MNT for Renal Disease Part 2 Flashcards
Chronic Kidney Disease is also known as ___ ___ ____
Chronic Renal Failure
CKD is defined as either…
-Kidney damage
-GFR <60 ml/min/1.73 m2 for 3 or more months
CKD causes a ___ ___ in kidney function over time
Gradual decline
If detected early, ___ and ___ ___ may slow the progression
Medications and dietary changes
___ ___ ___ is the best measure of kidney function
Glomerular filtration rate (GFR)
GFR is used to categorize a patient regarding the ___ of chronic kidney disease
Stage
Glomerular filtration rate is calculated by the MD by using the patient’s…
-Serum creatinine level
-Age
-Race
-Body size
-Gender
Description and GFR for stage 1 of CKD:
-Kidney damage with normal GFR
-GFR: 90 or more
Description and GFR for stage 2 of CKD:
-Kidney damage with mild decrease in GFR
-GFR: 60-89
Description and GFR for stage 3 of CKD:
-Moderate decrease in GFR
-GFR: 30-59
Description and GFR for stage 4 of CKD:
-Severe decrease in GFR
-GFR: 15-29
Description and GFR for stage 5 of CKD:
-Kidney failure; End-Stage Renal Disease
-GFR: <15 or on dialysis
____ means inadequate urine output
Oliguria
___- <___ ml/day of urine output indicates oliguria
100 - <500
____ is the complete cessation of urine flow
Anuria
___ to <___ ml/day of urine output indicates anuria
0 to <100
What are common causes of CKD?
-Diabetes mellitus
-Hypertension
-Glomerulonephritis
-Polycystic kidney disease
-Systemic lupus erythematosus
-Repeated urinary infections
-Nephrotic syndrome
What are two signs/symptoms of CKD?
-Azotemia
-Uremia
Azotemia is the accumulation of abnormal quantities of ___ ____ in the blood
Nitrogenous waste
____ refers to physical signs and symptoms of azotemia
Uremia
What are symptoms of uremia?
-Malaise
-Weakness
-N/V
-Muscle cramps
-Pruritus
-Dysgeusia
-Neurological impairment
What is a normal GFR?
90-120 mL/min/1.73 m2
Serum creatinine levels ____ with CKD
Increase
Daily production of creatinine depends on ___ ___ and is excreted by the kidneys
Muscle mass
Normal creatinine level for women:
0.5-1.1 mg/dL
Normal creatinine level for men:
0.6-1.2 mg/dL
Blood urea nitrogen levels ____ with CKD (but levels can change for reasons other than CKD)
Increase
Normal BUN level:
10-20 mg/dL
Medical treatment for CKD may include…
-Treating/managing underlying causes
-Dialysis (hemodialysis, peritoneal dialysis)
-Transplantation
Hemodialysis removed ___ and ___ ___ from the body
Waste, excess fluid
Hemodialysis usually requires ___ sessions per week for ___-___ hours each
3 sessions; 3-5 hours
With hemodialysis, blood passes through a ___ ___ to be filtered
Semipermeable membrane
Waste products are removed via ____
Diffusion
Water removal by hemodialysis is called ____ and is done with pumps that are connected to the dialysis machine
Ultrafiltration
The ____ is made of a collection of thousands of hollow plastic fibers inside a plastic cylinder
Dialyzer
What are three types of vascular access used for dialysis?
-Fistula
-Graft
-Catheter
An ____ ____ is made by sewing together an artery and a vein in the forearm
Arteriovenous fistula
An arteriovenous fistula allows for strong blood flow from the artery to make the vein ___ and ___
Larger and stronger
With an arteriovenous fistula, 2 needles are inserted into the fistula- one for ___ ___ and one for ___ ___ ___
Withdrawing blood; returning filtered blood
An arteriovenous fistula is the ____ access for long-term hemodialysis
Preferred
Arteriovenous fistulas are less prone to ___ or ___ ___ compared to other types of access
Infections; blood clots
Veins and arteries self-heal after each needle stick, so fistulas can last a ___ ___
Long time
An ___ ___ is a piece of tubing that is used to surgically attach an artery and a vein
Arteriovenous graft
Those with arteriovenous grafts are more likely to have difficulty with ___ ___ because it is made from synthetic material
Blood clots
Some arteriovenous grafts develop ___ because the material cannot self-heal after needed punctures (may cause graft failure)
Holes
A catheter is placed in the neck or chest and inserted into a ___ ___
Central vein
Catheters are for ___-___, ____ access
Short-term; temporary
An advantage of a catheter is that it can be used the ___ ___
Same day
Disadvantages of a catheter access:
-Most prone to infection
-Can accidentally be pulled out
Advantages of hemodialysis:
-Patient involvement is minimal
-Treatment is controlled by trained staff
Disadvantages of hemodialysis:
-Time-consuming
-Loss of protein (5-8 g per treatment)
-Fluctuations in serum levels of urea, potassium, phosphorus, and fluid
Complications include…
-Hypotension
-Infections as access site
-Graft failure
____ ____ is dialysis that uses the semi-permeable membrane of the peritoneum as the dialyzer
Peritoneal dialysis
With peritoneal dialysis, a high ___ dialysate is infused into the peritoneal cavity via a surgically places catheter in order to create a concentration gradient
Dextrose
With peritoneal dialysis, ___ ___ and ____ pass from the blood through the peritoneal membrane into the dialysis via diffusion
Waste products and electrolytes
With peritoneal dialysis, water passes via ____
Osmosis
Dialysate is then drained from the ___ ___
Peritoneal cavity
Bags usually hold ___, ___ or ___ liters of dialysate
1.5, 2.0, 2.5
What are three common strengths of dialysate?
-1.5% dextrose
-2.5% dextrose
-4.25% dextrose
High concentrations of dextrose is used if a large amount of ___ needs to be removed
Water
What are two types of peritoneal dialysis?
-Continuous ambulatory peritoneal dialysis (CAPD)
-Continuous cyclic peritoneal dialysis (CCPD)
Continuous ambulatory peritoneal dialysis is performed using ___-___ technology
Gravity-based
Continuous cycle peritoneal dialysis uses a machine called a ____ for installation and drainage of the dialysis solution
Cycler
Steps for performing continuous ambulatory peritoneal dialysis:
- Dialysate enters the peritoneal cavity, called “fill”
- While fluid dwells in the peritoneal cavity, extra fluid and wastes are drawn out of the blood and into the dialysate fluid
- After about 3-5 hours the dialysis fluid is drained, called “drain” and replaced by fresh fluid
Peritoneal dialysis is typically performed __-___ times per day
4-6
Advantages of peritoneal dialysis:
-Dialysis is done daily (less fluctuations in serum levels of urea)
-Home-based treatment
-More liberal diet
-May contribute to a more flexible lifestyle
Disadvantages of peritoneal dialysis:
-Protein losses of 10-20 g/day
-Dextrose can be absorbed by the dialysate and contribute, on average, 400-800 kcal/day (causes weight gain and poorly controlled diabetes)
A complication of peritoneal dialysis is ___ which can be severe
Peritonitis
Studies have shown that patients who are not adequately dialyzed have an increased risk of ___ and ____
Morbidity and mortality
___ ___ ____ is a measurement of reduction of urea that occurs during a dialysis treatment
Urea Reduction Ratio
Urea reduction ratio can be calculated with what formula?
(predialysis BUN - postdialysis BUN) / predialysis BUN
Someone would be well-dialyzed if there is a reduction in urea by >___%
65
Complications of CKD:
-Alterations in fluid volume (hypervolemia)
-Electrolyte abnormalities (sodium, potassium, and phosphorus)
-Hypertension
-Metabolic acidosis
-Secondary hyperparathyroidism
-Glucose intolerance
What type of anemia may be caused by CKD?
Normochromic, normocytic
Normochromic, normocytic anemia is caused by…
-Inability to produce erythropoietin
-Increased destruction of red blood cells due to circulating uremic waste products
Signs/symptoms of normocytic, normochromic anemia include…
-Decreased serum hemoglobin and hematocrit
-Fatigue, SOB, pallor, lightheadedness
To manage amemia, you can use ___ ___ ___
Human Recombinant Erythropoietin (EPO)
Drug nutrient interaction with human recombinant erythropoietin (EPO):
Increases need for iron for production of red blood cells
With EPO, many people are given IV iron; some examples are:
-Iron dextran (Infed)
-Iron gluconate (Ferrlecit)
-Iron sucrose (Venofer)
Iron stores should be measured monthly when on EPO, and we should monitor ___ ___
Serum ferritin
Goal serum ferritin should be over ___ ng/mL but under ____ ng/mL for hemodialysis patients receiving EPO
300; 800
Signs and symptoms renal osteodystrophy:
-Bone pain
-Pathologic fractures
-Metastatic calcification
The first step in the pathophysiology of renal osteodystrophy:
As renal function declines, the kidneys cannot excrete phosphorus load, leading to hyperphosphatemia
The second step in the pathophysiology of renal osteodystrophy:
Serum calcium levels decline due to a decrease in 1,25 dihydroxyvitamin D3, which leads to a decrease in intestinal absorption of calcium
The third step in the pathophysiology of renal osteodystrophy:
Low serum calcium levels trigger the release of parathyroid hormone, leading to bone resorption of calcium
The fourth step in the pathophysiology of renal osteodystrophy:
An increase in calcium phosphorus product leads to calcification of soft tissues
Serum calcium x serum phosphorus > ____ mg2/dL2 would lead to calcifications
70
The National Kidney Foundation’s goal is to keep calcium x phosphorus product under ____ mg2/dL2
55
MNT for renal osteodystrophy:
-Calcium: adjust total intake from food, supplements, and calcium-based phosphorus binds to avoid hypercalcemia
-Active vitamin D supplementation: Rocaltrol
-Decrease dietary phosphorus intake to 800-1200 mg/d
Calcium supplements should be ___ ___
Calcium carbonate
For renal osteodystrophy, calcium supplements should be given on an empty stomach ___ meals and at bedtime
Between
What are some examples of phosphate-binding medications:
-MOA
-Calcium-containing binders
-Sevelamer hydrochloride (Renagel)
-Ferric citrate
MOA bind with phosphorus in the ___
Gut
What are two examples of calcium-containing binders?
-Calcium Acetate (PhosLo)
-Calcium Carbonate (Oscal)
What is a possible complication of calcium-containing binders?
Hypercalcemia
Sevelamer hydrochloride (Renagel) lowers phosphorus without increasing ____
Calcium
Ferric citrate is an ___-___ binder
Iron-based
Phosphate binders should be taken ___ ___
With meals
There is a high prevalence of ____ ___ is dialysis patients
Cardiovascular disease
__ __ ___ is commonly seen secondary to hypertension
Congestive heart failure
Accelerated atherosclerosis can lead to ___ ___ ___
Coronary heart disease
Non-traditional risk factors for coronary heart disease:
-Inflammation
-Oxidative stress
-Abnormalities of lipoprotein metabolism
-Vascular calcification
MNT for cardiovascular disease:
Mediterranean diet pattern may improve lipid profiles
Other complications of CKD:
-Increased bleeding tendency
-Impaired leukocyte function (increased susceptibility to infections
-Neurologic manifestations (insomnia, difficulty concentrating, peripheral neuropathy, restless leg syndrome, seizures, encephalopathy)
-Malnutrition
____ is one of the most common complications of CKD, especially for those on dialysis
Malnutrition
Factors leading to malnutrition:
-N/V
-Taste alterations
-Anorexia
-Fatigue
-Multiple dietary restrictions
-Inadequate intake due to depression, financial challenges, lack of family support, missed meals due to dialysis, inability to obtain or prepare food
-Food-drug interactions
-Protein loss from dialysis treatment
-Inflammatory response (increases protein requirements)
