Denielle Saitta

NCP Renal
Patient M
I.

Introduction: Patient Profile

Patient M is a 66-year-old male undergoing dialysis 3 times per week. He reports that he
is on dialysis as a result of inability to control type 1 diabetes with other diabetic kidney
complications. The patients diagnosis is stage 5 kidney disease or end stage renal disease
(ESRD). Her current nutrition-related problems include iron deficiency anemia, anemia
in chronic kidney disease, type 1 diabetes, and secondary hyperparathyroidism of renal
origin.

II.

Disease Process
The main function of the kidney is to preserve homeostatic balances with
fluids, electrolytes, and organic solutes. The kidney expels toxic waste that builds up in
the blood. Each kidney houses 1 million units named nephrons. Nephrons role is to create
and concentrate urine, control body salt, water and acid/base equilibrium. When part of a
nephron is damaged, the whole nephron no longer works. The glomerulus, an important
component of the nephron, works to produce large amounts of ultrafiltrate, which is
altered by the rest of the nephron. The glomerulus also serves as a blockade that blocks
blood cells and larger molecules such as protein. The urine that is created flows into
collecting tubules and into the renal pelvis. The renal pelvis narrows into one ureter per
kidney, while each ureter carries urine into the bladder. Urine accrues in the bladder and
then is excreted.
Renal function is the capability of the kidney to effectively remove nitrogenous
wastes from the body. Renal failure takes place when the kidney become incapable to
expel ample amounts of waste. Patients can slow the advancement of their kidney disease
through aggressive hypertension treatment, medications, diet constraints such as sodium
and protein restriction, and glycemic control (Academy of Nutrition and Dietetics). In
most patients, kidney disease attacks the nephrons, which causes them to lose their ability
to filter. The nephrons are normally slowly ruined, and often takes years for patients to
discover that anything is wrong. Factors that contribute to the development of chronic
kidney disease (CKD) include: hypertension, glomerulonephritis, diabetes, polycystic
kidney disease, and congenital anomalies.
Patients are diagnosed with end stage renal disease (ESRD) when their CKD
progresses to the point that waste builds up in the blood, fluid is retained, and their blood
pressure increases. ESRD is defined as a glomerular filtration rate (GFR) of less than or
equal to 10 or 15 with diabetes (Academy of Nutrition and Dietetics). More specifically,
the pathophysiology of ESRD includes: inability to excrete waste products, inability to
maintain fluid and electrolyte balance, inability to produce hormones, and buildup of
levels of nitrogenous wastes. Symptoms of ESRD include: malaise (general feeling of
discomfort, illness), weakness, nausea, vomiting, muscle cramps, itching, metallic taste in
mouth, and/or neurologic impairment.
Management of ESRD includes renal replacement therapy, which can be conduct
in the form of hemodialysis (Hemo) or peritoneal dialysis (PD). Transplant is another
treatment option for ESRD. Hemo makes use of a simulated kidney to clean the blood

and return it to the body. PD cleanses the blood through dialysate, which is funneled into
the abdominal cavity. The contaminants from the blood are carried into the dialysate
through diffusion. Lastly, the dialysate is drained from the body along with the toxins.
A common long-term complication of diabetes is kidney damage. Also known as
diabetic nephropathy or diabetic kidney disease (DKD), this disorder is a result of
vascular defects that supplement diabetes and increases mortality risk. Diabetes is a main
risk factor for ESRD.
High levels of blood sugar make the kidneys work harder to do their job of
filtering, which over time can damage them so that they start to leak small amounts of
protein into the urine. That is why identifying albumin in a urine test means that the
kidneys are damaged. Risk factors that affect kidney disease advancement include
genetics, blood sugar control, and blood pressure. The better a person keeps diabetes and
blood pressure under control, the lower the chance of getting kidney disease. If you have
diabetes, it is important to take steps to keep blood sugar levels in the normal range,
control blood pressure, manage weight, and monitor lab values.
The prognosis for ESRD can be decided based on the patients choice to begin or
postpone dialysis. If the patient chooses to not begin dialysis, the patients diagnosis is
most often terminal. If the patient decides to begin dialysis, they have the capacity to live
a long and full life. From a nutrition stand-point, ESRD patients must pay close attention
to their sodium, fluid, potassium, and phosphorous intake. Lab values are routinely
monitored to make sure patients adhere to their diet and medication regimen.
III.

Patient history: essential hypertension, altered mental status, nausea with vomiting,
muscle weakness, secondary hyperparathyroidism of renal origin, iron deficiency anemia,
end stage renal disease, and anemia in chronic kidney disease.

IV.
Course of hospital treatment: Patient M undergoes dialysis 3 times a week at local
outpatient center.
V.

Nutrition Care
a. Nutrition Assessment
Weight
o 76 KG = 165 LB
Height
o 182.9 CM = 72 IN
BMI
o ((165)/((72)(72)) x 703 = 22.4 KG/M2
o Normal BMI
Ideal Body Weight
o 106+ 6(12)= 178
o 178 LBS
o (165 /178)*100= 93% IBW
Labs
o ALB: 4 (Normal > 3.5)
o CA: 8.9 (Normal 8.5 10.2)

o PO4: 5.3 (Normal 3.5 5.5)

o PTH: 591 (Normal 8-51)
o K: 3.8 (Normal 3.5 5.5)
o Creat: 11.56 (Normal 0.5-1.2)
o HGB: 11 (Normal 13.5 to 17.5)
o Kt/V: 1.38 (Target is > 1.2)
o URR: 70 (Normal > 65%)
Medication
o Calcium acetate- reducing blood phosphate levels
o Nephrovite- combination of B vitamins used to treat or prevent vitamin
deficiency
o Sensipar- calcimimetic agent that increases the sensitivity of the calciumsensing receptor
o Cozaar- keeps blood vessels from narrowing, which lowers blood pressure
and improves blood flow
o Carvedilol- to treat heart failure and hypertension
o Lasix- treats fluid retention
o Pepcid- treat and prevent ulcers in the stomach and intestines
o Travatan- to treat increased pressure in the eye
o Sodium bicarbonate- to relieve heartburn and indigestion
o Lipitor- reduces LDL, while increasing HDL
o Clopidogrel bisulfate- used to prevent blood clots
o Zemplar- man-made form of vitamin D, to treat or prevent overactive
parathyroid gland
o Epoetin alfa- to treat anemia
Nutrition Needs
o Kcal: 2,280 2,660 KCAL (30 35 KCAL/KG)
o Protein: 91.2 G PRO (1.2 G/KG)
o Fluid: 1000 ML or 4 CUPS
b. Diagnosis (PES) Statement
Altered nutrition related lab values related to end stage renal disease as evidenced
by altered Creatinine (11.56) and PTH (591).
Altered GI function related to disease state as evidenced by patient c/o nausea and
vomiting.
Increased nutrient needs related to end stage renal disease as evidenced by patient
receives hemodialysis 3 times per week.
c. Intervention Plan & Implementation
Nutrition related to health/disease: Nutrition education on basic renal diet, high
potassium foods, fluid restriction and snack ideas.
d. Monitoring/Evaluation
Will monitor weight, patient reported intakes, lab values, GI function, renal
function, and POC.
e. Documentation
Completed

References:
http://www.eatright.org/resources/health/diseases-and-conditions/kidney-disease
http://www.heart.org/HEARTORG/Conditions/Diabetes/WhyDiabetesMatters/Kidney-DiseaseDiabetes_UCM_313867_Article.jsp#.V0SfPPkrK00