renal research project chelsea cordes. chronic kidney disease function of the kidneys: excretory...
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Renal Research Project
Chelsea Cordes
Chronic Kidney Disease
Function of the kidneys:
Excretory
Acid Base Balance
Endocrine
Fluid and Electrolyte Balance
Causes of the disease:
Cancer
Hereditary
Uncontrolled DM and HTN
Treatment:
Transplant
Hemodialysis
Peritoneal Dialysis
Nutrition Implications of CKD
Protein: Needs dependent on stage of disease
Phosphorus
Potassium
Sodium
H2O
Purpose of ResearchScholarly project observing PO intake of hospitalized CKD pts in comparison to pts on a liberal diet.
Objective: Determine if there is a significant difference in PO intake.
Necessity:
Practicality of the renal diet is unclear.
Diagnostic significance of undernutrition is widely understood.
Protein Energy WastingPEW: abnormally low
levels/excessive losses of body protein mass and energy reserves.
More frequently CKD patients are exhibiting signs of PEW in the early to moderate stages of the disease.
Affects >20-25% of CKD population.
Result of: hyper-catabolic state, declining appetite, and activation of pro-inflammatory cytokines.
Study suggest PEW in CKD results in adverse clinical consequences.
Issues with the Renal Diet
Patient Compliance (leads to decline in quality of life).
Further exacerbations of PEW.
Pts feel: depressed, frustrated, uncertain about what meal plan is ideal.
Renal diets are considered “difficult to integrate into daily life, especially in regard to family and social occasions”.
Downside of Liberalization
Many still oppose the idea of liberalization:
The therapeutic approach to liberalizing protein/phosphorus intake is young and lacks significant supporting evidence.
Potential toxic components of high protein diet are of concern.
Why Research is Necessary
Relevance to the VA
Many veteran CKD patients are categorized as undernourished with prominent PEW.
Many veterans have issues with diet compliance as they are financially and physically dependent on others for care.
Goal of Research
1. Asses the PO intake of CKD diet patients verses liberal diet patients.
2. Compare overall patient satisfaction both pre and post
implementation of a one week menu cycle of each group.
MethodsProspective Quality Initiative Study aiming to inspire quality improvement in the current HD/Renal Diet at the MVAMC.
Goal: Prove liberal diet pts eat more than CKD diet pts due to being more satisfied with NFS.
Data Collection: Plate Waste Study of 25 CKD pts and 25 Liberal Diet pts.
Variables: anthropometrics, co-morbidities, length of stay, and difference in feeding behaviors.
Limitations: pt dentition, pt mental status, pt ability to self feed, secondary symptoms (N/V/C).
Baseline pt satisfaction pre and post implementation of 1 week menu cycle in both groups.
Subjects
25 MVAMC pts on CKD diets ages 65 or older
25 MVAMC pts on liberal diets ages 65 or older
Data AnalysisPlate Waste will be main means a data collection.
Plate waste carried out by subjective judgement of one surveyor.
Results were recorded in increments of 25%
Pt satisfaction will be determined on a scale from 1 to 5 based on 3 phrases:
“My meals taste good”
“My meals look good”
“My overall rating of Nutrition and Food Services is excellent”
Patient Satisfaction Survey
ResultsPost 1 week cycle implementation results showed:
“My meals taste good”: CKD 2.92 vs Liberal 3.48
“My meals look good”: CKD 3.4 vs Liberal 4.36
Overall Satisfaction: CKD 3.88 vs Liberal 4.36
Results of Pt Satisfaction
Survey Statements
Rati
ng
Plate Waste Results
CKD patients ate on average 42% of their mid-day meal.
Liberal diet patients ate on average 62% of their mid-day meal.
Patient Comments
““Rice and Rice and noodles are too noodles are too
hard”hard”
““I wish I had I wish I had
something something
other than juice other than juice
to drink”to drink”
““This food doesn’t This food doesn’t agree with me”agree with me”
““Some changes need Some changes need to be made to this to be made to this
diet”diet”
““Needs Needs more more
flavor”flavor”
““Don’t know Don’t know what the what the
complaining is complaining is about, tastes about, tastes
fine”fine”
DiscussionCKD nutrition requirements: 30 to 35 kcal/kg.
Current Renal diet provides 2000 kcal, current HD diet provides 2600 kcal.
At 42% typical consumption, pts only getting 840-1092 kcal and 22-38 g of protein per day.
Example Pt
5’10” male renal pt weighing and ideal wt of 166 lbs
Meeting 37% of his kcal needs (2263 kcal lower end)
Meeting 49% of his protein needs (45 g lower end)
This caloric deficit could lead to unintentional wt loss of greater than 2 lbs per week of lean muscle mass.
SolutionsConducting more valuable conversations/test trays on the renal/HD diet.
Utilizing/adapting recipes to renal friendly ones such as those found on the Davita website.
Considering expanding from a 1 week cycle to a greater length for CKD pts to offer more variety.
Chicken Fajitas with Pineapple SalsaDiet types:1Dialysis2Diabetes
Portions: 4 Serving size: 2 fajitas and 2 tablespoons salsaIngredients■8 flour tortillas, 6" size
■2 tablespoons canola oil
■12 ounces boneless, skinless chicken breast
■1/4 teaspoon black pepper
■2 teaspoons chili powder
■1/2 teaspoons cumin
■2 tablespoons lemon juice
■1/4 cup chopped green pepper
■1/4 cup chopped red pepper
■1/2 cup chopped onion
■1/2 cup chopped cilantro
■1/2 cup Pineapple Salsa
Renal and renal diabetic food choices■3 meat
■2 starch
■1 vegetable, low potassium
■1/2 fruit, low potassium
http://www.davita.com/recipes/
Example HD Menu
LimitationsLength of stay
Variance in mid-day meal recorded
Small sample size
Variance in meal prep
Lack of an objective tool for measuring plate waste
Possible bias, all aspects of research by one source
Variables such as: anthropometrics, co-morbidities, feeding behavior, patient dentition, patient mental status, patients ability to self feed, and secondary symptoms present
ConclusionsPts on liberal diets eat 20% more of their mid-day meal than pts on CKD diets.
Examination of pt satisfaction results suggest this deficit may possibly be related to patient satisfaction.
It could be assumed that CKD patients are generally less satisfied and are consuming less in total due to the changes from a 3 week menu cycle to a 1 week menu cycle and the resulting limited variety of food choices offered on the CKD diets.
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