I have a resident with ESRD on HD. He has an unstableable ulcer on his heel as well as an open wound on one of his toes. The toe now has necrotic tissue with bone probing. He is getting liquid prot shops twice a day. Also super cereal and double portion eggs at breakfast. He typically eats 100%. Just got his dialysis labs back and his alb is low (3.4) however it has steadily improv
Hello, I have a pt who has CKD, no stage specified in MD notes. Cr now 1.18, receiving hydration. Unknown baseline. Hx prostate CA, now noted to have gastric CA. Alb 2.8, requesting a prealb level. What would you suggest for protein estimation? I want to provide ^protein (1.2-1.4g/kg actual wt), however Im unsure if a high protein load will worsen the renal function. Normally I am not too worried
Case " 69 year old of 5 feet 9 inches and 54 kg is admitted with diagnosis of End stage liver disease and Porta caval shunt. His appetite is poor. I have planned for 3 meals with 3 small snacks and + Nutrihep formula powder. Please assit me with how many scoops to be added in initial stage. I planned to provide him 2 drinks of nutrihep powder formula in between as 1 snack + 1 at b
Are there any other renal RDs have to deal with their administrators and nursing putting pressure on you to redraw labs constantly in order to improve especially phosphorus so that the "numbers will look better?"
Hi. I work in a long term acute care hospital and we regularly see patients w/ CKD stages 2-4 with malnutrition - wt loss, poor intake, pressure sores, post op wounds, vascular & diabetic related wounds & needing nutrition support. How would you assess their protein needs? My colleague & I do things differently, she is more “by the book” & goes by 0.6-0.8g/kg. I do 0.8
Hello, I am a renal dietitian with about 85 patients (all hemo except 6 PD), and I work about 25 to 28 hours a week. For those of you in the hemodialysis setting, what percentage of time do you spend in documentation vs. time you spend with the patients? I am spending an estimated 75% of my time in documentation (monthly notes, assessments, and QAPI), and maybe 25% of my time doing education an
Hello! My facility is looking at starting a kidney stone clinic. The dietitian will collaborate with the nephrologists and urologists to provide nutrition education based on the type of kidney stone. Does anyone have any good articles to read or a webinar or anything on this?! I have done some research and started to create an educational piece, but wanted to see if anyone had any other helpful a
I have worked in 3 facilities so far in my career, and I am surprised that Suplena is never a supplement readily available.
It seems impossible to meet kcal needs for my CKD 3&4 pts, while not far exceeding their protein needs with any other supplement. I plan to look into the pricing, I know it is quite a specialized formula.
I'd love to hear what some fellow RDNs think about its
Hello! I am new to dialysis and am trying to increase albumin levels on my patients. Can anyone share any ideas that have worked for their clinics? I think a lot of our low albumins may have to do with fluid overload, so any tips on that is appreciated too!
Does anyone have any good resources for kidney stone MNT. Or anyone very comfortable with the topic? I havent had experience with it before and I am going to have two patients come into clinic needing diet evaluation and education - both have a hx of stones and plan to be kidney txp donors and MD wants me to educate them. Need tips! Thank you!
What would be the protein requirement for a failing kidney txp? I am thinking similar to CKD, around 0.8g/kg however at my job for obese pts we have to use upper IBW- therefore I was thinking of using 1g/kg/uIBW which may equate to ~0.8g/kg/actual body wt. Does any one have any experience with renal txp, that may be able to give me some insight?
Hi, recently I have been working with a lot of pts who have renal disease and pressure ulcers. In regards to those on HD, high protein intake is needed for both wound healing and nutrients lost via HD. One thing I am unsure of is the renal MVI, does this include sufficient vitamin C? or do we need to be recommending an additional vit C supplement to promote wound healing? Second scenario is the p
I currently work at a dialysis center that offers 4 shifts- the last one being a nocturnal shift. The first nocturnal patient starts at 7:30pm and the last one starts at 9:30pm. They are there for a 6 hour treatment.
My question is- do any of you have patients on a nocturnal shift like this? If so- how often do you see them per month? I see them at least once a month for lab reviews, bu
Is there a consensus among renal dietitians regarding the
weight used when estimating kcal and protein needs? I was taught to always use IBW, however it seems more appropriate to use dry weight or adjusted dry weight for obese individuals. Any thoughts?
Hi! I have a outpatient who is currently 15 weeks pregnant, receiving hemodyalisis, has DM type one, chronic constipation and severe gastroparesis and the GI doctor I work with is recommending a purred diet. She receives her dialysis from an outside location so I do not have recent sodium, potassium, phos or other labs. I'm also not sure of her dry wt. Reports a pre-gravid wt of 170 pounds
Does anyone know where I can find the patient education booklet called "Calcification- It Can Happen To You!" ? It is a booklet explaining the process of calcification in CKD patients and shows multiple pictures of calcification sores on people. I cannot seem to find it on the web so far.
I currently work at a Dialysis center and since my colleague left (November 2013) have had a caseload of 170+ pts including nearly 50 PD. My concern, other than the sheer volume, is I am unable to deliver quality service and will make errors. Is there any certified ratio of RD:patient hours required by CMS, I work 40 hours and my requests for more hours have been rejected. My fear is errors will