet Rx would you recommend?
Do you think this patient is compliant with his diet and medications? Explain.
Briefly describe your plan and method for instructing the patient on his diet.
Patient 2
The patient is a 20-year-old male with corticotrophin-releasing factor (CRF) and
hypertension (HTN) on continuous ambulatory peritoneal dialysis (CAPD). He is 6' tall
and weighs 133 pounds (lb).
Labs are as follows:
 BUN: 116
 Cr: 15.5
 TP: 5.3
 Alb: 3.2
 K: 5.7
 PO4: 8
 Ca: 9.3
Medications include NephroVite, pyridoxine, Rocaltrol®, Zantac®, PhosLo®, captopril,
nifedipine, amoxicillin, and Epogen® (subcutaneous). The patient has a poor appetite
and admits he is sometimes noncompliant with medications.
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What dietary restrictions would you recommend, if any, and why?
What are his estimated calorie needs? Show calculation.
What are his protein needs? Show calculation.
What is the patient’s CaPO4 product, and what can you say about it?
What would you recommend to the patient to improve his calorie intake?
Answers:
(answer key in italics)
Please note that different registered dietitians may have slightly different answers, depending
on their professional experience, professional judgment, and decision to use adjusted or
actual body weight for calculations.
Patient 1
The patient is a 27-year-old developmentally delayed male with a history of bilateral renal
hypoplasia on hemodialysis. He is 5'6" tall and weighs 54 kilograms (kg).
Body mass index (BMI)=19.2, ideal body weight ( IBW)=58–71 kg
Labs are as follows:
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BUN: 101— normal for dialysis patients is 50–100
Cr: 11.1— normal for dialysis patients is <15
TP: 7.3— within normal limits (WNL)
Alb: 4.1— WNL
K: 4— WNL
PO4: 7— slightly elevated; limit milk and milk products to one serving/day or increase
calcium carbonate
Ca: 7.7— low
Kt/V: 1.1— below target (1.4)
iPTH: 500— high
Urine output is 500 milliliters (mL)/day— limited urine output does not indicate
dehydration in dialysis patients; however, it means that it is an indication of further
deterioration of kidney function
Medications include calcium carbonate, NephroVite ®, folic acid, and enalapril. You know he
was on a renal diet before, but the dietitian who knows him is on vacation, and you need to
recommend a diet for him while he is in the hospital.
What diet Rx would you recommend?
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2240 kilocalories (kcal) (weight in kg 35 x kcal/kg)
77 grams (g) protein (weight in kg x 1.2 g/kg)
0.8–1.2 g phosphorus (or increase calcium carbonate)
2–4 g sodium
2–3 g potassium
1500 mL fluids (750–1000 mL/day, plus urine output)
Do you think this patient is compliant with his diet and medications? Explain.
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His iPTH is high and his PO 4 is high, indicating he is not taking his calcium
carbonate as prescribed.
Briefly describe your plan and method for instructing the patient on his diet.
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This patient needs to normalize his phosphorus and iPTH level
Because the patient is developmentally disabled, the registered dietitian should
include the caretaker and/or family members in the diet instruction
The patient should receive a sample daily menu with pictures of food and amounts
For dialysis days, the patient should receive a packable lunch menu
Weight maintenance is a goal for this resident, so encourage him to eat regularly and
finish all the food provided in the diet plan
Patient 2
The patient is a 20-year-old male with corticotrophin-releasing factor (CRF) and hypertension
(HTN) on continuous ambulatory peritoneal dialysis (CAPD). He is 6' tall and weighs 133
pounds (lb).
(60 kg ), BMI=18, IBW=160–196
Labs are as follows:
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BUN: 116— normal for dialysis patients is 50–100
Cr: 15.5— normal for dialysis patients is <15 (this is slightly elevated)
TP: 5.3— low
Alb: 3.2— low
K: 5.7— WNL
PO4: 8— normal for dialysis patients is 3.0–6.0 (this is high)
Ca: 9.3—WNL
Medications include NephroVite, pyridoxine, Rocaltrol ®, Zantac ®, PhosLo ®, captopril,
nifedipine, amoxicillin, and Epogen ® (subcutaneous). The patient has a poor appetite and
admits he is sometimes noncompliant with medications.
Review date: March 8, 2013