Term
| What percentage of instilled dextrose is typically absorbed from PD with a 6-hour dwell time? |
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Definition
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Term
| What are causes of pre-renal AKI? |
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Definition
Hypovolemia (volume loss, hemorrhage)
Cardiovascular failure |
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Term
| How does AKI affect metabolism? |
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Definition
| AKI patients are both hypermetabolic and hypercatabolic |
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Term
| How does CKD affect vitamin D metabolism? |
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Definition
| Less vitamin D is converted to active form (1,25) |
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Term
| Do patients on PD lose protein through the dialysis process? |
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Definition
| Yes, and losses can be significant (5-24 g/day) |
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Term
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Definition
| SLED is a modified HD treatment that uses low blood flow rates, low dialysate flow rates, and an extended dialysis time of usually 8 to 24 hours. It can achieve adequate solute and volume removal while causing less hemodynamic instability than conventional HD, and it doesn't require special equipment other than the standard HD equipment. |
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Term
| What is the difference between CVVHD and CRRT? |
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Definition
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Term
| What are the estimated protein needs for SLED? |
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Definition
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Term
| What are the estimated energy and protein requirements for patients on CRRT? |
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Definition
30-35 kcal/kg
1-2.5 g protein/kg |
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Term
| How should caloric provision by dialysate solutions in CRRT be handled? |
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Definition
| The dextrose load provided by dialysate should be calculated and EN or PN should be adjusted accordingly. If using PN, the dextrose load can be subtracted from the dextrose to be provided from PN |
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Term
| What type of micronutrient intake should EN/PN patients on CRRT receive? |
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Definition
Standard adult doses of lytes/micronutrients may be required in EN patients on CRRT.
PN patients on CRRT should receive standard vitamin and mineral packages. |
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Term
| What lab value should be used to assess renal function? |
|
Definition
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Term
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Definition
UNA is a measure of protein degradation in patients with renal failure. It is used to calculate protein balance in patients with renal failure because their urinary nitrogen output is typically very low and can't be used to quantify nitrogen loss.
TNA is an equation that attempts to account for all nitrogen output including urinary, fecal, change in BUN, and hemodialytic losses |
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Term
| What is the GFR limit for controlling acid-base balance? |
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Definition
| With a GFR <30, several mechanisms for controlling acid-base balance are ineffective |
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Term
| Why is anemia common in renal failure? |
|
Definition
| Decreased erythropoeitin production |
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Term
| What are the guidelines for lipid calories in patients with CKD? |
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Definition
| Excess lipid calories should be avoided to minimize risk of hypertriglyceridemia caused by diminished clearance rates in CKD |
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Term
| What are the estimated energy needs for ARF/CRF/PD/HD/CRRT? |
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Definition
ARF: Harris Benedict or 35-50 kcal/kg
CRF: Harris Benedict or 35-38 kcal/kg
Everything else has the same estimated needs |
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Term
| What are the estimated protein needs for Predialysis/PD/HD/CRRT? |
|
Definition
CKD: 0.6-0.8 g/kg
AKI: no restriction, whatever is appropriate given patient's condition
PD: 1.2-1.3 g/kg; up to 1.5-1.8 g/kg
HD: 1.2-1.3 g/kg; up to 1.5-1.8 g/kg
CRRT: up to 2.5 g/kg |
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|
Term
| What is the sodium range (in mEq/L) that should be used for renal failure patients on PN? |
|
Definition
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|
Term
| What is the potassium range (in mEq/L) that should be used for renal failure patients on PN? |
|
Definition
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|
Term
| How much glucose is delivered during HD, and is it considered nutritionally relevant for nutrition support? |
|
Definition
| About 30 g of glucose is delivered during HD and it is generally not considered relevant for nutrition support regimens |
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|
Term
| Have specialized amino acid mixtures shown benefit for AKI? |
|
Definition
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|
Term
| How does renal failure affect acid-base balance? |
|
Definition
| Acidosis occurs due to loss of normal acid excretion or loss of bicarbonate |
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|
Term
| How should metabolic acidosis in the context of renal failure be treated? |
|
Definition
| Bicarbonate therapy is recommended for patients with CKD or ESRD who have bicarbonate <22 meq/L |
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|
Term
| How does CKD affect water-soluble vitamin status? |
|
Definition
| Surprisingly, water-soluble vitamins tend to be deficient in CKD |
|
|
Term
| What are the recommendations for water-soluble vitamin supplementation in patients on dialysis? |
|
Definition
| A water-soluble vitamin supplement should be given to patients on renal-restricted diets |
|
|
Term
| What is the relevance of aluminum in regards to CKD? |
|
Definition
| CKD can cause aluminum toxicity. Intake should be restricted. Toxicity is less common now that dialysates are made with aluminum-free water and aluminum-based phosphate binders have been phased out |
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|
Term
| What is the goal lab status for iron supplementation in CKD/ESRD? |
|
Definition
| Ferritin >100 and TSAT >20% |
|
|
Term
| Should iron be given to septic patients? |
|
Definition
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|
Term
| How should vitamin dosing be adjusted in renal failure patients on PN? |
|
Definition
| Water-soluble vitamins should be given, but fat-soluble vitamins (except K) should be restricted in short-term PN |
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|
Term
| How should trace elements be adjusted in patients with AKI? |
|
Definition
| Trace element supplementation is not necessary in patients with AKI who receive blood products or in those in whom oral intake is restricted <2 weeks |
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|
Term
| How should trace elements be given to patients with AKI? |
|
Definition
| Trace elements should be given to patients with AKI once every 1-2 weeks |
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|
Term
| What is IDPN? What is its advantage? |
|
Definition
| Intradialytic PN is PN during dialysis. The advantage is that the volume provided through PN can be removed immediately via ultrafiltration |
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|
Term
| Is IDPN recommended for frequent use? |
|
Definition
| No, it should only be used as a last resort due to expense and risks |
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