Chapter 14, Problem 3CR

FEB 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…

PEB 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

REVIEW QUESTIONS True False 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. The Initial Nutrition Assessment/Plan of Care must be completed within 30 days of admission or 13 treatments, whichever is later. At a minimum, the DaVita Dietitian is required to document on the nutrition progress of each hemodialysis and peritoneal dialysis patient quarterly. DaVita's optimal goal for albumin is 4.0 or higher A low albumin is associated with increased morbidity and mortality in dialysis patients. Interdisciplinary patient assessments and plans of care must be completed monthly for unstable patients. The DaVita minimum goal for nPCR is 1.5. A low albumin is always due to poor protein intake in patients on hemodialysis Dialysis patients are at an increased risk for protein/kcal malnutrition. The most serious side effects of chronic hyperphosphatemia are bone disease and itching. When a patient exhibits hypokalemia and hypophosphatemia, the DaVita Dietitian should evaluate adequacy of dietary…

Study guide for nutrition assessment with people with CKD

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…

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 2013

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 2001

DaVita Dietitian Reference Manual Module 6 - Mineral and Bone Disorder Management REVIEW QUESTIONS 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. True False In patients with below-normal albumin levels, it is important to obtain a corrected calcium value to recognize potential hypercalcemia. Hectorol is an active vitamin D analog. Parathyroid hormone is produced in the pancreas. A good substitute for Dr. Pepper is Sprite. Chocolate, nuts and seeds are high in phosphorus. Cinacalcet replaces binder therapy for controlling phosphorus. Calcium carbonate taken between meals acts as a calcium supplement. High serum phosphorus levels are linked to the development of secondary hyperparathyroidism in CKD and a predisposition to metastatic calcification. Bone meal, dolomite, or oyster shell should not be used as a calcium binder because they may contain dangerous amounts of lead. Phosphate binders should be taken between meals. Alucaps are the first choice phosphate binder to try on…

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?