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ePublished: 01 Jul 2014
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J Renal Inj Prev. 2014;3(3): 75-78.
doi: 10.12861/jrip.2014.22
PMID: 25340173
PMCID: PMC4206054
  Abstract View: 3515
  PDF Download: 1507

Case Report

Accomplishing dietary and biochemical standards and improving hemodialysis efficiency with a non-compliant  patient; a case study

Chaudhary-Muhammaed Junaid-Nazar 1*, Manzoor A. Lala 2, Saba Izhar 3, Percy Joesph 4

1 Department of Medicine, University of Buckingham, Ealing Hospital, NHS Trust, London, UK
2 Rural Health Development Program, Rural Area Development Council, Punjab, Pakistan
3 Department of Medicine, Allamaiqbal Memorial Teaching Hospital, Sialkot, Punjab, Pakistan
4 Department of Medicine, University of Buckingham, Ealing Hospital, NHS Trust, London, UK
*Corresponding Author: *Corresponding author: Chaudhary Muhammad Junaid Nazar, , Email: dr.cmjnazar@livd.co.uk

Abstract

Background: It was not until mid nineties when UK (RAS) and US (K/DOQI) first launched the nutritional and biochemical standards for haemodialysis in patients with ESRF. The present case is related to a patient who’s blood results diverged widely from the nutritional and biochemical standards set by the RAS. And how the multidisciplinary team with this patient aimed to achieve these standards.Case: A 52-year old, staff nurse presented with end stage renal failure due to polycystic kidney disease with bilateral nephropathy, established on haemodialysis unusual inter-dialytic weight gains, often severe intradialytic cramps and hypotension to the point of being unresponsive. The patient’s high weight gain and high serum potassium and phosphate levels led to the patient being labelled non-compliant. Other contributing factors together with weight gains have to be explored.Conclusion: Renal health care professionals have guidelines which they can work with their patients. Outside target results should be investigated to ensure that patient receives the right treatment. Treatment modality and prescription have to be individualized according to the patient’s needs. Like this case it is worth considering other factors like events in the patient’s life cycle, personal, social and economical factors and staff’s attitude may contribute to the perceived non-compliance.

Implication for health policy/practice/research/medical education: During renal dialysis, intradialytic blood results can diverge widely from the recommended standards. Renal health care professionals have now guidelines including nutritional and biochemical targets readily available towards which they can work with their patients. When a patient’s blood results or fluid/nutritional intake are consistently outside the targets, the reasons for this should be investigated to ensure that the patient receives the right treatment. Please cite this paper as: Junaid-Nazar CM, Lala MA, Izhar S, Joesph P. Accomplishing dietary and biochemical standards and improving hemodialysis efficiency with a non-compliant patient; a case study. J Renal Inj Prev 2014; 3(3): 75-78. DOI: 10.12861/jrip.2014.22
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