Assignment 7 - Case Study: CKD

Case Study: Chronic Kidney Disease (CKD) – Stage 4 (Pre-Dialysis)

Objectives:

1. Develop a complete Nutrition Care Process (NCP), including a PES statement (Problem, Etiology, Signs/Symptoms).
2. Interpret and analyze lab values related to CKD.
3. Accurately estimate energy and protein needs for a pre-dialysis CKD patient.
4. Create a one-day renal diet meal plan tailored to Mark’s dietary needs.
5. Provide appropriate nutrition interventions, education, and support to improve adherence to a renal diet.

Case Overview:

Patient: Mark, a 56-year-old male, has been diagnosed with chronic kidney disease (CKD) Stage 4 (GFR = 20 mL/min) and is not on dialysis. After initially following a renal diet, he saw improvements but later stopped adhering to dietary and medication guidelines.

He occasionally takes his prescribed medications:

• Lasix (Furosemide) – a diuretic to manage fluid overload.
• Phos-Lo (Calcium Acetate) – a phosphate binder to lower serum phosphorus levels.

Mark was recently hospitalized due to oliguria (low urine output), leg cramps, and pedal edema.

Current Anthropometrics:

• Height: 5’10”
• Current Weight: 190 lbs (86.4 kg)
• Usual Body Weight (UBW): 170 lbs (77.3 kg)

Relevant Lab Values:

Student Deliverables:

1. Nutrition Care Process (NCP) for Mark (ADIME Format), including:

A - Assessment (HABCD):

• History: Medical history, medication adherence, lifestyle habits (e.g., fear of dialysis, dietary compliance).
• Anthropometrics: Height, weight, UBW, BMI, weight trends.
• Biochemical Data: Review of lab values (K, BUN, Creatinine, Ca, Alb, Phos, GFR). - Make sure you interpret them in the chart above.
• Clinical Data: edema etc.
• Dietary History: Analysis of usual intake...

D - Diagnosis (PES Statement):

• Problem: Identify the primary nutrition-related issue.
• Etiology: Underlying cause(s) of the problem.
• Signs/Symptoms: Evidence supporting the diagnosis (lab values, clinical symptoms, dietary intake).

I - Intervention:

• Energy and Protein Needs: Calculate and recommend appropriate kcal and protein intake.
• Dietary Modifications: Adjustments to control potassium, sodium, phosphorus, and protein intake while ensuring adequate nutrition.
• Meal Planning Guidance: Example of a one-day renal-friendly diet (see Part 2)
• Education & Counseling: Support strategies for Mark and his wife on grocery shopping, food preparation, and label reading.
• Medication Adherence Strategies: Ways to ensure compliance with Lasix and Phos-Lo.

M/E - Monitoring & Evaluation:

• What do you want to track and over what period of time? What is the goal?
  • Ex: Weight trend, lab values, symptom improvement, dietary adherence.

2. One-Day Renal-Friendly Meal Plan:

• Meets protein and calorie needs while controlling sodium, potassium, and phosphorus intake.
• Includes appropriate portion sizes and food substitutions for high-risk items.