Two years later, Dean is in Stage 5 CKD and has decided to initiate in-center hemodialysis.
Anthropometric Data:
Weight: 85 kg (187 lbs)
Biochemical Data:
Sodium 131 (135-145 mEq/L) Creatinine 5.6 (0.4-1.3 mg/dL) Potassium 5.6 (3.6-5.0 mEq/L) Glucose 79 (70-98 mg/dL) Chloride 113 (98-110 mEq/L) Calcium 9.5 (8.5-10.5 mEq/L) Carbon dioxide 17 (20-30 mEq/L) Phosphorus 4.9 (2.7-4.5 mg/dL) Blood urea nitrogen 98 (6-24 mg/dL)
Clinical Data:
Medications: Includes calcium acetate 3 with meals and 1 with snacks Nutrition-focused Physical Exam: Dean appears tired with some notable edema in his upper and lower extremities. Urine output: 1 L daily
Dietary Data:
24-hour Diet Recall: Breakfast (8 am): 1 cup corn flakes with 4 oz low fat milk, 8 oz coffee with nondairy creamer Lunch (12 pm): 1½ cups pasta with olive oil, green beans, 1 oz baked chicken, 12 oz ginger ale Dinner (7 pm): 2 oz baked fish, 2 cups white rice, 6 spears fresh asparagus, 12 oz water Diet prescription: 2 g sodium, 2 g potassium, low-phosphorus diet
1. How would you assess Dean’s weight loss?
2. How would you assess Dean’s labs?
3. What specific diet changes do you suggest for Dean as he initiates hemodialysis?