Review: Dialysis & MNT Flashcards
hemodialysis types
center: 3-5 hr/3 per wk home conventional: 3-4 hr/3 per wk short daily: 2 hr/5-7 per wk nocturnal: 6-8 hr/6 per wk or every other night
NxStage system
daily home dialysis, may feel better, less drastic fluid etc fluctuations
short daily & nocturnal HD
ppl need less BP & anemia meds, easier to control phos, less fluid restriction, more liberal diet, sleep better
HD: when is it needed
when BUN >80 mg/dL and creatinine >8 mg/dL
HD goals
maintain plasma levels of protein waste and electrolytes acceptable for dialysis pt.
try MNT and meds to control CKD related probs: anemia, osteodystrophy, CVD
HD Energy
30-50 kcal/kg (usual adult 35, over 60 years = 30-35)
always use dry or post-dialysis wt
HD Protein
1.0-1.5 g/kg dry wt
KDOQI = 1.2 g/kg
acutely ill = 1.2-1.3
half of protein should be high biological value
dialysis pts need a higher than RDA intake of 0.8
low plasma BUN and/or albumin
may indicate need for higher protein intake
high plasma BUN and/or albumin
may indicate protein intake is too high
acceptable BUN for dialysis pt
60-90 mg/dL
MNT HD tool
urea kinetic modeling to be sure dialysis is adequate
carnitine
decrease during dialysis (about same as normal urinary loses)
oral dose = 2g/day or less and IV 1.4g/day
higher dose have negative effects
MNT Variables that may help HD
control hypertriglyceridemia. increase HDL, improve ejection fraction/heart pumping.
lessen cardiac arrhythmias during dialysis, less muscle pain, weakness, cramps, hypotension.
help w/EPO resistant anemia.
acidosis
measure predialysis/stabilized serum bicarb monthly, should be >22mmol/L.
correct w/ oral administration of alkali therapy/bicarb dialysate solution.
fluid restriction
restricted to 1000ml/day + output.
excessive fluid
lead to edema, pulmonary edema, high wt gain b/w dialysis, high/low BP, CHF, cramps during dialysis
wt gain b/w treatments
should not exceed 1-2 lb/day.
common to see 2-4 lb b/w M & W, and 3-5 lb gains over weekend.
1 pt/2 c = 1 lb
thirst
increased by high BG or Na
what counts as a fluid
anything that melts to a liquid. IV fluids or blood. TF or liquid sups.
ice, ice cream, ices, jello, popsicles, pudding (juicy fruits also increase fluid intake)
K restriction
1500-3000 mg/day
K mEq
39 mg K = 1 mEq
K high plasma values
d/t high K consumption. salt substitutes (Morton Lite Salt, Cardia) are very high in K
high K foods
F&V, lima bean, peanut, sardine, yogurt
Na mEq
23 mg Na = 1 mEq
Na restriction
2000 mg/day
Na high plasma levels
d/t high Na food consumption.
causes thirst, swelling, high BP, heart strain
high Na foods
canned soup, baking soda/powder, meat tenderizer, MSG (Accent), bouillon, olive, V-8, Gatorade, ketchup, sauce/dressings, cheese, ham, tuna or smoked salmon
Phos normal range
3.5-5.5 mg/dL
Phos restriction
800-1600 mg/day
meds that decrease phos absorption
renagel, fosrenal, RenaGum (chitosan) or aluminum antacids like amphojel, alternagel, alu-caps, alu-tabs, calcium sups. (less use of aluminum due to side effects)
Ca sups to control phos
when plasma phos is <7.0 mg/dL
if above 7, calcification of soft tissues may occur
Ca & vit D normal values
for dialysis pt are 8.5-9.5 mg/dL
Ca recommendation
1000-1600 mg/day. limit total daily Ca load to <1500-2000
Ca sups - Citrical
= calcium citrate
Ca sups - Phoslo
= calcium acetate
Ca sups - Oscal, tums, Maalox
= calcium carbonate
high Ca, CaxP, phos, iPTH increase risk of
CVD, calciphylaxis, bone disorders
control high iPTH meds
hectoral (doxercalcipherol)
zemplar (paricalcitol)
sensipar (cinacalcet) - not a form of vit D
active vitamin D
1,25 dihydroxycholicalciferol made in kidneys
lack of 1,25(OH)2D contributes to
bone deterioration and PTH elevation
reval MVTs w/o vit A
diatx, rena, dialyvite 800, nephrocaps, nephrovit, renal tabs
Diatx more effective in
lowering plasma homocysteine levels as it has more folate, B12, B6
Vit A: serum retinol and RBP in CKD
are 2-5 times greater than normal d/t prolonged half-life from less renal clearance
Vit A: most is excreted as
retinoic acid. excretion may be compromised in CKF
Vit A: avoid
exceeding the RDA & retinol supps. carotenoids are OK
Vit E: SPACE study
in HD pts w/CVD, 800 IU daily vit E reduced composite CVD endpoints & MI
Water Sol Vits
may be some dialysis loss and inadequate intake
Water Sol Vits: CKD pts are at high risk for
elevated plasma homocysteine (a CVD risk factor)
Water Sol Vits: serum creatinine is a strong determinant of
plasma homocysteine (tHcy). tHcy levels are often 3-5 times normal in CRF d/t poor excretion & impaired nonrenal disposal
Water Sol Vits: Hcy metabolism needs
folate, B12, B6
plasma tHcy randomized supp trials
5 mg folate + MVT daily reduced plasma tHcy
(in 15, 30, or 60 mg folate/day, tHcy rebounded to higher than pre-therapy levels in 30 & 60 mg groups)
trials lowered plasma Hcy but failed to lower CVD…
hyperhomocysteinemia predicts
CVD events in HD pts
zinc def causes
hypogeusia, hyposmia, poor appetitie, rash, poor wound heal, imune and sexual dysfcn. poor child growth.
zinc def pts should avoid
magnesium laxatives such as MOM
CKD pts have lower
zinc status
zinc def predisposing factors
poor intake, loss d/t blood loss, poor transport if low albumin, less absorption d/t Ca and Fe sups, tissue redistribution
zinc sup recommendation
up to 50 mg/day. improved appetite, taste acuity, immunity, and sexual fcn have been reported
magnesium will
lower P
hypermagnesemia risks caused by CKD
n&v, weak, flushing, decreased consciousness, low reflexes, hypotension, arrhythmias, death
hypermagnesemia avoid
Mg containing laxatives and antacids: Mg citrate, MOM, Haley’s Mo, gelusil , Maalox, mylanta, gaviscon
