Diabetic Kidney Disease: An Overview of Evidence Based Guidelines and New Approaches to Application of Nutrition Therapy

Transcription

1 Lesson Plans Diabetic Kidney Disease: An Overview of Evidence Based Guidelines and New Approaches to Application of Nutrition Therapy Review basic renal function and use this article to discuss key components of evidence based nutritional management of DKD. Describe the stages of DKD, identify renal function changes, and provide a renal patient case history to illustrate each stage. Compare and contrast the macronutrient guidelines for a renal diabetic meal plan versus a diabetic meal plan. The instructor will present basic nutrition facts on the role and food sources of Omega-3 and omega-9 fatty acids. Review recommendations for dietary fats for DKD and discuss the unique properties of omega-3 and omega-9 fatty acids. nutritional components of a basic renal meal plan. physiological changes that occur between a normal functioning kidney and a diseased kidney. The student will discuss the differences between the renal and diabetic meal plans. physiological benefits of fatty acids within a person s basic meal plan. Students, either individually or in a group, will research evidence based nutrient commendations for DKD for one of the following nutrients in connection to DKD: carbohydrates, protein, fat, sodium, potassium, and phosphorus. At the end of the presentation, a nutrient-specific recommendation will be presented to the class. If more than one presentation involves the same nutrient, further the discussion between the two reports. Each student will design a one-day renal meal plan to meet the needs of the given patients renal stage. Each student will develop a 2-day meal plan for a person with diabetes and highlight the changes required if the patient had kidney disease. The student will develop a handout about fatty acids and their health/ nutrition value. 48

2 Nutrition Care for Earlier Stages of Diabetic Kidney Disease Compare the Diabetes Control and Complications Trial and the United Kingdom Prospective Diabetes Study and highlight the importance of glycemic control in renal outcomes. Included in this presentation are the renal-related outcomes for people living with diabetes. Compare and contrast the differences between a general healthy meal plan and a renal meal plan for patients with DKD stages 3-5. With the students assistance, the instructor will present the conflicting nutritional recommendations identified in the article. Discuss the rationale behind this articles statement that there is not a specific renal diet. Review renal labs (blood pressure, electrolytes, lipid and GFR) and goals to use with patient care. The student will state information about two major diabetes studies and apply the information when counseling patients. basic nutrition differences of a general meal plan using the MY PLATE guidelines, and a general renal meal plan with specific nutrients identified. The student will examine conflicting nutritional recommendations for DKD referring to evidence based guidelines for nutrient and health needs. normal ranges for specific laboratory values to use when assessing a patient s health status. Each student will analyze 2-3 articles which pertain to the role of nutrition in prolonging renal function. Each student will share 2 to 3 findings during group discussion. The student will develop a lowliteracy handout that presents the MY PLATE food groups with highlighted food groups that need to be addressed when presenting a renal meal plan. Use this article to role play a DKD patient counseling session which explains variations in nutrition needs to a confused patient. The student will develop a handout that lists specific laboratory values for diabetes and renal disease diagnoses. 49

3 Interfacing Nutrition Care for Hemodialysis, Peritoneal Dialysis and Diabetes Tour a dialysis center to observe patients using hemodialysis. Present nutrition guidelines for both hemodialysis and peritoneal dialysis. The instructor will invite a Identified guest speakers, a nephrologist and a renal specialist dietitian, discuss the technical aspects of using peritoneal dialysis and/or other forms of home dialysis therapy three types of hemodialysis accesses. The student will compare the nutritional differences between hemodialysis and peritoneal dialysis therapy. The student will explore the parameters of home dialysis and its impact on nutrition care. At the dialysis center, the student will interview a patient to learn about his/her hemodialysis schedule. The student will write a short story (1/2 to one page in length) about the interview. In groups of two students, pairs of students will develop meal plans for a patient with hemodialysis and peritoneal dialysis. Develop a table summarizing the pros and cons of the treatments on nutritional status, identify strategies to correct nutritional deficiencies and use two colored highlighters to mark the differences on the report and meal plan. Share your meal plan and summary with the class. Each student will investigate one peritoneal or renal replacement therapy company and discuss their findings with one or more students, sharing a summary with the class. The instructor or a guest pharmacist will present the medications used by a patient on dialysis and/or has diabetes. By being familiar with the diseaserelated renal and/or diabetes medications, the student will more efficiently guide the patient with their renal and diabetes regimen. After reviewing renal/diabetes cases studies, the student will identify the medications, (dialysate), nutritional supplements and describe their pharmokinetic role and impact on nutrition. 50

4 New-Onset Diabetes Mellitus After Transplantation (NODAT): Overview and Implications for the Diabetes Educator Discuss the incidence of NODAT and use this article for a group activity: Divide the class into groups according to the following topics: Pretransplant, Postransplant, NODAT Diagnosis, NODAT Lifestyle Intervention, and Pharmaceutical and Herbal Interventions. Gain experience using the Academy s EAL library and DCE s OTCE research resources. By discussing their research findings from various journal sources, the students will demonstrate their ability to read and evaluate the usefulness of the research article. Students will identify risk factors for NODAT, discuss lifestyle, educational and pharmaceutical needs of patients according to the assigned topic. Use research resources developed by Dietetics professional organizations to improve use of qualitative quantitative methodology. During four to five class periods, the designated students (group) will present a 30-minute presentation on the one of the six areas of interest regarding NODAT. Each group will provide class members with a bullet point handout summarizing care recommendations.at the end of the group presentations, students will discuss specific questions designed by the instructor concerning NODAT. From EAL or OTCE, each student will identify one journal article of their choice and present one renal research finding to the class. Use of Diabetes Medications in the Patient with Chronic Kidney Disease A pharmacist guest speaker will present the pharmacokinetics of diabetes medications in connection to renal functioning to the students. A pharmacist guest speaker will provide case studies of three to four DKD/hemodialysis patients, reviewing pertinent labs and medications. The student will name the diabetes medications which are contraindicated and those which are approved for use with chronic renal disease. When reviewing a patient s medications, the student will be able to identify the diabetes medications and their renal efficacy. Each student will research and report on one class of diabetes medications in connection with renal activity. Each student will receive index cards to record the medication name, activity, purpose, dosage, and renal clearance during the presentations. During the student s clinical rotation, they will use the medication index cards that were developed during the renal class presentations. The medication and its characteristics will be documented in the patient s chart. Glycated Hemoglobin as an Indicator of Glycemic Control in the Patient with Chronic Kidney Disease Discuss the impact of renal failure and dialysis on the glycated hemoglobin (HGBA1c) test and review alternatives for assessment, including fructosamine and glycated albumin. The student will identifyhow the hemoglobin A1c is affected by the impact of chronic kidney disease Using the American Diabetes resources, the student will develop a handout that demonstrates the various ways patient s blood sugar averages could be measured and each of their limitations. They are: Hemoglobin A1c, fructosamine, and glycated albumin. 51

5 The Challenges of Mineral Bone Disease, Chronic Kidney Disease, and Diabetes The instructor will present a lecture on normal bone development of the human body. (two assignments) The instructor will review the epidemiology of type 1 and type 2 diabetes and CKD within the American population, and review the clinical practice guidelines for CKD-MBD, the prevalence within the population of persons with type 1 and type 2 and chronic kidney concerns. The instructor will present the various hormones involved in bone metabolism including parathyroid and calcitriol. The student will be able to explain the basics of bone cell development. Each student will use this visual model/road map when consulting with a renal patient. The student will identifiy the diabetes medicatons that are contraindicated for DKD patients. The student will state the hormones involved in bone metabolism and their purposes. Each student will present a minute review of one of the following bone diseases: Osteomalacia Adynamic bone disease Osteoporosis Amyloidosis Osteopenia Pairs of students will complete the second assignment developing a visual model/road map that displays the paths used in bone metabolism, labels nutrients, hormones, and goals for each stage of kidney disease. Pairs of students will develop a handout summarizing diabetes medications and their activity, usage, and contraindications (renal). The student will research one hormone involved in bone metabolism and report their findings to the class. For extra credit, student will develop a poster that displays the activity of that hormone within the body. Recommendation: For teaching the public about renal health, refer to the following OTCE articles. Hetherington, V. RD, LDN, CDE Meeting the Challenges of Chronic Kidney Disease and Diabetes. Spiva, S. RDN, LD Renal resources. 52