Protein Status and Fluid Dynamics in Dialysis

Patients with end-stage renal disease who are unable or are waiting to receive a transplant rely on dialysis for live saving care. Dialysis replaces the role of the kidneys by removing waste products and excess fluid. Fluid overload is a common consequence as hemodialysis patients struggle to limit sodium and fluid consumption, making it difficult for intermittent dialysis to keep up. In addition, protein-energy malnutrition and low albumin levels can contribute to challenges with fluid removal that many patients experience. With the right nutrition and diet counseling, this could be avoided. Albumin provides 80% of the colloid osmotic pressure in [...]

Much Ado About Collagen

Collagen supplements are often featured in ads, search engines, television, and social media as a modern miracle to fight skin aging as well as other benefits. Consequently, many people have incorporated collagen supplements in their daily routine in hopes to support the health of their skin, joints, and hair. But what exactly is collagen and are collagen supplements really as helpful as the claims indicate? Even though the use of this “miracle” supplement is on the rise, most people don’t know what collagen is or what it does. With this blog we hope to help clear this up and help [...]

The Vitamin D Debate

Over the last several years, vitamin D has gained notoriety in mainstream healthcare, but clinicians working in CKD, ESRD, and dialysis have long been aware of this important nutrient. As CKD progresses, vitamin D levels are compromised due to the kidneys’ declining function and ability to activate vitamin D. This in turn reduces absorption of calcium in the GI tract which leads to increased secretion of parathyroid hormone (PTH). Left untreated, PTH levels will continue to increase and eventually convert to secondary hyperparathyroidism (SHPT). The consequences of SHPT range from moderate to severe and include abnormal biochemical data, bone disease, [...]

The Reality of Successful Weight Loss

The weight loss industry rakes in billions of dollars every year as millions of adults in the U.S. attempt, or in many cases reattempt, to lose weight. Only 20% of people who achieve the gold standard goal of 10% weight loss will go on to maintain it. With so much money, time, and effort being spent on achieving weight loss you would think that we’d spend an equal amount of time and effort on maintaining that weight loss, but that just isn’t the case. Yo-yo dieting or weight cycling leads to metabolic dysregulation and increases risk for cardiovascular disease. That [...]

The Gut-Mood Connection

Have you ever counseled a patient who frequently seems to be in an “off” mood?  What does that look like? Merriam-Webster Dictionary defines mood as the following: “predominant emotion” or “a prevailing attitude.”  When someone is “moody” they may display one or more of these emotions: Anger Sadness Tension Gloominess Fearfulness Perhaps the patient’s seemingly negative mood is related to poor gut health.  A growing amount of evidence shows a connection between gut health and mood, though the mechanism is not fully clear. A healthy gut is defined by high diversity and balance of healthy bacteria throughout the gut microbiome [...]

Bridging the Nutrition Gap with Dietary Supplements

In an ideal world, people living with chronic kidney disease (CKD) and end-stage renal disease (ESRD) would all have easy access and a strong desire to follow a nutrient-dense, well-balanced, kidney- and/or dialysis-friendly diet. Doing so could alleviate many of the burdens that accompany the disease and support overall improvement in quality of life. Unfortunately, this is not the case for the majority of patients. As a result, many patients are left struggling with big gaps in their nutrition whether they realize it or not. What exactly is the “nutrition gap?” It really refers to two things. First, it’s the [...]

Health for the Holidays

Health for the Holidays With holiday season in full swing amid an ongoing pandemic and smack dab in the middle of cold and flu season, now is a great time to remind dialysis patients what healthy food choices can fit into their holiday plans.  By providing a few prevention tips during the holidays as well as a list of immune boosting foods, we can help patients stay healthy with the support of tried-and-true nutrition favorites. When you click through the headlines and articles about “superfoods” or “immune-boosting” foods there are some trends that emerge, and often for good reason. Certain [...]

Research Breakdown: Exercise and Kidney Disease

According to the Centers for Disease Control, only 23% of adults above the age of 18 years old meet the recommended guidelines for aerobic and muscle strengthening exercise. In the chronic kidney disease (CKD) and end stage renal disease (ESRD) population subset, the percentages are likely even lower due to a common misconception that they cannot exercise. In reality, exercise is likely key to helping people living with CKD and ESRD improve their health outcomes and quality of life*. Below we explore the research on different types of physical activity and associated health benefits for CKD and ESRD. *If you [...]

The Brain on Fire: Inflammation and Cognitive Health

In chronic disease we talk a lot about inflammation.  A prolonged state of inflammation, which is observed in chronic illnesses, leads to increased cellular damage and oxidative stress. Sometimes we forget this damage can extend to all parts of the body, including our brains. Under healthy circumstances, inflammation is a good thing, responsible for clearing out infections and injury, and eventually subsiding to allow for the process of healing and repair to begin. The presence of chronic, low-grade inflammation is where science draws the line and inflammation stops being beneficial. The brain has ways of protecting itself from inflammation that [...]

Ethical Dilemmas

Dietitians - seasoned practitioners, new grads, and those that fall somewhere in between – face ethical dilemmas on a regular basis. Navigating the area of ethics can be difficult as the situations they face are not always black and white. A clear-cut ethical dilemma, like whether to administer someone dialysis or provide important dietary recommendations are easily dealt with. But what happens when the scenario has more gray area? Consider this scenario: There are 2 dietitians covering a dialysis clinic, Gale and Devin.  Gale, who has been at the clinic for a year, covers most in-center hemodialysis patients. Devin on [...]

Can Magnesium Solve Your Sleep Problems?

Magnesium is a mineral the human body uses in more than 300 enzymatic processes including those that support deep, restful sleep. It is abundant in many foods we consider healthy – nuts, seeds, beans, whole grains, spinach, etc. – and yet many Americans miss the mark on meeting their magnesium needs. The Recommended Dietary Allowance (RDA) for adults ranges from 310-420mg per day depending on age, sex, pregnancy, and lactation. The National Health and Nutrition Examination Survey (NHANES) of 2013-2016 indicates that 48% of Americans don’t get enough dietary magnesium. The people that do get enough tend to use nutritional [...]

Article Spotlight | Malnutrition, inflammation, & fluid overload & their associations with hemodialysis patient survival

  Fluid overload (FO) is a prevalent issue among people with end-stage renal disease on dialysis. There are many consequences related to fluid overload, ultimately leading to increased hospitalization, mortality risk, and poor quality of life. Historically, fluid status has been evaluated in isolation, however, as the study below authors propose, it may be more beneficial to assess fluid status in conjunction with malnutrition and inflammation status to better predict outcomes for patients on dialysis. Publication Link: Authors: Dekker MJE, Konings C, Canaud B, van der Sande FM, Stuard S, Raimann JG, Öztürk E, Usvyat L, Kotanko P, Kooman [...]

Beyond Vitamin D: Supplements that Might Help Manage CKD-MBD

In the world of kidney disease, Vitamins B3 and K are often overlooked, but these two nutrients may be useful in the fight against Chronic Kidney Disease Mineral Bone Disorders (CKD-MBD). Niacinamide, a form of Vitamin B3, has phosphorous binding abilities that benefit patients with CKD and ESRD. Researched in doses of 25mg-1500mg per day, niacinamide has shown to reduce phosphorous with or without the addition of traditional phosphate binders. Although commonly prescribed renal multivitamin contains 20mg of niacinamide, research indicates that higher amounts of niacinamide would be required to help bind phosphorous. A sweet spot may be 35mg [...]

Clinician Perspectives on IDPN

Intradialytic parenteral nutrition (IDPN) is a non-invasive infusion of amino acids, dextrose, and sometimes lipids given to hemodialysis patients. It is designed specifically to boost patient’s nutrition without increasing patient burden by using the dialysis access site during the patient’s regular dialysis session. The goal of IDPN is to combat malnutrition and protein energy wasting. Objectively we use albumin, prealbumin, nPCR, and weight and/or BMI to assess response to IDPN. Subjectively, patients report improved appetite, energy, and overall better quality of life after starting IDPN.  Although many clinicians currently using IDPN therapy are familiar [...]

Complementary and Alternative Medicine

In the past few decades, meditation has made its way into cultures all over the world. This ancient tradition, once only tied to different religious teachings, is now prescribed by physicians and practiced by many business professionals, scientists, athlete’s, politicians, military personnel and even students.  Stemming from the Latin word “Meditatum”, meditation means “to ponder”. This practice is about learning who we are, altering consciousness, finding awareness, and achieving peace. There are countless articles that identify the benefits meditation can have on a whole host of common health issues like high blood pressure, sleep [...]

The Power of Protein

In the dietitian nutrition world, we recognize that all macro and micronutrients are important for health. Yet protein tends to steal the spotlight, demanding attention in the media, in research, and in clinical nutrition counseling. It’s easy to understand protein’s popularity given every cell in our body needs it for structure and function. Body proteins are in a constant state of breaking down and rebuilding. Keeping our protein supplies, amino acids, well stocked is critical, otherwise the body will breakdown faster than it can rebuild, which comes with many negative health consequences. For healthy individuals, meeting protein and amino [...]

Boosting Motivation by Targeting Capability and Opportunity for Dialysis Patients

Behavior is impacted by 3 things – Capability, Opportunity, and Motivation. For End-stage Renal Disease (ESRD) patients on dialysis, we often focus on patient Motivation – the mental process that energizes and directs behavior - to help them take more responsibility for their own health outcomes. It’s important to acknowledge that there are limits when the sole focus is on patient motivation; even those highly skilled in behavior change counseling and motivational interviewing may find it difficult to stimulate behavior change in patients with ESRD. Any serious effort to improve patient motivation requires practitioners that pay equal attention [...]

Building Confidence in your Physical Assessment Skills

Physical assessment can provide insight to a patient’s health and nutritional status that may not otherwise be discovered without more expensive and time-consuming testing. Whether part of a composite nutrition score like in the Subjective Global Assessment (SGA) or on its own as a full Nutrition-Focused Physical Exam, the physical assessment is getting more attention and has become a trending topic in the RDN community.  Despite a wealth of research showing both reliability and validity of performing physical exams and support from institutions like the National Kidney Foundation and the Academy of Nutrition and Dietetics, many dietitians remain hesitant to [...]

IDPN Upgrade

The new KDOQI 2020 Updates were recently published after months of exhausting work done by an interdisciplinary team tasked with pouring over all the available literature in order to provide more guidance to the practice of renal nutrition. Kudos to them for all they’ve done, as this update was really needed and will be so helpful for all practitioners. At Patient Care America, we were thrilled to see positive momentum in the discussion on the use of IDPN therapy in clinical practice. If you are unfamiliar, Patient Care America provides intradialytic parenteral nutrition (IDPN) and intraperitoneal nutrition (IPN) therapies [...]

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