Just the Facts
Essentials
In the bag
True or False
100
As serum _______ decreases, risk of mortality and morbidity increases
what is Albumin?
100
________________deficiency can result in decreased immunity, digestive problems, depression, fertility issues, and lower mental alertness.
What is Protein/ Amino Acid?
100
A Plant based amino acid solution given IV to provide the protein equivalent to a 9-15 oz steak during a dialysis treatment.
What is IDPN?
100
IDPN/IPN is rarely covered by insurance
What is False
Most insurance covers IDPN- Medicaid, Medicare and Commercial
Only Medicare D will not cover IPN_ but the Medicare Advantage plans do
200
A dialysis pt with an Albumin less than 3.5 is at what percent higher rate of mortality.
a. double
b. 5 times
c. no risk
MILD > 4.0 g/d/L REFERENCE
MOD 3.5- 4.0 g/dL 2X RRD
SEVERE 3.0-3.5 g/dL 5X RRD ONS/ IDPN Covered
MOST SEVERE <2.5-3.0 g/dL 7- 8X RRD
200
There are 21_______ that appear in the genetic code and are needed for protein synthesis?
What are amino acids?
200
Previous lipids added to the IDPN were solely from Soybeans. Today Pentec provides their lipids with what type of oil?
What is OLIVE OIL
Clinolipids 80% Olive oil- less inflammatory than polyunsaturated oils
200
Pentec health will push a referral though despite not meeting DaVita specific criteria.
False, your Pentec team is well versed in DaVita policy and will hold a referral until criteria is met to move forward. We always welcome an insurance check and will monitor for you
300
Improving albumin by just _______ improves mortality and morbidity
a. 0.2 gm/dl
b. 0.5 gm/dl
c. 1 gm/dl
a. 0.2 example albumin 3.3 to 3.5
Albumin exhibited a robust association with both mortality and hospitalization risk. Studies show only 0.2 increase in Albumin reduces hospitalizations and deaths and infections 25-30%
300
The type of amino acids that needs to be consumed that aren't automatically produced by the human body are ________________
What are the essential amino acids? IDPN/IPN contains these essential amino acids
300
An average IDPN solution contains how many grams of protein in less than 1 liter of solution?
A 10-20gms
B 30-50gms
C 70-90gms
What is C 70-90 gms -
a daily supplement of a typical patient's need
300
KDOQI Guidelines recommend prescribing IDPN/IPN to treat malnutrition when Alb is less than 3.5
True
KDOQI 4.1.3
In adults with CKD on MHD with protein-energy wasting, we suggest a trial of IDPN for MHD patients, and AA dialysate for PD patients to improve and maintain nutritional status.
400
Protein malnutrition is present in ________ % of dialysis patients.
A 10%
B >50%
C 25%
What is > 50 %
More than half of your patients are likely to be suffering from protein malnutrition
PEW Albumin < 3.8
npcr <.8 or
less than 1.2 gm/kg protein intake
400
Grams of amino acids or protein potentially lost during a typical dialysis treatment.
a. 5 - 7gms
b. 12 -15 gms
c. 30- 40 gms
What is 12- 15 gms?
400
A hypertonic solution that creates an osmotic gradient driving fluid from interstitial space to intervascular space resulting in more efficient fluid removal and provides all the essential and non-essential amino acids.
What is IDPN (1400-2000mOsm/L, making it a hypertonic solution. In comparison, body fluid is 285-295 mOsm/L. )
400
Albumin can NOT improve when there is Inflammation
What is FALSE?
False
500
The expected length of time on therapy is
A) same for all patents
B) depends on insurance
C) individualized
C) The length of time on therapy varies. You have an assigned renal clinical case manager that monitors patients progress on therapy.
500
One of the Amino acids known to promote wound healing
What is Arginine?
Arginine is included in Pentec's IDPN/IPN formula
500
The therapy of exchanging some of the dextrose in the dialysate bag of a PD pt and replacing it with an Amino Acid solution called?
What is IPN- Intra-peritoneal Nutrition?
500
Amino Acids in IPN reduces total glucose degradation products (GDP) in a dialysate solution
True
Regular dextrose Dialysate used for PD patients have GDPs that over time compromise the peritoneum.
Amino acids do not