Nutrition pregnancy dialysis

BACKGROUND AND OBJECTIVES: There have been no recent analyses of the adequacy of training in U.S. nephrology training programs or the importance of specific aspects of fellowship training in the careers and practices of nephrologists who recently completed training. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: An internet-based survey was sent to members of the American Society of Nephrology who completed nephrology training in 2004 to 2008. Respondents were asked to rate their fellowship training (little or no training, some training but not enough to feel competent, well trained and competent) in specific areas and the importance of each area to their current careers and practices...

Pregnancy in chronic dialysis patients is unusual and associated with many complications. Infants are often born both prematurely and small for gestational age. We report a case of a 36-year-old diabetic hemodialysis patient G4P3 who had prolonged hyperemesis gravidarum, for whom intradialytic parenteral nutrition (IDPN) was started at week 14 and continued throughout her pregnancy. She delivered a 3.5-kg baby girl at the 36th week of gestation by cesarean section. We discuss the use of IDPN as adjunct therapy for pregnant dialysis patients...

Deaths that occur during medical care for the treatment of a disease are rarely certified as homicides. Some "medical" deaths, however, have been criminally prosecuted for manslaughter, reckless endangerment, or reckless homicide. We describe 5 deaths due to medical complications that underwent criminal prosecution. Three of the deaths were certified as homicides. Deaths certified as homicides due to the actions (or inactions) of a caregiver occur in 3 circumstances. The first is when the medical caregiver intentionally causes the death of the patient...

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Although unusual, pregnancy in chronic dialysis patients does occur. In fact, the percent of successful pregnancies in women on chronic dialysis may be increasing. But unfortunately, the rates for premature delivery, neonatal death, maternal hypertension, and preeclampsia in the chronic pregnant dialysis patient are high. Consequently, to have a successful outcome for the pregnant dialysis patient, close collaboration between the patient, her nephrologists, high-risk obstetrician, neonatalogist, dialysis nurse, and nutritionist is required...

Congenital nephrotic syndrome is present at birth or appears during the first three months of life and infantile nephrotic syndrome during the first year. Finnish type congenital nephrotic syndrome is an autosomal recessive disease. Nephrotic syndrome is present at birth, severe and does not respond to therapy. Infectious and nutritional complications are frequent. Renal function deteriorates necessitating a dialysis-transplantation program. Between age five and eight. The disease does not recur after transplantation...

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Residual renal function (RRF) remains important even after commencement of dialysis. Its role in the adequacy of peritoneal dialysis (PD) is well recognized and is increasingly utilized in incremental PD regimes, but it is also vitally important in hemodialysis (HD) patients, in whom it, as in PD patients, may improve survival. It may allow for a reduction in the duration of HD sessions. It reduces the need for dietary and fluid restrictions in both PD and HD patients. Other contributions include improved middle molecule clearance, better hemoglobin, phosphate, potassium, and urate levels, enhanced nutritional status and quality of life scores, and better outcomes in pregnancy...

In the early 1970s, aluminium toxicity was first implicated in the pathogenesis of clinical disorders in patients with chronic renal failure involving bone (renal osteomalacia) or brain tissue (dialysis encephalopathy). Before that time the toxic effects of aluminium ingestion were not considered to be a major concern because absorption seemed unlikely to occur. Meanwhile, aluminium toxicity has been investigated in countless epidemiological and clinical studies as well as in animal experiments and many papers have been published on the subject...

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Pregnancy in dialysis patients is a rare occurrence. When pregnancy does occur, the risk of spontaneous abortion, stillbirth and neonatal complications, such as prematurity and growth retardation, are fairly high. The authors describe their experience in the follow-up of a patient with chronic renal failure who became pregnant during regular dialysis treatment and followed nutritional care. The outcomes were successful and she gave birth to a healthy baby. It is emphasized that special dedication to the nutritional control enabled a good outcome of the pregnancy...

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This is a case study of a woman who became pregnant whilst receiving haemodialysis in a London teaching hospital. She courageously disregarded the doctors' advise to abort the fetus. The doctors advised her to wait until she had a kidney transplant to become pregnant again, rather than increase maternal and fetal risk on dialysis. She was due to have a live-related transplant from her father in the spring. The case study describes a practical account in detailed measure to equip nurses with the knowledge to provide specialised care to high-risk dialysis expecting mothers...

The third edition of the Guidelines for Nutrition Care of Renal Patients has been developed to follow the American Dietetic Association's Medical Nutrition Therapy (MNT) Protocol format and to further assist dietitians in providing optimal and consistent care to renal patients. The guidelines define the level, content, and frequency of nutrition care that is appropriate based on the best available scientific information and expert opinion. Seven separate guidelines, primarily written for care provided in the outpatient setting, are defined in the publication...

Suboptimal response to recombinant human erythropoietin (rHuEPO) is common in a substantial percentage of patients with chronic kidney disease. Consequently, a higher dose of rHuEPO is needed to attain target haematocrit (Hct) in such patients. Variables that affect rHuEPO dose requirements can be broadly divided into modifiable and immutable characteristics. To date, most of the scientific studies on rHuEPO hyporesponsiveness have focused on modifiable variables that affect rHuEPO response, such as iron status and dialysis adequacy, while exploration of immutable variables has received less attention...

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Childbearing is important to women with renal disease, but pregnancy has generally been regarded as very high risk in these women. In this review, an attempt is made to clarify the nature and severity of those risks in the settings of chronic renal insufficiency and end-stage renal disease, including dialysis patients and transplant recipients. Hypertension is the most common life-threatening problem in all three groups. A wide range of antihypertensive medications have been used, with angiotensin-converting enzyme inhibitors the only drugs absolutely contraindicated because of their association with neonatal anuria, pulmonary hypoplasia, and neonatal death...

The authors describe their experience in the follow-up of four patients with chronic renal failure who became pregnant while being treated with chronic hemodialysis. The outcomes were successful and each gave birth to healthy babies. The adequate nutritional condition previous to the pregnancies added more safety to their management. Special dedication to the nutritional control enabled a good outcome of their pregnancies. It stressed the importance of the intervention of the nutritionist-dietitian in the follow-up of nephrologic patients and the integration of a multidisciplinary staff...

Pregnancy in the face of kidney disease poses a new dimension to medical nutrition therapy. Individualization for specific nutrient needs is paramount, whether the patient has renal insufficiency, requires hemodialysis or peritoneal dialysis, or has a renal transplant. Practice guidelines for pregnancy and kidney disease were first developed in 1986 and revised in 1992. These guidelines provided the foundation for present nutritional management of pregnant women with kidney disease. Based on the most current research and clinical case reviews, the following is a revision of these guidelines, incorporating medical nutrition therapy protocols and outcome parameters to improve assessing, tracking, and monitoring patient care in this unique population...

The measurement of a physiological event caused by a change in dimension, conductivity, or permittivity can be easily carried out by the impedance technique, requiring only the application of two or more electrodes, which are easy to apply. In some cases, the impedance is transformed into its resistive and reactive components, in others the total impedance is measured. In certain cases only a change in impedance, with or without separation into its components, contains enough information to be correlated to the physiological event...