DaVita Dietitian Reference ManualModule 7 - Adequacy of HemodialysisCase 3Beverly's monthly adequacy of dialysis results came back lower than usual. Her Kt/V is1.13. Flow sheet data reveals the following:Prescribed BFR 400, patient ran BFR 325 during treatmentBlood pressure dropped to 72/58 during treatment, so UFR was turned off.Dry weight 65 kg, pre dialysis weight 69 kg, post dialysis weight 66.5 kg1. What are DaVita's goals for Kt/V?2. What is your impression of why the Kt/V is low?3. What additional information would help in determining why Beverly'sadequacy results were below goal?

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Answered: DaVita Dietitian Reference Manual…

Ebk:Nutrition & Diet Therapy

10th Edition

ISBN:9780357391747

Author:DEBRUYNE

Publisher:DEBRUYNE

Chapter23: Protein-, Mineral-, And Fluid-modified Diets For Kidney Diseases

Section: Chapter Questions

Problem 2CA

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DaVita Dietitian Reference Manual Module 7 - Adequacy of Hemodialysis REVIEW QUESTIONS True False 1. 27 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. Urea Reduction Ratio is a more accurate measurement of dialysis adequacy than Urea Kinetic Modeling. A fistula is the preferred type of vascular access. In the formula Kt/V, the V represents volume of total body water in which urea is distributed. In the formula Kt/V, time is measured in 15-minute increments, so 220 minutes would be rounded off to the nearest quarter hour. The DaVita minimum goal for adequacy is a spKt/V≥ 1.0. A measured height and accurate dry weight are required to obtain an accurate Kt/V result. A very low post BUN result usually means the patient is not eating enough protein. KRU is a measure of residual urea clearance by the patient's kidney, requiring a 24-hour urine collection. The Kt/V Delivered (single pool) is the value used for determining adequacy and comparing outcomes in DaVita facilities. Catheters are…
DaVita 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…
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?
DaVita Dietitian Reference Manual Module 7- Adequacy of Hemodialysis CASE STUDIES Case 1 David was diagnosed with chronic kidney disease a year ago, and now needs hemodialysis. At his first treatment, the nurse hooks up the bloodlines to an access in David's chest. He tells her that he had surgery on his arm three months ago so it can be used for dialysis eventually. 1. What type of access does David have for the initial treatment? 2. Is David's arm access most likely a graft or fistula? 3. What possible reasons prevent use of a fistula or graft for the first dialysis treatment? Case 2 Ramon, a hemodialysis patient for six years, has lost 1.5 kg over the past six weeks. He denies nausea or vomiting, but does admit to eating less at meals and skipping dinner some days. Current dialysis prescription is: 3 1/2 hours (210 minutes), 3 times a week, ASAHI 1050S, APS dialyzer, dialysis flow rate 800 ml/min, blood flow rate 400 ml/min. Monthly bloodwork is as follows: Date K PO4 Pre-BUN…
Nutrition Internvention
Test Full Name ResultFlag UREA UREA 16.15 Ca Ca TBIL AST TBIL 24 AST 42.70 ALT DBIL ALT 13.6 DBIL N Ind B 14 " HONG 5189 the Unit Reference m 15-45 mg 2-102 0-12 UL 0:40 0.00 0-0.25 002 These are my brother's own blood tests. I'm a student. My physical condition is weak. Please, I want the right treatment to treat my brother.
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 8-Anemia Management CASE STUDIES Case 1 Peter is new to hemodialysis. His renal failure is due to hypertension. He weighs 120 kg. Prior to admission to the dialysis facility, he did not receive Procrit, Aranesp or Epogen (EPO). His bloodwork includes: • Hemoglobin = 9.0 mg/dL • Iron Saturation (ISAT) = 15% Fernüin = 95 ng/mL HD SHAPE 5.1 was ordered by the physician. What are your recommendations? Case 2 Sandy is new to hemodialysis. Her renal failure is due to diabetes. During the month prior to admission to the dialysis facility, she received Procrit (2000 units, once a week which is comparable to Epogen at the same dose). She weighs 65 kg. Sandy has an infection on her foot due to diabetes Her bloodwork includes the following. Hemoglobin = 9.4 mg/dL Iron Saturation (ISAT) = 25% Ferritin = 1230 ng/mL HD SHAPE 5.1 was ordered by the physician. What are your recommendations? What factors are affecting this patient's response to erythropoietin?

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