DaVita Dietitian Reference Manual Module 12-Peritoneal Dialysis DISCUSSION QUESTIONS 1. Identify 3 advantages and 3 disadvantages of peritoneal dialysis compared to hemodialysis. 2. How do the nutritional needs of PD patients differ from those of HD patients? 3. What are the goals for Kt/V for PD?
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- DaVita Dietitian Reference Manual Module 6 - Mineral and Bone Disorder Management DISCUSSION QUESTIONS 1. What are calcitriol, Hectorol and Zemplar? • Why are they prescribed? • How are they given? • How is therapy monitored? • What is the patient's role in therapy? 2. What is cinacalcet and when is it used? . What is the Dietitian's role? 3. What are the differences between the oral forms of active vitamin D/vitamin D analogs (calcitriol /Hectorol/Zemplar)? • When they are used? 4. What are 3 effects of high phosphorus levels? 5. What is calciphylaxis? Metastatic calcification? 6. Name four phosphate binder options. • How are phosphate binders dosed? • What are advantages and disadvantages of each? ©2013 DaVita HealthCare Partners Inc. All rights reserved. Copyrighted Material Page 26 of 44 Origination Date: April 2001DaVita Dietitian Reference Manual Module 7-Adequacy of Hemodialysis DISCUSSION QUESTIONS Define the following abbreviations: • UKM • URR . . • Kt/V What are the minimum DaVita outcome goals for Kt/V and URR? How is the DaVita Quality Index calculated for Kt/V? Discuss effect of adequacy on: ⚫ Phosphorus . ⚫ Potassium • Hemoglobin • Appetite, intake and weight ⚫ Albumin . How is residual renal function measured? What term is used for residual clearance of urea? What are advantages and disadvantages of each dialysis access? Which dialyzes the least efficiently and why?DaVita Dietitian Reference Manual Module 12--Peritoneal Dialysis 1. 2 3. 4 5 6. 7. 8. 9. 10. REVIEW QUESTIONS True False With PD, there is a greater responsibility for patients to monitor their own dialysis than with hemodialysis. The higher the dextrose concentration in the PD solution, the more fluid removed and the more calories absorbed. PET testing is used to measure peritoneal dialysis adequacy. PD is contraindicated in diabetics due to the high glucose load of PD solutions. Malnutrition is prevalent among PD patients due to protein losses through the peritoneal membrane. This protein malnutrition contributes to increased morbidity and mortality. Sodium and phosphorus are restricted in the diet for PD patients, however potassium intake is usually more liberal than for HD patients. Protein losses are greater during peritonitis. The calories absorbed from dialysate are negligible. Insulin can be given intraperitoneally, if necessary. PD patients are at risk for high triglycerides…
- DaVita Dietitian Reference Manual Module 12--Peritoneal Dialysis CASE STUDIES Case 1 A 38 year old female patient with polycystic kidney disease is here for a clinic visit. She presents with the following labs: albumin 3.5, Hgb 12.1, Corrected Ca 10.8 (3rd time 10.2), Phosphorus 6.9, K 5.4. Her weight is 185 lbs and she is 6'1" tall. She reports a good appetite and weight has been stable. Two months ago, intact PTH was 1972. She has been counseled numerous times on the importance of controlling calcium and phosphorus, however, she loves milk and cheese. She is on Rocaltrol 0.25 mcg/day. She takes Renvela 800 mg as her phosphate binder, using 3 with meals and 2 with snacks, and she is adherent. Her nephrologist has just prescribed Sensipar 30 mg q dinner. What is your care plan for this patient and what nutritional counseling and patient education would you provide? Case 2 A 65 year old man, S/P heart transplant, Hepatitis C and six-month history on hemodialysis is beginning PD. He is…FEB 4 DaVita Dietitian Reference Manual Module 1 Introduction Commonly Prescribed Medications for Dialysis Patients Below is a list of commonly prescribed medications for dialysis patients. Complete this worksheet throughout the training to become familiar with these medications, their use and nutritional effects. Discuss with Preceptor. MEDICATION Module 3-Nutrition Assessment Colace Miralax DESCRIPTION/ INDICATION FOR USE Kayexalate Module 5 - Nutrition Support Nepro Novasource Renal ProCel Liquacel Module 6 - Mineral and Bone Disorder Management Aluminum hydroxide CalciChew Calcium acetate Calcium carbonate (Tums) Calcijex Calcitriol Fosrenol Hectorol MagneBind Oscal PhosLo Phoslyra Renagel 2013 DaVita HealthCare Partners Inc. All rights reserved. Origination Date: November 2002 A útv e SIDE EFFECTS/ NUTRITIONAL IMPLICATIONS Page 18 of 22 Revised: October 2013FEB DaVita Dietitian Reference Manual Module 1 - Introduction REVIEW QUESTIONS 1. 2. 3. 4 5. 9 6. 7. 8. 9. 6 10. True False DaVita's Mission is to be the provider, partner and employer of choice. Stage 5 CKD (GFR< 15 cc/minute) is classified as kidney failure. Two of the leading causes of CKD are diabetes and hypertension. Peritoneal dialysis therapy can be done independently at home. Healthy kidneys function to maintain acid/base balance, remove wastes and fluid, produce erythropoietin and to activate vitamin D. The diet for hemodialysis is more liberal than the diet for peritoneal dialysis. A typical hemodialysis treatment schedule is 5 times per week for 2 hours per treatment. The dietitian does not have to wear PPE since he/she does not initiate or terminate the dialysis treatment. Nutrition report cards are discussed with the patients on a quarterly basis. FUN is a DaVita Core Value 2013 DaVita HealthCare Partners Inc. All rights reserved. Origination Date: November 2002 4 tv d…
- DaVita Dietitian Reference Manual Module 6-Mineral and Bone Disorder Management CASE STUDIES Case 1 James is a 37 year old African American male with CKD Stage 5 secondary to hypertension. He has been on hemodialysis for 5 years. He has a history of hypocalcemia and hyperparathyroidism. He weighs 63 kg. His albumin usually runs in the range of 3.7-3.8 mg/dL. His binder prescription is PhosLo 667 mg, 2 gelcaps at each meal and 1 with snacks. Labs Intact.PTH Corrected Calcium Phos IV Hectorol mcg 7/20 8.1 5.4 1.0 mcg 8/3 8.0 4.6 1.0 mcg 9/28 400 8.5 4.4 1.5 mcg 10/5 8.8 5.0 1.5 mcg 11/16 9.6 5.0 1.5 mcg 12/28 420 9.9 5.4 Per the Zen Tool, what change (if any) would be made to the IV Vitamin D dose? What are your thoughts on the labs? Case 2 Joseph is a 58 year old Hispanic male, on hemodialysis for one year. He has a history of hyperparathyroidism and hyperphosphatemia. He weighs 74 kg. His binder prescription is Fosrenol 500 mg 1 tablet with each meal. Labs Intact PTH Corrected Calcium…DaVita Dietitian Reference Manual REVIEW QUESTIONS Module 8-Anemia Management True False 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. The renal vitamin should be taken daily and after dialysis on hemodialysis days. An adequate supply of vitamins B12, folate, and B6, as supplied by the renal vitamin, is needed for red blood cell production. The start dose for Epogen therapy is based on body weight and hemoglobin level. A patient's Iron Saturation (ISAT) is 15% and Ferritin is 95 ng/mL. This indicates absolute iron deficiency. A patient's Ferritin is 1200 ng/mL. This may be due to iron excess, infection, inflammation, or multiple transfusions. The healthy liver produces the hormone erythropoietin, necessary for red blood cell production in the bone marrow. A high normal or high MCV (close to or greater than 100 um³/cell) suggests a deficiency of B12 and/or folate. The DaVita Dietitian should reinforce taking the renal vitamin and timing it properly. The renal vitamin contains vitamin A in order to…DaVita Dietitian Reference Manual Module 6 - Mineral and Bone Disorder Management Case 3 Sue Ann is a 52 year old Asian female on peritoneal dialysis using cycler therapy. She has been on dialysis 2 years. She weighs 64 kg. She is taking oral calcitriol and her binder prescription is Renvela 1 tablet with each meal and snack. Labs Intact PTH Corrected Calcium Phos Oral Calcitriol 6/30 400 8.9 7.4 .25 mcg 3x/week 8/11 11.0 7.0 25 mcg 2x/week 9/11 626 9.0 6.8 .25 mcg 3x/week 10/12 555 10.3 6.9 25 mcg 2x/week 11/14 680 10.4 6.6 What are your thoughts regarding the Intact PTH and other labs? What therapy options would you recommend? What are your thoughts regarding patient education needs?
- - DaVita Dietitian Reference Manual + 60% V Module 1 - Introduction BASIC DEFINITION ABBREVIATION / TERM Module 6 - Mineral and Bone Disorder Management MBD PTH KDIGO Zen Tool Module 7 - Adequacy A-V fistula (AVF) A-V graft (AVG) Albuminuria BFR Catheter CVC Dialysate Dialysis DFR spKt/V stdKt/V KOA KRU URR Module 10-Continuous Improvement DQI FHR FHM IP QIP 2013 DaVita HealthCare Partners Inc. All rights reserved. Origination Date: November 2002 Page 21 of 22 Revised: October 2013 ductionNutrition monitoring and evaluating ptPEB 4 DaVita Dietitian Reference Manual Module Introduction Commonly Used Abbreviations and Terms In Dialysis Below is a list of commonly used abbreviations and terms used in dialysis. Complete this worksheet throughout the training use in order to become familiar with these terms and abbreviations. Discuss with Preceptor. ABBREVIATION / TERM Module 1 - Introduction CKD BASIC DEFINITION HD ICHD GFR KDOQI NKF CMS Module 2- Resources CRN Module 3 - Nutrition Assessment RRT Target Weight NPCR/nPNA SGA IDWG IDT POC MIS Module 5-Nutrition Support IDPN IPN ONS ©2013 DaVita HealthCare Partners Inc. All rights reserved. Origination Date: November 2002 Page 20 of 22 Revised: October 2013 tv S A W
