title: Accomplishing dietary and biochemical standards and improving hemodialysis efficiency with a non-compliant  patient; a case study.
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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Medicine, University of Buckingham, Ealing Hospital, NHS Trust, London, UK.
authors.forename: Chaudhary-Muhammaed
authors.initials: CM
authors.lastname: Junaid-Nazar
authors.affiliation: Rural Health Development Program, Rural Area Development Council, Punjab, Pakistan.
authors.forename: Manzoor A
authors.initials: MA
authors.lastname: Lala
authors.affiliation: Department of Medicine, Allamaiqbal Memorial Teaching Hospital, Sialkot, Punjab, Pakistan.
authors.forename: Saba
authors.initials: S
authors.lastname: Izhar
authors.affiliation: Department of Medicine, University of Buckingham, Ealing Hospital, NHS Trust, London, UK.
authors.forename: Percy
authors.initials: P
authors.lastname: Joesph
keywords: Diet; End Stage Renal Failure; Hemodialysis; Renal Association Standards; Renal Disease