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What is the mortality of CVD with Renal Dz?

-More likely to die from CVD than progress to stage 4 CKD
-Approx. 50% deaths due to CVD in HD & PD pts.
-NO Statin drugs with Dialysis
-High rates: Heart failure, LVH, atherosclerosis
-Accelerated atherogenesis with dialysis


What are the “non-traditional” risk factors with dialysis?

-Abnormalities in lipid metabolism
-Ca & P imbalances
-Vascular Calcification
-Oxidative stress/ inflammation


Why is CRP elevated with dialysis?

-reflects pro-inflammatory cytokines which predict decreased ser alb/ assoc. with malnutrition in dialysis
-Assoc. with increased CV mortality


What is the additional MNT recommendation with CVD and dialysis?

-Additional MNT recommendations: omega-3 foods twice/week


What can Secondary Hyperparathyroidism (SHPT) progress to?

-Can progress to severe, intractable forms of bone disease
-Phosphorous is NO longer being removed
-Parathyroid gland may need to be removed to limit complication’s


What is Osteitis Fibrosa?

**Prolonged PTH exposure
-Rapid bone turnover
-Excess collagen/ inadequate mineralization
-More prone to fracture
-Vascular & soft tissue calcification


How is SHPT managed?

-Restrict dietary phosphorus
-Phosphate binders
-Vitamin supp. (oral or IV)- dosed to prevent over/under suppression of PTH
-Close monitoring serum levels


What causes Anemia with Renal Dz?

Low Hgb due to:
-Inadequate synthesis
-Blood loss w/ HD


How is anemia treated?

-Treatment with rHuEPO and iron
-Administration IV or SC- HD vs PD
-Adequate Fe important


What can result from EPO unresponsiveness?

-Fe deficiency
-Chronic inflammation
-Chronic blood loss
-Folate / B12 deficiency


What are sources of IRON for with Peritoneal Dialysis?

-Ferrous gluconate
-Ferrous sulfate
-Ferrous fumarate
-Polysaccharide-iron complex
-Heme iron polypeptide


What must be considered with iron supplementation?

-Directions for administration
-Effect of Fe stores on absorption
-Side effects of oral Fe supplements


What is Parenteral Nutrition?

-Feeding a person intravenously, bypassing the usual process of eating and digestion. The person receives nutritional formulae that contain nutrients such as glucose, amino acids, lipids and added vitamins and dietary minerals.

-When it was developed: 1960’s
-Alternate names: TPN, CVN, IVH


What is Peripheral Parenteral Nutrition?

-Provided through a PERIPHERAL VEIN → amino acids, electrolytes
-More dilute, lge volume solutions than TPN


What is Total Parenteral Nutrition?

-Provided through a CENTRAL VEIN
-Large Volume of blood can dilute conc.
-Provides Amino Acids, Dextrose, Lipids, Electrolytes, MVI


What formula is used for PPN?

-formula via IV – peripheral vein;
-Used for
1. maintenance electrolytes
2. improved nitrogen balance in mildly catabolic patients


What is provided by 1 liter of ProcalAmine?

-29 g protein
-130 kcals
-Standard electrolytes
-735 mOsm


When should TPN be used?

For FLUID RESTRICTED patients who cannot be fed via GI tract (food or EN) = MUST use TPN

-This is because:
1. Decreasing the fluid will increase the osmolarity = inappropriate to use PPN
2. PERIPHERAL veins are SMALL = must limit to 900 mOsm/L.
3. CENTRAL veins are much LARGER and can handle much higher osmolarity.


What are Normal Saline IV Fluids?

NS = normal saline
— Contains 0.9% NaCl in water
— 280-300 mOsm/L


What are D5W IV Fluids?

D5W = 5% dextrose in water
— Provides 50 g dextrose/L
— 250 mOsm/L


What are D5W 1/2 NS IV Fluids?

D5W ½ NS = 5% dextrose in ½ normal saline
— Contains 0.45% NaCl
— Provides 50 g dextrose/L
— 400 mOsm/L


What must be considered with IV Fluids?

Osmolarity from IVFs may count toward osmolarity for PPN → if the IVFs and PPN are going into the same vein!


Why can water NOT be used in IVs?

**FYI – pure water CANNOT be used for IVFs because the osmotic pull of fluid into RBCs would cause the cells to swell and burst


What should be considered when determining needs for PN?

1. Functional GI tract?
2. Are complete nutrition needs being met via oral diet or TF?
3. Can patient afford to wait to see if oral/TF is possible before initiating PN?
4. Does patient already have a central line? (Could be the difference between choosing PPN and TPN)


What are the needs for patients on PPN?

-Patient needs supplemental nutrition now, but EN not feasible/ risk for TPN is too high
-PN needed for 2 weeks or less
-Adjunct to oral/enteral feeds (complete needs can’t be met via GI tract)
-*ProcalAmine is sometimes an easy option if you only need to sustain your patient for a few days


What are the needs for patients on TPN?

-Oral/EN likely not feasible to meet full nutritional needs > 2 weeks
-Need for nutrients outweighs risks of TPN (severe protein-energy malnutrition)


What medical conditions would warrant used of PN?

-Short bowel syndrome
-Small bowel resection
-Bowel obstruction
-Intractable vomiting
-Risk for aspiration – even with EN (rare)


What nutrition diagnoses would require PN use?

-Altered GI function
-Impaired nutrient utilization
-Inadequate/excessive parenteral nutrition infusion (use only when changing infusion)