Skip Navigation Link

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Improving the understanding, detection, and management of kidney disease.

CKD and Nutrition for Dietetic Educators

NKDEP has developed a suite of materials to support dietetic educators in teaching students and interns about nutritional interventions for chronic kidney disease (CKD) patients. The materials are designed to provide students and interns with the basic information they will need to counsel patients who have CKD once they become practicing registered dietitians (RD). The dietetic educators materials suite includes a presentation, Chronic Kidney Disease 101: Nutrition Intervention, which covers kidney function, kidney disease, and basic information about the CKD diet in the outpatient setting. Additionally, the suite includes five outpatient case studies, which challenge students to think critically about nutritional interventions and apply their CKD nutrition knowledge. The case studies feature patients with a variety of kidney-related conditions; including hypertension and prediabetes, albuminuria and type 2 diabetes, several CKD complications, and kidney failure."

expand  

Why is it important to teach dietetic students and interns
about nutrition for CKD? »

When they become RDs, your students and interns will likely see many patients with CKD. CKD is a serious and growing public health problem in the United States. More than 20 million Americans aged 20 and older may have CKD, based only on a decreased glomerular filtration rate (GFR), a measure of kidney function. Additionally, the rising rates of diabetes and obesity will continue to fuel its growth, as both diabetes and obesity increase the risk of developing CKD and speed its progression.

Individualized medical nutrition therapy (MNT) is critical for patients with CKD. MNT may delay CKD progression, prevent or treat complications such as malnutrition, and improve quality of life. Additionally, MNT may lower healthcare costs. CKD is one of the few diagnoses that Medicare provides reimbursement for MNT, as the cost of treating kidney failure is increasing. It is important that CKD patients receive individualized MNT from an RD knowledgeable in CKD diet and nutrition across the continuum of kidney disease. To prepare dietetic students and interns to meet this need as practicing RDs, education around identifying and treating patients with CKD should be included in the dietetic internship and preceptor programs.

Nutritional interventions for CKD targeted at urine albumin excretion may be relevant for several diseases. Abnormal urine albumin excretion is used to identify damaged kidneys and is also associated with cardiovascular disease (CVD) and increased mortality. Additionally, for many people, albuminuria is the earliest sign of CKD and can be an indicator of rapid kidney disease progression. Several nutritional interventions—including sodium restriction, weight loss, blood pressure control, and adequate protein intake—may reduce urine albumin excretion, which may in turn lower risks for development or progression of CKD, development of CVD, and mortality.

expand  

How do you use the suite of materials? »

The Chronic Kidney Disease 101: Nutrition Intervention Presentation provides an overview of kidney function and kidney disease and basic information about the CKD diet in the outpatient setting. Educators can present the module in a classroom setting. Notes are included with each slide to guide educators through the presentation. Alternatively, educators can assign the presentation as homework, to review in advance of a classroom discussion.

The Case Studies are designed to challenge students to think critically about nutritional interventions for CKD and apply their CKD nutrition knowledge. The case studies can be reviewed via an in-class discussion or assigned to students as individual or group homework. Since there are several case study options, it may be beneficial to discuss at least one case study in class and assign the other case studies as homework. The Carlos Mendes case study may be the most challenging of the four case studies, requiring students to explain abnormal lab parameters with kidney function, diet, and associated medications. Therefore, this case study may be a useful tool for class discussion. Answer keys are included for each case study and are not intended to be distributed prior to case completion.

expand  

What if I feel unprepared to teach CKD? »

We recognize that some practicing RDs and dietetic educators may have limited CKD experience and may feel unprepared to teach CKD. Most would agree they received very little exposure during internship. Many experienced practitioners are just learning about the importance of albuminuria in identifying kidney damage. When considering the numerous CKD complications such as anemia, mineral and bone abnormalities, chronic metabolic acidosis, and hyperkalemia, it is not surprising that CKD may be more "complicated" to teach or master. NKDEP has free resources for educators who feel they need an update about CKD prior to using the case studies:

  • The Chronic Kidney Disease Nutrition Management training program, a series of five modules for practicing RDs, has comprehensive information on kidney disease, slowing the progression of CKD, CKD complications, the CKD "diet," and the transition from CKD to kidney failure. The training program may help educators prepare for teaching their students and interns about CKD and nutrition. The program may also be appropriate for the more ambitious student who is seeking additional information. The Academy of Nutrition and Dietetics provides CEU credits for these modules as part of their online training certificate program.
  • The Chronic Kidney Disease and Diet: Assessment, Management, and Treatment Guide pdf icon (1.2M) was developed to help RDs provide effective MNT to CKD patients who are not on dialysis. The evidence-based guide includes information on the basics of CKD; assessing kidney function and damage; slowing CKD progression; preventing, monitoring, and treating complications; and resources for patient education.

Materials Suite for Dietetic Educators

Chronic Kidney Disease 101: Nutrition Intervention

PowerPoint slides

PowerPoint (4.7 MB)
This presentation covers the basics of kidney disease and the CKD diet. You can review the module with your students and interns in a classroom setting, or assign the module as homework.

The module is in read-only format. When you open the file, a pop-up box will appear. To view the module content, please click on 'Read Only' in the pop-up box. You will not be able to make any edits to the presentation.

Instructions for use:
The module is available for download in read-only PowerPoint format. When you open the file, a pop-up box will appear. To view the module content, please click on 'Read Only' in the pop-up box. You will not be able to make any edits to the presentation.

Case Studies

The four outpatient case studies feature patients with a variety of kidney-related conditions:

The Case of Harriet Nells: Prediabetes, Hypertension, and CKD

In reviewing and discussing the case of Harriet Nells, a 58-year-old African American female with prediabetes, hypertension, and CKD, students will learn to identify CKD using the estimated GFR and urine albumin-to-creatinine ratio (UACR), to associate improved blood pressure control with reduced risk for CKD progression, and the recommended sodium intake for CKD. Additionally, students will be presented with a common challenge faced by nutrition practitioners: a discrepancy between what the client wants to address and the focus of the physician's referral. In the referral for Harriet Nells, the physician has noted he is primarily concerned about sodium and blood pressure control; however, students will find that Harriet Nells wants to focus on weight loss to prevent diabetes.

For distribution to students:

Harriet Nell's Medical Nutrition Therapy Referral Form pdf icon (821K)
This completed referral form contains information about Harriet Nells that will help students prepare for her outpatient visit. To best understand the information included in the referral form, it may be helpful for students to review the form's rationale for data inclusion.

Blank Case Study pdf icon (536K)
This case study contains background information obtained from the referral and Harriet Nells, including a diet recall; and has questions for students to answer about appropriate nutritional interventions.

Blank Explaining Your Kidney Test Results Work Sheet pdf icon (140K)
This tear-off pad work sheet was designed for use by health care professionals to help people understand their kidney test results. Have the students fill it out as if they were using the tool in person with Harriet Nells. It may be helpful to discuss the graphics with the group.

For checking case study answers/preparing for a class discussion:

Case Study Answer Key pdf icon (606K)
This answer key gives learning objectives for the case study, highlights key points from the case, and provides answers to the case questions, looking through the CKD perspective.

Explaining Your Kidney Test Results Work Sheet Answer Key pdf icon (115K)
This answer key shows how the Explaining Your Kidney Test Results Work Sheet might be filled out during an initial and follow-up consultation with Harriet Nells. These are the basic test results used to identify CKD.

The Case of Allen Blake: Albuminuria and Type 2 Diabetes

In reviewing and discussing the case of Allen Blake, a 36-year-old white male with type 2 diabetes and albuminuria, students will learn to associate sodium restriction, weight loss, blood pressure control, adequate protein intake, and tobacco cessation with reduced urine albumin excretion. Additionally, they will see how medications that block the renin-angiotensin- aldosterone system can lower urine albumin levels.

For distribution to students:

Allen Blake's Medical Nutrition Therapy Referral Form pdf icon (983K)
This completed referral form contains information about Allen Blake that will help students prepare for his outpatient visit. He has uncontrolled diabetes and an elevated urine albumin indicating significant kidney damage. Note the Additional Information at the bottom, he has missed numerous appointments for diabetes education. To best understand the information included in the referral form, it may be helpful for students to review the form's rationale for data inclusion.

Blank Case Study pdf icon (553K)
This case study contains background information from Allen Blake including issues with his diabetes control, medication adherence and lifestyle. The questions are designed to focus on the albuminuria as he is there because his doctor said "something about kidney damage." He may not be ready to address his diabetes, a common occurrence in the outpatient setting. The follow-up visit is intended to show the benefit of MNT.

Blank Your Kidney Test Results "Report Card" pdf icon (140K)
This report card was designed for use by health care professionals to help people with CKD keep track of their lab values. Have the students fill it out as they might if they were using the tool with Allen Blake. Note: Not every parameter and lab result is discussed at every patient visit.

Blank Explaining Your Kidney Test Results Work Sheet pdf icon (140K)
This tear-off pad work sheet was designed for use by health care professionals to help people understand their kidney test results. Have the students fill it out as if they were using the tool with Allen Blake.

For checking case study answers/preparing for a class discussion:

Case Study Answer Key pdf icon (635K)
This answer key gives learning objectives for the case study, highlights key points from the case, and provides answers to the case questions. Although some clinicians may prefer to focus on his diabetes control (educators are free to do so), he was referred for CKD and is there due to his concern about the kidneys. In reality, practitioners may find themselves struggling to prioritize topics with clients. The answer key is not intended to be distributed to students prior to case completion.

Your Kidney Test Results "Report Card" Answer Key pdf icon (103K)
This answer key shows how the Your Kidney Test Results "Report Card" might be filled out during a consultation with Allen Blake. If the students only focus on the ABCs of diabetes (A1C, blood pressure and LDL cholesterol), they would miss the CKD. The elevated albuminuria is significant and should be addressed. Note that medications are written by the appropriate parameters; this may be useful for his understanding of the medications. Diabetes Educators may have some training with medications, but familiarity with medication names may be advantageous for all RDs when clients have questions about their medications.

Explaining Your Kidney Test Results Work Sheet Answer Key pdf icon (65K)
This answer key shows how the Explaining Your Kidney Test Results Work Sheet might be filled out during a consultation with Allen Blake. As noted above, she has reduced kidney function and a normal UACR.

The Case of Millie Jones: Hyperlipidemia, Vitamin D, and Anemia

In reviewing and discussing the case of Millie Jones, a 79–year–old white female with hypertension, long-term type 2 diabetes, hyperlipidemia, and CKD, students will learn to associate normal UACR with slower progression of CKD, people can have a low but stable eGFR. Additionally, students will learn to identify diet strategies that may reduce lipids in CKD, total 25(OH)D as the marker for vitamin D status in CKD, hemoglobin as marker of anemia, and transferrin saturation and ferritin as iron indices used to assess iron status in CKD.

For distribution to students:

Millie Jones's Medical Nutrition Therapy Referral Form pdf icon (1M)
This completed referral form contains information about Millie Jones that will help students prepare for her outpatient visit. She has a very low eGFR and shows no evidence of kidney damage, as evidenced by a normal UACR. The physician refers her for dyslipidemia and notes she had to stop taking a statin due to muscle pain. Due to her reduced kidney function, Millie Jones experiences some CKD complications. To best understand the information included in the referral form, it may be helpful for students to review the form's rationale for data inclusion.

Blank Case Study pdf icon (526K)
This case study contains background information obtained from the referral and Millie Jones including lab data from the previous 8 months showing that acute illness may cause a transient decrease in kidney function with return to baseline. The questions focus attention on the importance of a normal UACR and vitamin D in CKD. The follow-up visit involves anemia and iron. .

Blank Explaining Your Kidney Test Results Work Sheet pdf icon (140K)
This tear-off pad work sheet was designed for use by health care professionals to help people understand their kidney test results. Have the students fill it out as if they were using the tool with Millie Jones.

For checking case study answers/preparing for a class discussion:

Case Study Answer Key pdf icon (594K)
This answer key gives learning objectives for the case study, highlights key points from the case, and provides answers to the case questions. In addition to starting a new medication to treat dyslipidemia, she is prescribed numerous nutritional supplements to treat CKD complications. Her lab data shows reduced kidney function and normal UACR.

Explaining Your Kidney Test Results Work Sheet Answer Key pdf icon (45K)
This answer key shows how the Explaining Your Kidney Test Results Work Sheet might be filled out during a consultation with Millie Jones. As noted above, she has reduced kidney function and a normal UACR.

The Case of Carlos Mendes: Complications of CKD

In reviewing and discussing the case of Carlos Mendes, a 77-year-old Hispanic male with long-term type 2 diabetes, students will learn to associate the functions of the kidneys, diet, and medications as they relate to the complications of CKD. Additionally, they will learn to identify appropriate interventions for hypoglycemia in CKD. This case is different from the previous cases; students have to explain the role of kidney function and discuss diet and medications for each abnormal lab parameter.

For distribution to students:

Carlos Mendes's Medical Nutrition Therapy Referral Form pdf icon (973K)
This completed referral form contains information about Carlos Mendes that will help students consider his case. He is approaching kidney failure and experiencing more frequent hypoglycemia. To best understand the information included in the referral form, it may be helpful for students to review the form's rationale for data inclusion.

Blank Case Study pdf icon (483K)
This case study contains background information from the referral and from Carlos Mendes including a diet recall. There is an additional complications grid to be used by the students.

Blank Complications Grid pdf icon (461K)
This grid lists several issues Carlos Mendes is experiencing and provides space for students to fill in the implications for kidney function/kidney disease and potential diet and medical interventions for each listed issue. Note: Students may find it easier to fill out the grid using the rationale on the back of the MNT referral and reviewing the slide set. Class discussion may provide opportunity to summarize kidney functions as they relate to metabolic abnormalities, diet, and medications.

Blank Your Kidney Test Results "Report Card" pdf icon (140K)
This report card was designed for use by health care professionals to help people with CKD keep track of their lab values. Have the students fill it out as they might if they were using the tool with Carlos Mendes. Note: All parameters are included, but may not be from the same date.

For checking case study answers/preparing for a class discussion:

Case Study Answer Key pdf icon (482K)
This answer key gives learning objectives for the case study, lists complications to be discussed and has focuses specifically on hypoglycemia. See more information about the Complications Grid below.

Complications Grid Answer Key pdf icon (594K)
This answer key provides the implications for kidney function/kidney disease and potential diet and medical interventions for each issue listed in the blank grid.

Your Kidney Test Results "Report Card" Answer Key pdf icon (408K)
This answer key shows how the Your Kidney Test Results "Report Card" might be filled out during a consultation with Carlos Mendes.

The Case of Juan Cruz: Approaching Kidney Failure

In reviewing and discussing the case of Juan Cruz, a 60-year-old Puerto Rican man with a recent diagnosis of chronic kidney disease due to type 2 diabetes, students will learn to identify chronic kidney disease using estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR) and apply the basic steps for eating right for chronic kidney disease.

For distribution to students:

Blank Case Study pdf icon (483K)
This case study contains background information on Juan Cruz including recent lab data, a diet recall, and a nutrient analysis in an initial and follow-up visit. The case study includes both nutrition-based and clinical questions.

For checking case study answers/preparing for a class discussion:

Case Study Answer Key pdf icon (482K)
This answer key gives learning objectives for the case study, highlights key points from the case, and provides answers to the case questions.

Page last updated: April 2, 2014