Download End Stage Renal Disease - Jacqueline Farralls Portfolio

ESRD
Discussion of the disease
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CKD is a syndrome of both progressive and irreversible loss of excretory,
endocrine, and metabolic functions of the kidney
Etiology
o Diabetes, hypertension and glomerulonephritis are the leading causes of
kidney failure
o Ethnicity – African Americans four times more likely, native Americans
and Hispanics are two times as likely as white Americans
o Family history
o Chronic kidney disease leads to a buildup of fluid and waste products in
the body. This condition affects most body systems and functions,
including:
 Blood pressure control
 Red blood cell production
 Vitamin D and bone health
Diagnostic measures
o National Kidney Disease Education Program has definded CKD as having
a GFR of less than 60/mL minute for three months or longer.
o The stage of CKD is determined by the GFR, which measures the rate at
which substances are cleared from the plasma by the glomeruli in the
kidneys.
Medical and Surgical Treatment:
o There are two types of renal replacement therapy for individuals – type is
decided on by both the patient and physician based on multiple factors
 Hemodialysis
 Is the most common form of treatment
 In order to perform hemodialysis an access must be created
that allows blood to flow out of the body to be filtered and
then be put back in. There are three access types:
o Catheter, graft and fistula is preferred and most
common
o Fistulas are less likely to form blood clots or
become infected, and historically last longer than
the other access types.
 In-center hemodialysis are prescribed 3 times a week for an
avg. of four hours
o Daily home dialysis and nocturnal home dialysis
can also be done but create stress and need a trained
partner
 Peritoneal
 Access to the patients blood supply is gained by a catheter
surgically placed in the peritoneal cavity
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A dialystate is inserted that lines the peritoneal wall
allowing passage of molecules across the membrane and
into the dialystate.
 Two types of PD exist
o Continuous ambulatory PD (CAPD)
 Requires no machine and change it four
times a day – most sleep with it at night
o Continuous Cycling PD (CCPD)
 Does require a machine - fills and empties
the abdomen 3-5 times during the night
 Renal transplantation is the other method of treatment
 Very risky and need to consume immunosuppressors the
rest of their life.
 Psychological
 Depression is common in dialysis patients
 Recommended to consult with social workers, and gain
support from family
Medical Nutrition Therapy
o Nutrition Assessment
 Majority of individuals with CKD have comorbid conditions like
hypertension or diabetes
 Malnutrition is very common in patients with CKD especially
those on dialysis
 PEM is most severe
 Signs and symptoms prevent themselves when GFR falls below 30
mL/minute
 Important to access for usual dietary intake and intolerances
because dietary restriction is elongated for CKD
o Nutrition Diagnosis
 Nutrition implications are complex with CKD and many diagnoses
are often present including:
 Inadequate energy intake
 Excessive fluid intake
 Excessive protein intake
 Excessive mineral intake (potassium, phosphorus, sodium)
 Involuntary weight loss/weight gain
 Food and nutrition knowledge deficit
 Undesirable food choices
o Nutrition intervention
 Nutrition intervention in ESRD are to meet energy requirments,
prevent malnutrition, minimize uremia, maintain blood pressure,
and fluid status
 Hemodialysis diets are high in protein and control intakes of
potassium, phosphorus and sodium.
 Protein loss is approximately 10 to 12 grams of free amino
acids per day and 5 to 15 per day of albumin
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General recommendations are 1.2 grams of protein/kg of
body weight
 50% of protein should be high biological value
 Limit fluid intake
 It will make it much easier on the patient – avg. fluid intake
is limited to 32 oz.
o Liter of water weighs 2.2 pounds
o Monitor and Evaluate
 Classified as either
 Clinical
o Biochemical measures and hematological measures
 Patient behavioral
o Meal planning, meeting nutrient needs, awareness
of potential food and drug interactions
 Consider blood pressure control, maintenance of body mass
Prognosis
o The leading cause of death in patients with chronic kidney disease is
cardiovascular disease
o Life expectancy depends on age and additional medical problems
associated
o An individual between the age of 45-55 has 70% chance for five year
survival
o Some kidney disease patients on dialysis are very ill and long-term
survival is not anticipated because dialysis can be tedious and cause
medical complications
Instruction Materials – Renal hemodialysis diet
1. General instructions and focus
a. Meet nutritional requirements, prevent malnutrition, minimize uremia,
maintain blood pressure and fluid status
2. Diet instruction for you
a. Create a diet high in protein, with control of potassium, phosphorus,
sodium, and fluids
Nutrient (Adjusted Edema-Free Body
Direction
Weight)
Protein
106 grams of protein per day – 50 % must
be high biological value
Energy
3000-3100 kcal (35 kcal/kg– under 60
years old)
Fat
750 – 1050 kcal from fat or 83.3 – 116.6 g
of fat
Cholesterol
Less than 200 mg/day
Fiber
20-30 g/day
Potassium
2 grams per day
Sodium
2 grams per day
Phosphorus
800 mg per day
Fluid
1 L/day
Therapuetic lifestyle changes for client
 Increased Protein Consumption
o 106 grams per day or 425 kcal (15%)
 Based on 1.2g/kg of body weight
 Why Increase protein?
 Loss of free amino acids in the body of a hemodialysis diet
is approximately 10-12 g per day
 Carbohydrates
o 450 grams per day or 1,800 kcal (60%)
 Fat
o 83 grams per day or 750 kcal (25%)
 Fluid
o No more than 1 L of fluid per day of fluid
o It is important to only drink when thirsty
Interdialytic weight gain should be no greater than 5% body weight, which is equivalent
to no more than 1 liter of fluid per week
Meet daily requirements of all vitamins
 Avoid high doses of Vitamin A and C
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Avoid magnesisum
Supplementation of Vitamin B12, folic acid and Vitamin C is required to
meet nutritional needs
Sample Menu
 Recommended foods
o Eat a high protein food at every meal of the day
 Fish, meat, poultry, fresh pork, or eggs
o Whole grain breads and cereals are a great way to obtain good calories
o Dairy foods low in phosphorus
 Cream cheese, ricotta cheese, Unsalted butter, Sherbert (instead of
ice cream)
o Fruits
 Apple, berries, pineapple, watermelon, grapes
o Low potassium vegetables
 Broccoli, carrots, celery, cucumber, onion, squash
o Sherbert is great for desert of meals
 Foods to avoid
o All fruit juices have sources of potassium
 Avoid – oranges and orange juice, kiwis, prunes and prune juice,
raisins, bananas, melons
o Potatoes (including French fries), tomatoes and tomato sauce, asparagus,
avocado
o Avoid any fast food or deep fried food
Monitor and Evaluation
 Monitor lab values of serum albumin, serum creatine, serum potassium, BUN,
sodium, phosphorus and hope to maintain a within normal range
Great websites to consult:
U.S. Department of Health and Human Services
http://kidney.niddk.nih.gov/kudiseases/pubs/eatright/index.aspx
Nephrology Physicians
http://www.nephinc.com/food-lists.asp
References:
Finkelstein, F., & Finkelstein, S. (2000, October). Oxford journals . Retrieved from
http://ndt.oxfordjournals.org/content/15/12/1911.full
Initia, R. (2012, March). National kidney foundation. Retrieved from
http://www.kidney.org/atoz/content/dietary_hemodialysis.cfm
Rubin, R. (2009, August 24). Usa today. Retrieved from
http://usatoday30.usatoday.com/news/health/2009-08-23-dialysis_N.htm
The renal association. (2011, November). Retrieved from
http://www.renal.org/whatwedo/InformationResources/CKDeGUIDE/CKDstages.aspx
National Kidney and Urologic Diseases Information Clearinghouse. (2008, August
1). Eat right to feel right on hemodialysis. Retrieved from
http://kidney.niddk.nih.gov/KUDiseases/pubs/eatright/index.aspx
Nephrology Physicians. (n.d.). Nephrology physicians, llc. Retrieved from
http://www.nephinc.com/food-lists.asp
Mayo Clinic Staff. (2012, July 06). Mayo clinic. Retrieved from
http://www.mayoclinic.com/health/kidney-failure/DS00682
Chronic kidney disease (ckd). In (2012). U.S. Department of Health. Retrieved
from http://www.nlm.nih.gov/medlineplus/chronickidneydisease.html
American Kidney Fund. (2010, December). Chronic kidney disease. Retrieved
from http://www.kidneyfund.org/kidney-health/kidney-problems/chronic-kidneydisease.html
(2011). Treatment methods for kidney failure: Hemodialysis . National Institute of
Diabetes and Digestive and K. Retrieved from
http://kidney.niddk.nih.gov/kudiseases/pubs/hemodialysis/
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