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)
Energy (kcal/kg SBW)
Protein (g/kg SBW)
Hemodialysis
Peritoneal Dialysis
30-35
30-35
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 drugnutrient interactions:
Table 2. Medications (16)
Medication
Acetaminophen
Use
Pain Reliever/Fever reducer
Drug/Nutrient Interactions
BP medication, cholesterol medication,
antibiotics, etc
Nifedipine
Reduce BP/reduce angina
Grapefruit products
Clonidine
Reduce BP
Alcohol
Primvastatin
HMG CoA reductase inhibitor, or,
Alcohol, grapefruit products, other statins,
statin, reduce LDL and increase HDL
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
n/a
supplement, indigestion
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 50pound 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
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
Opt: 4.0
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
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