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 Post-BUN URR KWV nPCR Albumin Weight 12/3 5.2 5.6 75 15 80 1.78 1.10 4.2 61.5 1/7 5.0 6.2 72 16 78 1.72 1.09 4.0 61.2 2/4 4.2 4.3 69 22 70 1.30 1.02 3.8 60.0 3/5 5.5 6.2 85 30 65 1.18 0.88 3.5 59.0 4/1 5.8 8.6 110 42 62 1.10 0.82 3.3 58.0 1. Assess the lab values. What trends can you identify? 2. What are some potential reasons for the decrease in albumin and dry weight?
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 Post-BUN URR KWV nPCR Albumin Weight 12/3 5.2 5.6 75 15 80 1.78 1.10 4.2 61.5 1/7 5.0 6.2 72 16 78 1.72 1.09 4.0 61.2 2/4 4.2 4.3 69 22 70 1.30 1.02 3.8 60.0 3/5 5.5 6.2 85 30 65 1.18 0.88 3.5 59.0 4/1 5.8 8.6 110 42 62 1.10 0.82 3.3 58.0 1. Assess the lab values. What trends can you identify? 2. What are some potential reasons for the decrease in albumin and dry weight?
Chapter14: Formula Method
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Transcribed Image Text: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
Post-BUN
URR
KWV
nPCR
Albumin
Weight
12/3
5.2
5.6
75
15
80
1.78
1.10
4.2
61.5
1/7
5.0
6.2
72
16
78
1.72
1.09
4.0
61.2
2/4
4.2
4.3
69
22
70
1.30
1.02
3.8
60.0
3/5
5.5
6.2
85
30
65
1.18
0.88
3.5
59.0
4/1
5.8
8.6
110
42
62
1.10
0.82
3.3
58.0
1. Assess the lab values. What trends can you identify?
2. What are some potential reasons for the decrease in albumin and dry
weight?
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