Polly Peru
Rachelle Sebastian
DFM 451 – Community Nutrition Assessment
Sarah Josef MA, RD
San Francisco State University
Overview
 Introduction
 Mission, Goals, and Objectives
 Literature Review
 Materials and Methods
 Results
 Discussion
 Summary
 Primary Grant Funders
 Reference List
Introduction
• One in nine American adults is currently suffering from chronic kidney
disease.
• Chronic kidney disease is the eighth leading cause of death in America
and 485,000 Americans have advanced to end stage renal disease
(ESRD).
• Treatments are limited to hemodialysis, peritoneal dialysis and kidney
transplantation.
• The kidneys perform many vital functions in the body which include:
filtering toxins out of the body, regulating blood pressure, maintaining
acid-base balance, and stimulates the bone marrow to make red blood
cells by producing the hormone erythropoietin.
Mission, Goals, and Objectives
 Our mission is to design a hemodialysis nutrition education program-
focused on imparting sodium and protein nutrition education for
hemodialysis patients at the Pleasanton DaVita Dialysis Clinic in
Pleasanton, California.
 The first goal is to educate hemodialysis patients about sodium content in
foods and to recommend comparable alternatives.

Objective: To instill the ability to decipher food labels to empower
patients to identify and determine low-sodium foods and
alternatives.
 The second goal is to educate hemodialysis patients on the importance of
consuming adequate protein and to provide them with healthy protein
options.

Objective: To instill the ability to recognize high-quality protein
options and portions to avoid protein energy malnutrition
(PEM).
Literature Review
• Two major challenges for hemodialysis patients are the restriction of
sodium and meeting their individualized protein recommendations.
1. The dietary sodium guideline for dialysis patients is 2000 – 3000
milligrams per day and is individualized based on the patient’s medical
history and interdialytic weight gains.

Damaged kidneys cannot eliminate excess sodium and fluid form the body and
can result in fluid buildup in extracellular tissues and the bloodstream.

The extra fluid can cause dangerous complications such as increased blood
pressure, edema, shortness of breath, and heart failure.
2. The Kidney Disease Outcomes Quality Initiative Clinical Practices
Guidelines recommends 1.2 - 1.3 g/Kg body weight per day for hemodialysis
patients.

Dialysis treatments remove protein waste and some amino acids from the
blood resulting in higher needs of high quality protein.

Protein energy malnutrition (PEM) in dialysis patients is associated with
increased morbidity and mortality
Materials and Methods
Sodium Workshop
•
During the month of March 2014 our team conducted two sodium
workshops in the lobby of the Pleasanton DaVita Dialysis Clinic.
A colorful display table of high sodium foods
and provided low sodium alternatives.
We provided low and sodium free recipes and
offered samples of renal safe low sodium snacks
to the patients.
Materials and Methods
Sodium Workshop
Spaghetti sauce
Materials and Methods
Protein Education Workshop
•
During the month of April 2014 our team conducted two protein
education workshops.
Materials and Methods
Protein Bars Display
We prepared handouts providing ideas of high quality
protein choices.
We offered samples of dialysis approved protein bars.
Results
• Based on our pre and post
sodium FFQ our team was
disappointed to observe that
there was less than a 10%
difference between the pre
and post FFQ data.
 Sodium compliance is a
continual issue that Renal
Dietitians contend with.
 The socioeconomic class of
the majority of the patients
that attend the Pleasanton
DaVita Dialysis Clinic range
from upper middle class to
wealthy.
Ranked In Order of Patient Preference
1. Crunchy Rice Rollers
1 roll=5 milligrams of Sodium
2. Food Should Taste Good Multigrain tortilla chips
1oz (about 10 chips) = 80 milligrams of Sodium, 65 milligrams of Potassium
3. Barefruit Fuji Red Apple Chips 1oz (about ½ cup)=10 milligrams of Sodium
4. Skinny Pop popcorn
28 g (about 4 cups)=50 milligrams of Sodium
(1)
(2)
(3)
(4)
 A large number of the
patients do dine out five to
six times a week.
Results
• Each month DaVita Dialysis
Clinics collect and analyze
albumin levels for individual
patients and the average for
the overall clinic.
Ranked In Order of Patient Preference
1. Luna Bar – Lemon Zest
2. Zone Bar – Strawberry Yogurt
3. Atkins Bar – Cranberry Almond
4. Atkins Bar – Chocolate Peanut Butter Bar
5. Balance Bar – Chocolate Mint Cookie Crunch
9 grams of Protein
14 grams of Protein
14 grams of Protein
17 grams of Protein
14 grams of Protein
 Due to time constraints we
were unable to collect the
overall albumin levels for
May 2014
(1)
(2)
(3)
(4)
• Our poll of the patients
indicates that they prefer fruit
flavored bars over the
chocolate bars.
(5)
Discussion
 Most of the patients at Pleasanton DaVita Dialysis Clinic
were eager to participate, ask questions and sample the low
sodium snacks and protein bars.
 Our team found that the majority of the patients appeared
to have a clear understanding of the renal diet, but do not
comply with the guidelines of the diet.
 A common theme we encountered was that many of the
patients justified their non-compliance with the renal diet as
compensation for having to endure dialysis three times a
week or that the dialysis machine would remove the bad
effects of what they consumed.
• It is very important for the technicians and nurses to have
knowledge of the renal diet to help guide their patients in
attaining and maintaining their health while on
hemodialysis.
Summary
 The need for science based quality hemodialysis nutrition
education is evident based on the high prevalence of chronic
kidney disease in the United States.
 Maintaining the proper balance of nutrients, electrolytes, and other
chemicals is crucial for individuals suffering from chronic kidney
disease.
 Non-compliance to the renal diet guidelines is a major obstacle to
maintaining an individual’s quality life while on hemodialysis.

Overcoming this obstacle is not an easy task and requires patience,
understanding and a non-judgmental attitude on the part of the
nutrition educator.
 It was our intention to provide nutrition education strategies to
the hemodialysis patients of the Pleasanton DaVita Dialysis
Clinic that would allow them to maintain their health status
while on dialysis by successfully implementing our programs
goals and objectives by utilizing our project design and methods
as described.
DaVita Healthcare and the American Kidney
Fund
 Based on our mission statement and goals, DaVita
Healthcare and the American Kidney Fund would be
optimal grand funders for our program.
 Both organizations are dedicated to improving the lives
of individuals diagnosed with kidney disease and living
on dialysis.
Reference List
Clark-Cutaia. (2014). Adherence to hemodialysis dietary sodium recommendations: influence of
patient characteristics, self-efficacy, and perceived barriers. Journal of Renal Nutrition,
24 (2), 92-99.
Gray, L.D., Burrowes, J.D., Chertow, G.M. (2014). Nutrition in kidney disease.
Springer, New York: Springer Science + Business Media
Jadeja, Y. P., & Kher, V. (2012). Protein energy wasting in chronic kidney disease: An update
with focus on nutritional interventions to improve outcomes. Indian Journal of
Endocrinology & Metabolism, 16(2), 246-251. doi:10.4103/2230-8210.93743
Kidney disease and dialysis information - DaVita. http://www.davita.com/
Kidney Fund. (2012). Kidney disease statistics.
Retrived from http://www.kidneyfund.org/about-us/assets/pdfs/akfkidneydiseasestatistics-2012.pdf
Kovesdy, C. P., Shinaberger, C. S., & Kalantar-Zadeh, K. (2010). Epidemiology of Dietary
Nutrient Intake in ESRD. Seminars in Dialysis, 23(4), 353-358. doi:10.1111/j.1525139X.2010.00745.x
Meral, K., Murat, T., Mehmet, O., Oner, O., Gulay, A., Soner, D., & ... Ercan, O. (2009). The
benefit of salt restriction in the treatment of end-stage renal disease by hemodialysis.
Nephrology Dialysis Transplantation, 24(3), 956.
Snyder, R. (2013). What you must know about Dialysis: The secrets to surviving and thriving on
dialysis. Garden City Park, New York: Square One Publishers.
Stark S, Snetselaar L, Hall B, Stone RA, Kim S, Piraino B, Sevick M A (2011) Nutritional Intake
in Adult Hemodialysis Patients, Top Clin Nutr, Vol. 26, No. 1, 45–56.
Wu, W. H. (2013). Changes in the energy and sodium content of main entrées in U. S. chain
restaurants from 2010 to 2011. Journal of the Academy of Nutrition and Dietetics, 209219.