STAGE 4 KIDNEY DISEASE Case Study Presentation Abby

STAGE 4 KIDNEY DISEASE Case Study Presentation Abby Owsinski Sodexo Dietetic Intern June 9, 2015

OBJECTIVES Define Kidney Disease Differentiate between the stages of kidney disease- Stage 1 through End Stage Renal Failure Present Case Study

WHY KIDNEY DISEASE? Family History Experience Renal Rotation

STATISTICS FROM NKF “ 1/2 of Americans don’t understand that healthy kidneys are responsible for creating urine. ” “ Over 26 million American adults have kidney disease, and most don’t know it. ” More than 40% of people who go into kidney failure each year fail to see a nephrologist before starting dialysis- a key indicator that kidney disease isn’t being treated in its earliest stages. ” “ In 2011, more than 92, 000 Americans died from causes related to kidney failure. ”

KIDNEYS Two kidneys Each about the size of a fist, located on either side of the spine at the lowest level of the rib cage Contain up to a million functioning units called nephrons Major function of the kidneys is to remove waste products and excess fluid from the body Regulate body’s sodium, potassium and acid content Produce hormones that impact other organ function Filter and return to the bloodstream about 200 quarts of fluid every 24 hours

KIDNEY DISEASE Chronic kidney disease is defined as having some type of kidney abnormality or “marker” such as protein in the urine and having decreased kidney function for three months or longer. Stage Four CKD- likely to need dialysis or kidney transplant

SIGNS OF KIDNEY DISEASE Albumin/protein in the urine High blood pressure Ankle and leg swelling, leg cramps Going to the bathroom more often at night High levels of BUN and creatinine in blood Less need for insulin or antidiabetic medications Morning sickness, nausea and vomiting Weakness, paleness and anemia Itching

CAUSES OF KIDNEY DISEASE Diabetes High Blood Pressure Glomerulonephritis Polycystic Kidney Disease Kidney Stones Urinary Tract Infections Congenital diseases Drugs and toxins

RISK FACTORS Age Family history of CKD African American, Hispanic American, Asians and Pacific Islanders

TESTS FOR KIDNEY DISEASE ACR GFR Normal < 30 mg >90 ml/min Stage 4 CKD 30 -300 mg 15 -29 ml/min End Stage CKD 30 -300 mg < 15 ml/min

CASE STUDY TO- 82 year old Caucasian male Ht: 5’ 10” Wt: 182 lbs, 82. 7 kg BMI: 26 Past Medical History: bladder cancer, prostate cancer, hypothyroidism, HTN, peripheral vascular disease, vitamin D deficiency, Stage 4 CKD Family Medical History: Mother and brother passed away from kidney failure ( brother received hemodialysis) Social History: nonsmoker, daily physical activity, no drug use, alcohol on special occasions

KEY FACTORS Lifestyle Family History of interrelated conditions Diet- ethnic foods

INITIAL VISIT Outpatient at St. Lukes in Coaldale Patient not following a diet at home Unaware of dietary restrictions for renal disease Pt has received blood work to test renal labs

FOLLOW-UP VISIT Renal Labs- Slight improvement Dietary Changes- Good Compliance Exercise- more regular exercise Weight Loss- desired loss achieved No symptoms related to CKD reported at this time

MEDICATION LIST Zoladex Ketoconazole Cortef Synthroid Nexium Norvasc Detrol LA Lipitor Calcium +D with Magnesium and Zinc Vitamin D Vitamin B 12 Omega 3 Krill Oil

LAB VALUES TESTED 1/14/15 BUN- 32 H (from 35) CR- 2. 25 H (from 2. 30) GFR- 29. 9 ( from 30. 4) Sodium- 139 (from 141) Potassium- 4. 8 ( from 4. 5) Phosphorus- 3. 6 ( from 3) Calcium- 9. 5 ( from 9. 3) Albumin- 4. 3 ( from 4. 0) Glucose- 96 (from 93)

TREATMENT OPTIONS Dialysis is the only means of taking care of your body’s needs when your kidneys no longer function When should TO consider Dialysis? Dietary Changes ?

DIALYSIS Hemodialysis - Fistula , Graft, Catheter Peritoneal Dialysis Life Expectancy

DIETARY CHANGES Protein Potassium Phosphorus Sodium Sweets

CKD SUMMARY

RESEARCH Early Detection and Screening Treatment Initiation Cost $$$$ Genetics Epidemiology

SUPPORT National Kidney Foundation - Awareness Campaign https: //www. kidney. org/everybodypees Davita - Educational Videos http: //www. davita. com/videos

RESOURCES 1. Levey AS, Coresh J, Balk E, Kausz AT, Levin A, Steffes MW, et al. National Kidney Foundation Practice Guidelines for Chronic Kidney Disease: Evaluation, Classification, and Stratification. Ann Intern Med. 2003; 139: 137 -147. doi: 10. 7326/0003 -4819 -139 -2 -200307150 -00013 2. Ryu, J. , Cha, R. , Kim, D. , Lee, J. , Yoon, S. , Ryu, D. , . . . Investigators, A. (n. d. ). The Clinical Association of the Blood Pressure Variability with the Target Organ Damage in Hypertensive Patients with Chronic Kidney Disease. Retrieved March 30, 2015, from http: //www. ncbi. nlm. nih. gov/pmc/articles/PMC 4101784/ 3. Fishbane, S. , Hazzan, A. D. , Halinski, C. , & Mathew, A. T. (2015). Challenges and opportunities in late-stage chronic kidney disease. Clinical Kidney Journal, 8(1), 54– 60. doi: 10. 1093/ckj/sfu 128 4. Mohebi, R. (n. d. ). Obesity Paradox and Risk of Mortality Events in Chronic Kidney Disease Patients: A Decade of Follow-up in Tehran Lipid and Glucose Study. Retrieved April 1, 2015, from http: //www. jrnjournal. org/article/S 1051 -2276(14)00259 -3/abstract 5. Mahan, K. (2012). Krause's food and the nutrition care process. (13 ed. ). St. Louis, Missouri: Elsevier Saunders. 6. About Chronic Kidney Disease. (n. d. ). Retrieved March 22, 2015, from https: //www. kidney. org/kidneydisease/aboutckd#facts 7. Stage 4 of Chronic Kidney Disease. (n. d. ). Retrieved March 30, 2015, from http: //www. davita. com/kidneydisease/overview/stages-of-kidney-disease/stage-4 -of-chronic-kidney-disease/e/4751