Question

Dorothea is a 72-year-old black woman who is 5 ft 5 in tall and weighs 149 pounds. She has coronary heart disease and a long-standing history of hypertension with progressive loss of kidney function. She recently started receiving hemodialysis and is gaining about 4 pounds/day between treatments. She has convinced herself that because she is on dialysis, she can eat and drink whatever she wants and "the machine will take care of it." Yesterday, she ate the following as shown below: Breakfast: Grits with cheese; bacon; biscuit with butter; coffee Lunch: Hamburger on bun with ketchup and mustard potato chips; banana; sweetened tea Dinner: Fried chicken; macaroni and cheese; collard greens; pound cake; sweetened tea • What risk factors does Dorothea have for CKD? • Based on her age, weight, and use of hemodialysis, what should the composition of her diet be (e.g., number of calories, grams of protein, grams of sodium)? • Why is she gaining 4 pounds/day between treatments? What is a more reasonable goal? What would you suggest she do to achieve the goal? • Evaluate her protein intake and recommend changes she could make to achieve her protein goals. • What foods is she eating that are not heart healthy? What substitutions would you recommend? • Evaluate her sodium intake and recommend changes she could make to limit her sodium intake. • What foods is she eating that are high in potassium? What alternatives would you suggest? • What would you tell Dorothea about the use of dialysis and her theory about eating anything she wants? • Which is the lesser risk: getting enough calories and protein by eating non-heart-healthy foods or adhering to the sodium and other restrictions but not getting enough calories and protein?

Answer 1

Risk factors of CHRONIC KIDNEY DISEASE, which Dorothea has:

• OLD AGE( she is 72yrs old)
• CARDIOVASCULAR DISEASE (She is a know case of CORONARY HEART DISEASE)
• HIGH BLOOD PRESSURE ( she is a known case of HYPERTENSION)
• UNHEALTHY DIETARY PATTERN
• RACE OR ETHINICITY (she is a black woman)
• INCREASED BMI (A cardiovascular disease patient should maintain a BMI <22.5Kg/m2)
• ABNORMAL KIDNEY FUNCTIONS ( as a complication she started to have impaired renal function)

DIETARY COMPOSITION FOR HEAMODIALYSIS

1. CALORIES - 30 - 35KCal/Kg/day

​​​​​​​ie, Dorothea's weight is 149pounds in Kilogram it is 67.58Kg. if we take the least value is 30KCal/day,

Dorothea's Calorie intake per day = 67.58 × 30

= 2027KCal/day

2. PROTEIN IS 3% OF TOTAL CALORIE INTAKE PER DAY. ie;

2027 × 3 ÷ 100 = 60.8 KCal

we know, 1gram of protein gives 4kcal

hence;

60.8 ÷ 4 = 15.2gm/day

Dorothea's protein intake per day is 15.2gm

3. SODIUM INTAKE IS LIMITED TO 5gm/day (2gm or 85mmol)

​​​​​​​4. POTASSIUM INTAKE IS 60mEq/day (3.5 - 4.5mg/day)