Updates

1
Updates

• Make sure you are getting PP from Alice
  Andersons web page to get the most current
  slides
• Review of Test 5
• 10 is tricky but actually correct
• No Bonus point - 25 was an essay
• Case studies will not be accepted after next
  week!
• Review of Updated Syllabus Next Test Next
  Week

2
Chapter 26

• Protein-, Mineral-, and Fluid-Modified Diets for
  Disorders of the Kidneys Urinary Tract

3
The Ins Outs of Dialysis

• Featured Guest Speakers from St. Alphonsus
  Nephrology Center
• (These Slides correspond summarize the guest
  speakers main points.)
• Janine Neiwirth, R.D., C.S.R., L.D.
  
  
• Renal Dietician
• Pam Jones, R.N.
• Peritoneal Dialysis Specialist

4
Kidney Failure

• What Goes In . . . Doesnt Come Out
• Hemodialysis only works 3 days a week Your
  kidneys work 24/7!
• Thats why a special diet is needed.

5
The Realities of Kidney Failure

• Kidney Renal
• Chronic vs. Acute Renal Failure
• 50 or more on Dialysis are Diabetic
• Diabetics frequently have more Complications than
  non-diabetics
• 60 of patients 60 years old

6
Options for Treating Renal Failure

• Transplant Must Qualify
• Hemodialysis Our main topic today
• Peritoneal Dialysis
• Do Nothing

7
A Peek at Life on Dialysis . . .
8
Renal Diet What is it?

• Depends on who you ask
• Is it for pre-dialysis or dialysis?

• For Dialysis
• High protein
• Low potassium, Sodium, Phosphorus
• Limited Fluids

9
PROTEIN and lots of it!

• Taste changes meats taste icky
• Dialysis removes proteins
• Inflammation, infections, etc.
• Goal Serum albumin 3.5 or higher

10
Supplements a necessity

• Type depends on patient, availability
• 2kcal/cc supplements with Med Pass
• Healthshakes, etc.
• But arent those fluids?
• Protein powder in foods
• High protein snacks preferred by patient

11
FLUIDS 4 cups Urine

• Fluid liquid at room temperature
• Limit weight between dialysis to 3 kg
• Their weights will vary!!!
• Too much weight miserable dialysis . . .
  Eventually heart/lung failure

12
Dry Mouth

• High blood sugar dry mouth
• High sodium intake dry mouth
• Some meds, (especially for BP) dry mouth
• Take meds with applesauce
• Try ice/frozen grapes/frozen lemonade

13
SODIUM 2-4 grams

• Recommend NAS unless high fluid gains
• Less taste Less po intake
• NO SALT SUBS high in potassium
• What does low serum sodium mean?

14
PHOSPHORUS

• In almost everything!
• Especially those high protein foods
• Limit milk products, dry beans/peas, nuts,
  processed foods
• Take binders BEFORE meals

15
Binders is that painful?

• Medication to decrease phosphorus in GI tract
• Must be taken with meals to work
• Tums, PhosLo, OsCal, Renagel, Alucaps, etc.
• No OTC antacids, (MOM, etc magnesium builds up)

16
Vitamin D

• Given during diaysis for patients who need it
  based on labs
• Do not give oral Vitamin D (multivitamins)

17
POTASSIUM

• Normal for dialysis 3.5-6.0
• Too high? weak legs . . . . . Heart attack
• Most can have one high potassium food per day
• What foods are high? Potatoes, Tomatoes, Oranges
  Bananas . . .

18
Vitamins

• Make sure your patient has a renal vitamin
  ordered
• B vitamins and Vitamin C are dialyzed out
• Vitamin A builds up bone problems
• Examples Nephrovite, Dialyvite, Diatx,
  Nephrocaps

19
Iron

• Iron given IV during dialysis if needed based on
  labs
• Oral iron is not being used for hemodialysis
  patients at this time
• Peritoneal patients may be on oral iron
• Iron is monitored by RNs at dialysis- IV Fe is
  sats/ferritin are low

20
Normal Labs for Dialysis

• Albumin 3.5-5.0
• Potassium 3.5-6.0
• Phosphorus 3.5-6.0
• Calcium 8.5-10.5 (adjust for low albumin)

21
Ins Outs Summary

• Renal Diet is Important
• Not for everyone
• Individualize
• Allow choice as possible
• What would it be like?

22
Call your local Renal Dietician, (RD, CSR)

• Twin Falls/Burley Janine Neiwirth, 737-4608
• PD Boise/Nampa Laura Anderson, 367-6810
• Boise Dara Jazierny, 367-2059
• Nampa Rachel Arndt, 461-5698
• Ontario Clara Flynn, New Center
• Pocatello Elaine Neibaur, 677-1094