Sample Paper on Nutrition Therapy – End Stage Renal Disease

Why did Mr. D’s kidneys fail (requiring dialysis)?

The reasons causing Mr. D’s kidney failure can be deduced from his friend’s account after finding Mr. D unconscious in his apartments. Mr. D reported negligence of not taking his insulin shots and failing to check his blood sugar intentionally in a bid to lose weight fast could be the reason. Oher reasons behind the kidneys failure upon medical admission could be high blood sugar levels, above 700mg/dl, despite already being in the pre-dialysis stages of kidney disease. Nevertheless, the real culprit is his several recorded diabetic ketoacidosis (DKA) episodes.

Why was Mr. D’s risk for developing End Stage Renal Disease (ESRD) higher compared to other type 2 diabetic patients?

Generally, diabetes is the primary cause of End Stage Renal Disease (ESRD). This disease is the last stage of chronic kidney disease. Essentially, one requires either constant dialysis or a transplant to stay alive at this stage. The disease may also be caused by several other factors including kidney stones blocking urinary tract, prostate enlargement and other birth abnormalities. Mr. D’s risk of developing ESRD was higher than other type 2 diabetes patients because his calories consumption was high, at 1800, while he skipped his insulin shots, and he was a heavy drinker causing his pancreatic function to decline and his insulin resistance to increase.

What caused Mr. D’s excessive weight loss from age 33 to 47? (Diabetes diagnosis to the start of dialysis?)

Mr. D’s behavior of skipping his insulin shots can be blamed for his weight loss. Diabetic persons with insufficient insulin suffer from the inability to absorb glucose from their blood c into their bodies. This resultantly leads to the body burning fat ad muscles for energy causing rampant and sudden weight loss.

What contributed to the 15% weight loss in since he started dialysis? (One year ago).

Dialysis is a complex process that involves removing excessive fluid gain from a diabetic patient’s body. Mr. D’s delay in starting his dialysis treatment may have caused an accumulation of fluid over time because his kidneys could no longer get rid of this fluid. The removal of this built up fluid may be responsible for Mr. D’s 15% weight loss in his dry weight since starting his dialysis. The removal of fluid caused serious dehydration in Mr. D as shown by his complains of feeling nausea and vomiting after dialysis. This dehydration in turn orchestrated his dry weight loss.

Choose several applicable nutritional diagnoses phrases/nutrition problems from the Nutrition diagnosis list in Chapter 11 (Box 11-1). Which one do you think is the most important and why?

Malnutrition is a major co-morbid condition among the people with the End-stage renal disease. It presents itself in approximately 40% of patients treated with maintenance dialysis. Moreover, several serum proteins that are associated with malnutrition are also associated with decreased survival in their patient population. Patients should have periodic nutritional screening to prevent morbidity and mortality as a result of malnutrition. They should as well have essential laboratory tests carried out. Initially, nutritional counseling should be carried out intensively and then after cone or two months intervals, sessions should be scheduled (Wolfson, 1998). In case there presents some inadequacy in nutritional intake, signs of malnutrition are present or rather the adverse effects or ailments threaten the nutritional status, then the counseling sessions should be increased.

Why do dialysis patients require so much protein?

Dialysis patients require large amounts of protein to replenish the proteins they lose every time during dialysis. According to Durose et al. (2004), dialysis removes small amounts of iron, water-soluble vitamins and minerals, peptides and amino acids. During peritoneal dialysis, significant protein losses occur through large pores in the peritoneal membrane from the capillaries that supply the membranes.

What are Mr. D’s current estimated calorie and protein needs?

Mr. D’s protein intake should be between 30 to 35 kcal/kg (Lynn & Jennifer, 2016). Every patient with End Stage Renal Disease should be evaluated to ascertain his or her nutritional status and receive a diet plan. A reduction in protein and calorie intake is highly encouraged. Protein intake reduction is essential for two main reasons; the first in order to decrease urine toxins and help quick digestion and gastric emptying, the second is due to the insufficiency of the average energy intake required. His protein needs ought to be in the range between 8 to 10 ounces per day.

Are there any referrals to community programs that may help Mr. D?

Mr. D situation can be handled by several community programs such as the American Medical Association (AMA) and the American Diabetes Association (ADA). These are prevention programs that help physicians prevent or impede type 2 diabetes in serious situations. These programs bear a high success rate because they depend on moderate weight loss to realize preventive health advantages (Cameron, 2010). The only condition should be that the program is following the Centre for Disease Control and Prevention (CDC) approved curriculum and realizing meaningful outcomes.

What can be done to increase his compliance with the dietary and medical therapies?

Mr. D should be connected to a community program that will constantly check on him and encourage him to take his medication seriously. This move can increase his compliance with dietary and medical therapies though only partially. Assessing his compliance using laboratory series of blood sugar tests can also be an effective way of increasing his compliance. The reason being, his habit of skipping his medication, especially his insulin shots, will be easily identified. Weight monitoring is an insufficient assessment tools because it could be as a result of any other cause such as malnutrition or the repetitive dialysis procedures. Insulin works best when timely administered in the appropriate manner. It should be injected directly into the fatty tissue under the skin. Additionally, every new injection ought to be at least a finger-width apart from the last injection (Yuill, 2003)





Cameron, J. S. (2010). Kidney Failure, the Facts. Oxford: Oxford University Press

Durose, C.L., Holds worth, M. & Watson, V. (2004). Knowledge of dietary restrictions and the medical consequences of noncompliance by patients on hemodialysis are not predictive of dietary compliance. J Am Diet Assoc 104, 35-41.

Lynn, K.T., & Jennifer, B.O. (2016). Nutrition Therapy for Kidney Disease. CRC Press.

Wolfson M. (1998). The effectiveness of nutrition interventions in the pre-ESRD and the ESRD population. Am J Kidney Dis. 1998, 32(4), S126-30.

Yuill, G. M. (2003). The Treatment of Renal Failure. Manchester: Manchester University Press.