Chronic Kidney Disease and the Nutrition Care Process
Pocket Guide by Maureen P. McCarthy, MPH, RD, CSR, LD;
Jessie M. Pavlinac, MS, RD, CSR, LD; Arianna Aoun, MS, RD, CSR, LD
Study Guide written by Susan Burke March, MS, RDN, LDN, CDE;
edited by Wolf J. Rinke, PhD, CSP, RDN

©2015 Wolf Rinke Associates. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, scanning, or otherwise, without the prior written permission of the Publisher.

CUSTOMER COMMENTS

Heidi Stout: "I especially liked the motivational interviewing techniques with examples and that there are more focused goals for each stage of change. The examples and focused goals help clarify and give me more direction on how I can implement these techniques."

Cynthia S. Bonney: "I really liked the charts for different meds, supplements, etc. This information is now readily available so can be referenced in the future."

Connie  Lennon: "This course was very challenging for me, but I learned a lot more in regards to Chronic Kidney Disease and Glycemic control. I did like the case studies as it truly made me think what I would do in real life which I think makes things stick in my memory."

Stephanie Robinette-Towle: “I have worked in dialysis for several years and really enjoyed this up-to-date information and review. GREAT INFORMATION AND I REALLY ENJOYED IT!!”

Cheryl Robinson: "Excellent educational practice and resource. Thank you. I have worked in dialysis since 1994 with Kidney patients and I always enjoy learning something new."

Diane Hare: "[I like] the tables that list medications, nutritional needs, lab values. Also I like the section regarding nutrition counseling."

OVERVIEW AND INTRODUCTION

Welcome to the pre-approved, accredited CPE program for Chronic Kidney Disease and the Nutrition Care Process. The program consists of a pocket guide of the same title by Maureen P. McCarthy, MPH, RD, CSR, LD, Jessie M. Pavlinac, MS, RD, CSR, LD, and Arianna Aoun, MS, RD, CSR, LDand this study guide. The CPE program is designed to help you provide medical nutrition therapy (MNT) for patients with chronic kidney disease (CKD) stages 3 to 5D. It is also designed to help you earn 14 Level 2, Continuing Professional Education Units (CPEUs).
To get the most out of this CPE program, it is suggested that you adhere to the following four steps:

We will email your Certificate of Completion.

When you submit your CPE Reporting Form to us via www.easyCPEcredits.com, fax, or mail be sure to write your correct email address in the space provided on the CPE Reporting Form. If writing by hand, be sure to print your email address clearly.

LEARNING OBJECTIVES

Upon completion of this CPE program you will be better able to:

• Apply the Evidence-Based Nutrition Practice Guidelines (EBNPG) for Chronic Kidney Disease (CKD) when evaluating patients/clients for screening and referral for Medical Nutrition Therapy (MNT);
  
• Perform a food-and nutrition related assessment for patients with CKD;
  
• Write a Problem, Etiology, Signs and Symptoms (PES) statement, identifying appropriate domains related to CKD;
  
• Write a Nutrition Diagnosis, as described in the Nutrition Care Process and Model (NCPM), and apply the appropriate International Dietetics and Nutrition Terminology (IDNT);
  
• Apply nutrition recommendations from the National Kidney Foundation Kidney Disease Outcomes Quality Initiative (NKF-KDOQI);
  
• Assess the different treatments for different stages of CKD;
  
• Interpret biochemical data in patients/clients with CKD;
  
• Evaluate medications that could impact renal function in patients with CKD such as those for hypertension (HTN), phosphate binders, cardiac medications, and hypoglycemic agents for type 2 diabetes (DM2);
  
• Assess supplements that can interact/impact a patient/client's renal function;
  
• Calculate energy, protein, and fluid needs as appropriate for the patient/clients stage of CKD: stages 3, 4, 5, and 5D;
  
• Calculate adjusted body weight (ABW) to determine energy and protein needs for underweight and obese patients;
  
• Apply knowledge about requirements of vitamins to identify potential deficiencies in CKD;
  
• Evaluate patient's intake and recommend use of Intradialytic Parenteral Nutrition (IDPN);
  
• Develop a nutrition prescription appropriate to the patient/client's stage of CKD;
  
• Perform nutrition monitoring and evaluation to determine whether the patient/client is meeting nutrition goals;
  
• Assist patients/clients in achieving recommended intakes for protein, fiber, calcium, vitamin D, potassium, and phosphorus with various stages and treatments for CKD;
  
• Evaluate patient/client's readiness for nutritional counseling and determine behavior change strategies;
  
• Develop physical activity recommendations appropriate to patient/client's abilities and stage of CKD;
  
• Specify percentage of calories recommended from high biological protein sources;
  
• Counsel patients/clients on appropriate supplement dosage/usage;
  
• Recommend patient nutrition education resources from professional sources including the Academy of Nutrition and Dietetics (Academy).

TABLE OF CONTENTS

Authors and Reviewers
Abbreviations
Chapter 1: Chronic Kidney Disease, Evidence-Based Practice, and the Nutrition Care Process
Chapter 2: Nutrition Assessment
Chapter 3: Nutrition Diagnosis
Chapter 4: Nutrition Intervention--Part One: Planning the Nutrition Prescription
Chapter 5: Nutrition Intervention--Part Two: Implementation
Chapter 6: Nutrition Monitoring and Evaluation
Appendix: Common Renal-Specific Vitamins
References
Index

ABOUT THE AUTHORS OF THE POCKET GUIDE

Sara Erickson, RD, CSR, LDN, CNSC, Pediatric Renal Dietitian
Carolinas Healthcare System (Levine Children's Hospital), Charlotte, NC

Rachael R. Majorowicz, RD, LD Clinical Renal Dietitian Mayo Clinic Rochester, MN

Jean Stover, RD, LDN Renal Dietitian DaVita Conshohocken, PA

MEMBERS OF THE IDNT ADVISORY PANEL
Donna Pertel, MEd, RD Elise Smith, MA, RD, LD

ABOUT THE AUTHOR OF THE STUDY GUIDE

Over the past 25 years Registered and Licensed Dietitian Susan Burke March has made her personal passion for healthy living and smart weight management her vocation. Susan holds undergraduate and graduate degrees in nutrition and education, is a certified diabetes educator, and holds advanced certificates of training in Adult Weight Management (Levels 1 and 2) and Childhood and Adolescent Weight Management. She served as Chief Clinical Nutrition Manager at Mt. Sinai Hospital of Queens, New York.
Susan is the former Vice President of Nutrition and Chief Nutritionist for eDiets.com, a leader in the online weight management program arena. She led the nutritional development of a roster of healthy weight programs, and spearheaded development of unprecedented features and services that today are commonplace in the online weight management industry. Susan served on the board of the Weight Management Dietetic Practice Group of the Academy of Nutrition and Dietetics, and as a spokesperson for the Florida Academy of Nutrition and Dietetics.
Susan is the author of the practical and informative book Making Weight Control Second Nature: Living Thin Naturally (Mansion Grove House, 2009) and the accompanying 26-CPEU study guide published by Wolf Rinke Associates (2010). She and her husband Ken are currently living and studying Spanish in Ecuador's third largest city, Cuenca. Susan is the Nutrition and Health Columnist for CuencaHighlife.com, and enjoys blogging about Ecuadorian food, health issues, and nutrition news for the expat community.

ABOUT THE EDITOR OF THE STUDY GUIDE

Wolf J. Rinke, PhD, RDN, CSP is the president and founder of Wolf Rinke Associates, a company that has provided high quality CPE programs to nutrition professionals since 1990.
He earned a BS at Drexel University, a MS at Iowa State University, a PhD in Continuing and Vocational Education (Adult Ed) at the University of Wisconsin, and interned at Walter Reed Army Medical Center. He participated in a test item writer workshop sponsored by the Commission on Dietetic Registration (CDR).
Wolf is a past Adjunct Associate Professor, Graduate School of Management & Technology, University of Maryland, and a former Adjunct Faculty Member, School of Continuing Studies, The Johns Hopkins University.
He is the past president of the DC Dietetic Association and has been honored by the Academy with the Award for Excellence in the practice of Management; the Outstanding Dietitian of the Year Award; the Outstanding Service Award; and has delivered the Lenna Frances Cooper Lecture.
At the Academy he has served in numerous leadership roles including Chair, Scholarship Committee, DBC; Chai, Communication Committee, CDR; Chair, Area Coordinating Committee, COE; Chair, COE, and member of Resource for Education Programs Committee; Honors Committee; CDR, Licensure Panel and Ethical Practices Task Force; CDR; House of Delegates and Board of Directors.
He is the author of more than 500 articles, numerous CPE home-study programs, several popular books, and the free monthly eNewsletter "Read and Grow Rich" written specifically for savvy Nutrition Professionals like YOU!
Subscribe now at www.easyCPEcredits.com--you'll be glad you did!

ACKNOWLEDGEMENTS

Special thanks to the following individuals for their careful review of this CPE program:

Sandra Baker, MS, RDN, LDN
Director of Nutrition Services
Meritus Medical Center
Hagerstown, MD

Krista Campbell, MS, RDN, CDN
Clinical Dietitian
Rochester Regional Health System
Rochester, NY

Juliet Mancino, MS, RDN, CDE
Projects Coordinator, EMPOWER Study Lead Interventionist
University of Pittsburgh School of Nursing
Pittsburgh, PA