Renal Dialysis Unit

This past week marked my first pre and post hemodialysis clinic in the Renal Dialysis Unit (RDU) in the hospital. What a pre and post day includes in that the dietitian (and myself) go to the clinic three times (10:00, 14:00, 19:00) on Wednesday and Thursday to see the hemodialysis (HD) patients. For those of you whom are unfamiliar with dialysis, here's the basics: depending on how often each patient needs to have HD, depends on how many times they need to go to the clinic to have their blood cleaned (remove PO4, K+, fluid, add calcium, etc. depending on the individual - i.e. not everyone will have fluid removed or calcium fortified above the norm). Some people go to the clinic three times a week (M, W, F), some go four times (M, W, F, Sat), or some can go twice (T, Th). It all depends on what the nephrologist determines would be best for each individual patient. There are different start times in the RDU for HD, which is why the dietitian and I went at three different times each day. This allowed for the patient to be set up on dialysis and for their pre-dialysis blood work to be returned from blood services.

What the dietitian and I did while we were in the RDU: we looked at the patient's pre-dialysis blood work (urea, creatinine, phosphorus, potassium, calcium, magnesium, and albumin), wet weight, dry weight from the previous HD day, and ask the patient how they have been doing in regards to eating (compliant with individualized renal diet?), if they have been or are on any phosphate binders such as Tums or Renegel (which help to bind the phosphorus in foods that are eaten to reduce the phosphate load in the body) and when they take them if they are on them. We asked how their bowels are doing, if they had any nausea or vomiting or illnesses over the past month (which could have an affect on their blood work and weight), any supplements taken (Nepro, Ensure, Glucerna, Boost), if medications have changed (we also check in the chart to verify), and provide encouragement or diet education when required. It is quite the busy time going from patient to patient - seeing ~ 4 or 5 patients in each time slot, then charting on each one.

I was able to the various routes of HD, i.e through a central line access or through fistulas made via surgery in the arm (fusing together a vein and an artery to help the vessels handle the increased blood flow when the blood is being pumped out of and into the body). I was able to see a very interesting patient who had a fistula in his left arm, but had multiple aneurysms in his arm that throbbed and pulsated. I asked the nurses if this was common, and apparently it is. Patients can be given a protective sleeve to help protect the aneurysms, but usually the patients just try to be careful.

I found it very interesting to see the HD machines up close, look at the lab values of each patient, and to speak with the patient regarding diet compliance, medication compliance, and chatting with each patient. Because the patients do frequent the RDU numerous times a week, a rapport is able to be established whereas with in-patients in the hospital, this is difficult as they are only in hospital for limited amounts of time.

While in the RDU, I was "tested" on my knowledge of the nutrient content of foods (phosphorus, sodium, potassium) as well as on my knowledge of renal and diabetic diets. I learned a lot about ideal lab values for dialysis patients vs. pre-dialysis patients vs. the average healthy population. Very interesting and educational experience.