Blog2021-09-13T20:48:42+00:00

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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: https://www.jrnjournal.org/article/S1051-2276(18)30153-5/fulltext 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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