Kathryn Atwater

Major Case Study #1

ESRD: End Stage Renal Disease

Introduction/Patient Profile

The patient is a 71-year-old Hispanic, white female. She is separated from her

husband and has three children. When first speaking with her, she was living with her

daughter. After follow-up, she discussed how her daughter and her had an altercation,

which led her to start living alone at her old home. She said her “sisters” of the Jehovah’s

Witness faith and neighbor would help her with food and transportation. Her daughter had

been her main means of transportation and food. She completed a primary school level of

education and does not currently work.

Initially, the patient was hospitalized on January 30, 2013 for a chronic CHF

exacerbation and severe anemia. Following lab tests and medical evaluations, it was

discovered that her Chronic Kidney Disease had developed to Stage 5 Kidney disease or

End Stage Renal Disease. A high level of creatinine (5.06 mg/dL) solidified the decision to

immediately start her on hemodialysis. On February 2, 2013, a CVC was placed on her right

chest and dialysis began directly after. She planned to get an AVF placed in her arm as soon

as possible to make her dialysis safer, and more efficient.

Her past medical history had a quite a few ingredients. She has diabetes, but

currently, she is not on any medication to control it because losing 50 lbs. helped to get her

glucose levels WNL without any medical intervention. She also has CKD, hypertension, CHF

(as discussed), Coronary Artery Disease, hypercholesteremia (which also went down with

weight loss), legally blind (as discussed), glaucoma, anemia, and a previous stroke or CVA.

Due to her stroke, she does experience mild memory loss but nothing to where it would

debilitate her from living on her own. She is completely conscious and aware of what is

going on around her. In her family, the only medical history she knows of is of her mother,

as she has not ever really “known” her father. Her mother had a heart attack, diabetes,

kidney cancer, colon cancer, and hypertension. All of her children are in good health

currently and are interested in helping keep her in good health for as long as they can with

diet and transportation to dialysis.

The patient has a pretty “healthy lifestyle” to accompany her current diagnosis. She

is legally blind, which limits her ability to be able to have and keep a job. She attempts light

physical activity throughout the day but due to a previous CVA, she is only ambulatory with

a walker. Over the past year, however, she has made an honest effort to lose weight and

has succeeded in losing approximately 50 lbs. She is only 5 feet tall and currently weighs

118.6 pounds, so losing that amount of weight is clearly beneficial to both her and her

ESRD. Her food intake was largely based on what her daughter brought home for her to eat

so it was difficult to predict exactly what she would have that day as she was not able to

drive to the store and get it herself. She reported having a good sleeping pattern and takes,

on average, one nap a day. Her appetite is good as she is trying her best to follow the “renal

diet” and continue to eat small portions. As discussed previously, her diet depends on what

her daughter brings her to eat after work. Her daughter does not cook much, so leftovers

were something she enjoyed regularly. She eats about three meals a day with one snack.

Currently, she has no tobacco or alcohol use. She previously smoked one pack of cigarettes

a day for 30 years but quit approximately 3 years ago. She did not report any GI problems.

The patient has a good prognosis overall because her lifestyle is on the healthier side and

she is determined to do the best that she can.

Disease Background

End-stage renal disease (ESRD) is either the near complete or complete failure of

the kidneys to function adequately and properly. In this disease, the kidneys are no longer

efficiently working in a manor that will effectively allow you to live your everyday life. The

main etiologies for ESRD within the U.S. are diabetes and hypertension. The damage is

permanent, so treatments are in effort to slow the progression of the disease, not to cure it.

The prognosis of an individual with ESRD is not good if treatment is not sought, in fact, it is

deadly (1).

ESRD is preceded by Chronic Kidney disease. In fact, ESRD is the final stage of CKD,

Stage 5. The pathophysiology is a long line of factors. The kidney is made up of many tiny

little nephrons that contribute to the glomerular filtration rate (2). The glomerular

filtration rate (GFR) measures your level of kidney function. The physician calculates it

using a blood creatinine test, age, race, gender, and other factors. Diagnosis of ESRD is

initially marked by the decreased GFR. Many people have little to no kidney function

meaning their GFR rate is next to nothing with minimal if any urine ouput. The GFR rate,

determines what level of CKD you have:

State 1: Kidney Damage with normal or increased GFR (>90 mL/min)

Stage 2: Mild Reduction (60-89 mL/min)

Stage 3: Moderate Reduction (30-59 mL/min)

Stage 4: Severe Reduction (15-29 mL/min)

Stage 5: Kidney Failure-ESRD (<15 mL/min) (3)

There are also other methods for diagnosis of ESRD. A blood test will determine the

blood cell counts (RBC’s), electrolyte levels (potassium, calcium, iron, etc.), and overall

functioning of the kidney in relation to how a “healthy” kidney functions. Urine tests are

done to determine if there is protein in the urine, which is common in many ESRD patients

(if there is urine output in the individual). An ultrasound can be used to show the size of

the kidney, which typically decreases with ESRD due to not utilizing it fully. A biopsy will

detect abnormal cells to see if there are any other causes for the kidney not functioning to

confirm or rule out ESRD (10).

ESRD, as discussed, is primarily caused by diabetes and hypertension, but it can also be

caused by genetics, extreme trauma to the kidneys, an infection (sepsis), obesity, and

others (8). The following are nutritionally implicated causes. These include

hyperlipidemia, hyperphosphatemia with calcium phosphate deposition, decreased levels

of nitrous oxide, and smoking (3).

There are many symptoms associated with ESRD or Stage 5 Kidney Disease. These

include, but are not limited to, anuria (no urine output) or very little during urine, swelling

primarily in the hands and feet (edema), little to no appetite, nausea, vomiting, confusion,

protein in the urine, headaches, anxiety, restlessness, dry skin, itchy skin, and bone pain

(3,8). Muscle twitching or cramping are a common symptoms due to high levels of

potassium. This is typically in relation to high dietary intake of potassium and the inability

of the kidneys to excrete it properly (3). Other possible, but not as common, symptoms are

easy bruising, metallic breath odor, numbness of the hands or feet, frequent hiccups, and

sleeping issues (9).

Hyperkalemia is often associated with ESRD. It usually only develops when the GFR

falls to less than 20-25 mL/min because as the kidneys decrease in function, their ability to

excrete potassium efficiently also decreases. Usually, this is more visible in a person with a

high potassium diet or people who have low levels of serum aldosterone. Hyperkalemia is

common in individuals who take ACE inhibitors or anti-inflammatory drugs (NSAIDSs).

The level of potassium can increase due to an extracellular shift of potassium that occurs

from a lack of insulin e.g. diabetes patients (3). Hyperkalemia can be life-threatening

depending on the intensity level (>5.5 mmol/L). In patients with ESRD, even a slight intake

of potassium can result in high potassium levels, so restriction of potassium rich foods is

critical. Foods typically high in potassium are bananas, beans, tomatoes, potatoes, fruits,

and grains. High levels of potassium can lead to heart palpitations, nausea, muscle

twitches, and in severe cases the heart will cease to function e.g. death (6).

Metabolic acidosis is also part of Stage 5 kidney disease. As kidney disease

progresses, they are not able to excrete urea produced in protein metabolism through the

urine. In effect, with stage 5 kidney disease, there can be a severe accumulation of

phosphates, sulfates, and other anions e.g. a severe anion gap. This has a major effect on

the body’s protein balance and can cause protein-energy malnutrition e.g. lean body mass

loss and muscle weakness (3). Overall, it causes but is not limited to:

Negative nitrogen balance

Increase protein degradation

Reduced albumin synthesis (3)

The kidney is an important tool for handling the level of salt and water in the body by

excretion. The level of sodium and water in the body are directly related, as sodium levels

increase, more fluid (or water) is retained. Therefore in ESRD, the mechanisms that

control these levels become depreciated and total body volume overload occurs. The body

is no longer able to use the kidneys to excrete excess levels. This will eventually lead to

edema, which is seen in most ESRD patients whom have not yet been treated for their

disease (3).

Anemia is another a common condition in ESRD patients (3). Anemia is the, “absolute

reduction of the total number of circulating red blood cells.” Approximately 44.1% of

people with Stage 5 kidney disease will have anemia. In ESRD, the anemia is due to the

inability of the kidneys to produce proper, if any, amounts of the hormone erythropoietin

(4). Erythropoietin is a hormone that stimulates red blood cell production from bone

marrow (5). In a healthy individual, the kidneys are responsible for 90% of erythropoietin

production (4). As kidney function declines it is accompanied by decreasing erythropoietin

production, which in turn means less RBC production, and anemia results (3).

Dialysis is the main method of treatment of ESRD. Dialysis is a process that filters the

blood to remove toxins and excess fluid, which have built up due the kidneys no longer

doing it themselves. It purifies the blood stream of excess sodium, waste products,

electrolytes, fluids, and other bi-products of the diet and helps to control blood pressure

like the kidneys used to. Without dialysis, toxins will build up in the body and will prove

deadly (11).

There are two types of dialysis. The first, and most common form of dialysis is

hemodialysis. It uses a hemodialyzer to take “dirty” blood out and put “clean” blood back in

(11). This is done through an access point most commonly seen as an AVF (arteriovenous

fistula). This access is created by surgically joining an artery and a vein together. During

hemodialysis, blood enters the dialyzer where it is met with a solution known as dialysate.

Dialysate is responsible for removing the waste products and fluids from the blood (10).

Hemodialysis typically lasts around 3-4 hours and is performed three times a week.

Different flow rates and dialysis lengths exist for each dialysis patient depending on their

diagnosis (11). The second type of dialysis is peritoneal dialysis. This dialysis method is

involves a catheter being surgically inserted into the abdomen of the ESRD patients.

Dialysate solution is then placed within the body cavity through the catheter and uses the

peritoneum as the membrane through which the blood is filtered. Peritoneal dialysis can

either be categorized as “continuous ambulatory peritoneal dialysis” where gravity is the

method of removing the fluid from the abdomen or “continuous cycling peritoneal dialysis”

where a patient attaches to a cycler at night and the fluid is removed while they sleep (11).

There are a few common medicines given to renal patients undergoing dialysis. These

include Epogen, phosphate binders, and Hectoral. Epogen is a drug used in dialysis

patients to stimulate erythropoietin production from the kidneys to reduce anemia (as

discussed earlier). This also usually comes with an iron supplement to aide in the process

(13). Phosphate Binders are used to decrease the amount of serum phosphorus.

Hyperphosphatemia is another condition associated with ESRD because phosphorus is a

larger molecule that cannot be filtered out properly through dialysis. Phosphate binders

attach to the dietary phosphorus ingested in the diet and excrete it through the feces,

without giving it a chance to get into the blood. They are to be taken right at the time of

food ingestion in order to be effective. Detecting phosphorus is difficult because it is not on

the nutrition labels so the binders are to be taken, no matter with all food (7). Hectoral is

an active form of Vitamin D known as doxercalfierol. It is used to lower PTH levels, which

are commonly high common ESRD patients (1,13).

A specific diet is prescribed for ESRD patients, whether on peritoneal dialysis or on

hemodialysis.

Table 1. Renal Diet (12)

Hemodialysis Peritoneal Dialysis

Energy (kcal/kg SBW) 30-35 30-35

Protein (g/kg SBW) Greater than or equal to1.2 1.2 -1.3

Phosphorus (mg/kg SBW) 800-1000 800-1000

Potassium (mg/d) 2000-3000 3000-4000

Sodium (mg/d) 2000-3000 2000-3000

Fluid (mL/d) 750-1000 2000

A “Renal Diet” is prescribed and extremely important in maintaining a high quality of

life. This diet that has 4 main factors, with the recommended amounts listed above. First,

they are to limit their phosphorus intake. As stated previously, it can cause calciphylaxis or

hardening of the bodies soft tissues. High levels of phosphorus can pull calcium out of the

bones, make the bones brittle, cause itching, and create calcium deposits in the arteries and

on bones. High phosphorus foods include dairy, diet colas, convenience store foods, and

many others. Next, they need to limit their potassium intake. High potassium can cause the

heart to beat irregularly and in severe cases, stop. High potassium foods include fruits and

vegetables so patients need to be aware of portion sizes and which varieties are higher

than others. The third is protein. Depending on the patient’s level of protein, high or low,

the protein intake is adjusted higher or lower. Protein is important for muscle repair,

creation of antibodies to fight off illness, and keeping the nervous system functioning. Too

high of protein can result in urea build up in the blood which is bad, but too low can result

in higher affinity to sickness e.g. monitoring is crucial. The third category is fluids. Without

being able to excrete fluids through urination the fluids begin to build up in the body and

can cause swelling, high blood pressure, and lethargy (15).

The resident of this case study was diagnosed with End-Stage Renal Disease on

February 3, 2013 after initially being hospitalized for a CHF exacerbation and severe

anemia. She understands her diagnosis and reasons for treatment and wants to do

everything she can to make dialysis as enjoyable as possible. Her dialysis prescription is as

follows:

Type: Hemodialysis

Days: M-W-F

Treatment Length: 2.5 hr

BFR: 350 mL/min

Dialysate Flow Rate: 800 mL/min

Access: CVC catheter – Jugular (Right)

Average Fluid Gain: 1.6 kg

EDW: 52 kg

Current Admission

The patient’s main diagnosis is Stage 5 Renal disease or End Stage Renal Disease.

During her hospitalization for a CHF exacerbation and severe anemia on January 30, 2013,

it was established that her Stage 4 CKD had progressed to Stage 5 through her high serum

creatinine level of 5.06 mg/dL. Immediately, on February 2, a CVC or Central Venous

Catheter was placed in her right chest and she started on hemodialysis. She was also

placed on intravenous Epogen to stimulate red blood cell and hemoglobin production and

reduce her anemic level. On February 20, 2013, she began dialysis treatment at DaVita

Riverpark Dialysis Center.

Upon being admitted to DaVita, the patient was on and additionally prescribed

many medications. Table 2 is a list of these medications, their use, and possible drug-

nutrient interactions:

Table 2. Medications (16)

Medication Use Drug/Nutrient Interactions

Acetaminophe

n

Pain Reliever/Fever reducer BP medication, cholesterol medication,

antibiotics, etc

Nifedipine Reduce BP/reduce angina Grapefruit products

Clonidine Reduce BP Alcohol

Primvastatin HMG CoA reductase inhibitor, or,

statin, reduce LDL and increase HDL

Alcohol, grapefruit products, other statins,

spironolactone,

Docusate Stool softener n/a

Escitalopram Antidepressant Alcohol; Cold or allergy medicine, narcotics,

sleeping pills, muscle relaxers

Medication Use Drug/Nutrient Interactions

Lisinopril Ace-Inhibitor/reduce BP/treat CHF Alcohol, salt substitutes, other BP

medications, potassium supplements

Tramadol Pain reliever Alcohol, antidepressants

Clonidine Reduce BP Alcohol

Tums Phosphate binder, calcium

supplement, indigestion

n/a

Epogen RBC production n/a

Hectoral Decrease PTH levels Magnesium containing antacids, digoxin

Nutrition Care Process

The patient’s primary diet order was a renal diet. She is also prescribed a low fluid

intake due to her CHF and a carbohydrate controlled diet in effort to keep her diabetes in

control. It had already gone down to a level not requiring medical therapies due to her 50-

pound weight loss.

Table 3 outlines the patient’s anthropometrics.

Table 3. Anthropometrics

Amount

Height 60” (5 ft)

Weight 53.8 kg (118.4 lb)

IBW 54 kg

% IBW 99.6%

BMI 23.11

Table 4. outlines the patients Biochemical Labs. The high (H) or low (L) values are noted,

however, they are marked high or low based of what would be considered “normal” for a

healthy person. For dialysis patients, the lab values are not expected to be within the

normal range, but a range that has been calculated for dialysis patients (12).

Table 4. Biochemical Labs

Patient Normal Dialysis Rec.

Calcium (mg/dL) 7.6 (L) 12-16 8.4-10.2

Potassium (mEq/L) 4.2 3.5-5.0 3.5-5.5

Phosphorus (mg/dL) 5.2 (H) 2.5-4.5 3.0-5.5

Sodium (mEq/L) 138 135-145 135-145

Hemoglobin (g/dL) 9.8 (L) 12-16 10-12

Ferretin (ng/mL) 1217 (H) 3-151 200-500

PTH – Intact (pg/mL) 333 (H) 10-65 150-600

Albumin (g/dL) 3.4 (L) 3.5-5 Min: 3.5 Opt: 4.0

Hb A1c (%) 6.2 (H) 4.4-6.1 Less than 7.0

Glucose (mg/dL) 172 (H) 70-105 80-180

URR (%) 76 - 65 or above

Creatinine (mg/dL) 4.38 (H) 0.8-1.6 2-15

The patient’s current diet was primarily based off of what her daughter brought

home each day. When she lived with her daughter, each day her daughter would bring

home dinner for the patient from wherever she decided to go that night. She would tell her

daughter what was acceptable within the “Renal Diet” but many times her daughter would

not exactly adhere to it. Her daughter said it was because she was “still learning.” Her

daughter cooked dinner on Wednesdays and Sundays but every other night she purchased

a form of take-out. She did however, purchase different snacks and do all of the grocery

shopping for the home so her mother was not without food throughout the day. The

patient said she usually had three meals a day two small snacks. For her 24-hour recall she

reported having 2 eggs over-easy with a slice of bread and a teaspoon of butter for

breakfast. For lunch, she had leftover Chinese food consisting of pepper chicken with snap

peas, red peppers, and carrots with a half cup of white rice. For dinner, she reported not

having anything because her daughter did not bring anything home that day and she was

tired. Her two snacks were one Mexican cookie and a half of an apple. The diet she

reported was fairly close to her recommendations, but not eating dinner is not

recommended. Nutrition in dialysis is one of the key components to staying healthy, so

eating three meals and getting adequate nutrient intake is crucial. Being that she was

legally blind, she was not able to drive to the grocery store herself and preparing meals was

extremely difficult so it was primarily up to her daughter to do it for her.

The prior Medical Nutrition Therapy, if any, for this patient is unknown. This, in

return, means that the evaluation of the outcome of this therapy is not known nor what her

nutrition status was prior to her admission. The only values that are known are what was

tested and recorded at the DaVita facility upon admission.

When she was admitted to DaVita, her lab values were clearly skewed. However,

none of the values were of severe concern. For someone just starting hemodialysis, the

levels were common. Her BMI is within normal range so her weight is not an issue. She is

of normal risk for someone with End Stage Renal Disease. The only risk she had was due to

the fact that her diet was primarily in the hands of her daughter who needed more

education on the renal diet. It was planned that her daughter meet with the dietitian at a

later date to discuss her mother’s specific needs further.

Table 5 outlines the patient’s specific macronutrient needs.

Table 5. Macronutrient Needs

Amount

Energy 1550-1600 kcal

Protein 60 g

Phosphorus 800 mg

Potassium 2000 mg

Sodium 2000 mg

Fluid 1000

Note: The typical phosphorus prescription is 1000 mg but due to her small frame, she is

prescribed a lower recommended amount. The typical fluid prescription is 1500 mL but

she is on a physician ordered low fluid intake secondary to her diagnosis of congestive

heart failure.

The PES statement for the patient is as follows: Limited kidney function related to

end stage renal disease as evidenced by low serum calcium, anemia, low serum protein,

high serum phosphorus, high PTH, and high serum creatinine levels.

A nutrition intervention and care plan was established for this patient. First, the

patient was instructed to take Tums as a phosphate binder to decrease her high serum

phosphorus level and also put on a lower phosphorus diet. Next, the intravenous level of

Hectoral dosage prescribed at the hospital was increased in effort to decrease her PTH

level. Then, her dosage of Epogen prescribed at the hospital was also increased to further

relieve her anemia and increase her hemoglobin level. Finally, it was recommended that

she undergo evaluation and surgical procedures to create a fistula access point. Overall,

the patient was instructed to adhere to her renal dialysis diet prescription. Labs are to be

drawn monthly so after receiving her next set of results, more MNT can be provided.

Her follow-up was very insightful. Due to her anemic levels, a hemoglobin test was

administered every few weeks at the DaVita clinic. The final test results indicated that her

hemoglobin level increased to 10.9 g/dL so her Epogen dose was reduced as she was now

within the recommended dialysis level. She also underwent the surgical procedure for a

fistula on March 14, 2013. It was also communicated that due to an altercation with her

daughter, she had moved out of her daughter’s house and was now living on her own. She

instructed that her neighbors and Jehovah’s Witness sisters would be providing her with

meals, groceries, and transportation to dialysis. It was of concern because new people

aiding with care would require education on what was acceptable for the renal diet. Plans

to consult them on the diet were being created. She is completely cognitive and alert so

living alone is legally acceptable and all necessary precautions and measures were being

taken. Overall, the patient’s labs and physical state were acceptable. She was only gaining

approximately 1.6 kg between treatments and reaching her EDW of 54 kg each time. The

prognosis for her is extremely positive if she continues to adhere to her guidelines.

Summary

End Stage Renal Disease is a disease that is irreversible, even with a transplant. A

transplant kidney only lasts, on average, 5-10 years. It is only a treatment just as dialysis is

a treatment. The goal of treatment is to slow the progression of the disease. Dialysis is a

necessary treatment in order for these patients to live. Without it, toxins will build up in

the body and the disease will prove deadly. Nutrition is a key component to maintaining

optimal physical status and providing the smoothest treatment possible. Maintaining

proper lab values is crucial and without MNT, this would not be possible.

This patient was a compliable and pleasant individual. She seemed to know and

understand the necessary requirements of her dialysis treatment and was willing to try to

adhere to them as much as possible. I was able to stress what was important to her and

feel comfortable that she understood what I was communicating to her. Knowing that she

had the self-discipline to lose 50 pounds gave me all the confidence that she would be just

fine and compliant with her treatment. I did become concerned when she moved out of her

sisters house, but I am confident people will help her find the necessary means to continue

the positive path she is on. She has a positive attitude and a positive prognosis.

Glossary of Terms

1. A-V Fisula (AVF): Arteriovenous fistula; surgical connection of artery & vein in order to make an access point for hemodialysis patients

2. A-V Graft (AVG): arteriovenous graft; used if a fistula cannot be done; synthetic tube surgically placed under skin to act as a vein and provide an access point for hemodialysis patients

3. Albuminuria: Albumin or protein in the urine

4. Anemia: deficiency of red blood cells or hemoglobin in the blood

5. BFR: Blood flow rate through dialysis tube

6. CAD: Coronary Artery Disease; stage of atherosclerosis where fatty deposits build up on artery walls

7. Calcitriol: oral active for of vitamin D used to absorb excess calcium from intestines

8. CAPD: Continuous ambulatory Peritoneal dialysis; exchanges done 3-5 times during the day and once at night by the use of gravity (no machine necessary)

9. Catheter: Piece of equipment blood goes through for dialysis; in hemodialysis the catheter can be placed in many areas but in peritoneal dialysis the catheter is placed in the abdomen

10. CCPD: Continuous Cycling Peritoneal Dialysis; patients hook to a “cycler” machine that makes the exchanges automatically, throughout the night, for 8-10 hours.

11. CHF: Congestive Heart Failure; failure of the heart to pump with normal efficiency

12. CKD: Chronic Kidney Disease

13. CVC: Central Venous Catheter; temporary hemodialysis access located in chest wall going directly to heart

14. DFR: Dialysate Flow Rate; rate at which the dialysate flows through the dialyzer to filter out molecules

15. Diabetes Mellitus: deficiency of the pancreas to produce the hormone insulin, therefore the body is unable to metabolize glucose brought into the body from the diet; marked by high levels of serum glucose

16. Dialysate: The material that passes through the membrane in dialysis and usually contains substances that diffuse easily in solution; primarily comprised of dextrose

17. Dialysis (medical definition): either of two medical procedures to remove wastes or toxins from the blood while adjusting fluid and electrolyte imbalances by utilizing rates at which substances diffuse through a semipermeable membrane; dialysis acts as the artificial kidneys

18. Dialyvite: Renal Vitamin

19. Edema: condition of abnormally large fluid volume in the circulatory system or in tissues between the body's cells

20. Epogen: erythropoietin stimulating hormone to increase red blood cell production in bone marrow

21. Ferrous Sulfate: oral iron supplement

22. GFR: Glomerular Filtration Rate; best measure of kidney function; flow rate/how well a kidney filters fluid

23. Glaucoma: a condition of increase pressure within the eye, causing gradual decrease of sight

24. Hectoral: active Vitamin D used to decrease parathyroid hormone levels

25. Heparin: blood thinner used to prevent blood clots

26. Hypercholesteremia: High cholesterol levels within the blood

27. Hyperkalemia: Elevated blood potassium level

28. Hypertension: High blood pressure

29. ICHD: In center hemodialysis; hemodialysis done 3 days a week in a dialysis center

30. Kt/V: Dialysis adequacy; in general, how well dialysis is working

31. Nepro: Calorie supplement for dialysis patients

32. Phosphate Binder: Group of drugs used to reduce the absorption of phosphorus and phosphate associated with dietary intake; to be taken with meals

33. PhosLo (Calcium acetate): phosphate binder; drug used to treat hyperphosphatemia

34. Renvela: Phosphate binder; drug used to treat hyperphosphatemia

35. Sensipar (Cinacalcet): drug used to decrease parathyroid hormone levels when hectoral is not beneficial anymore(comprised of calcium so only used when calcium levels are low

36. Target (dry) weight: EDW; weight without fluid; post-dialysis weight goal

37. Tums (Calcium carbonate): phosphate binder: first step in reducing high levels of phosphorus (after diet); also used as antacid for indigestion and heartburn

References

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