Chapter 8, Problem 6LO

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…

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 Case 3 Beverly's monthly adequacy of dialysis results came back lower than usual. Her Kt/V is 1.13. Flow sheet data reveals the following: Prescribed BFR 400, patient ran BFR 325 during treatment Blood 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 kg 1. 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's adequacy results were below goal?