Case Study

Lily Petrov is 71 years old and lives in a rural town in Ontario. She never married and has no children.  She lives alone in a small two-story townhome. She prefers to be called Lily.

After working as a registered nurse for 35 years, Lily retired 6 years ago when she was diagnosed with chronic kidney disease (CKD). The diagnosis came as a surprise to Lily as she did not have any symptoms. A yearly physical exam and blood work at that time revealed that her GFR was 28. Since her diagnosis, her GFR has fallen to 23. Lily has told her physician that she will refuse dialysis when her kidneys are no longer able to function, and she does not wish to go on a kidney transplant list.

Two weeks ago, Lily was discharged from the local community hospital post-operation for gallbladder surgery. While hospitalized, the nurses learned that Lily eats a diet rich with dairy, meat, and pastries (foods known to contribute to gallbladder disease). They also learned she prefers not to follow a CKD dietary regime as she finds the foods to be bland. Her decline in kidney function and the appearance of new symptoms (itchiness, some sleep problems) associated with renal decline were attributable to her choice not to follow her prescribed CKD diet of low potassium, low sodium and low purine foods. The team decided to refer her for follow up by a CCAC nurse as they felt her declining health could be enhanced with some nutritional education. With more knowledge, the team believed that Lily would implement the dietary regime to prolong her health.

The CCAC nurse met with Lily one week after her discharge. She provided lots of health literature and pamphlets about advanced kidney disease. The nurse found Lily in her backyard pulling up weeds in her garden and feeding the birds. Lily served the nurse some orange juice and bagels – both not ideal foods for CKD diet. The CCAC nurse was surprised to learn that Lily felt her health was excellent, despite feeling tired on occasion. When the nurse probed Lily more about her health, the nurse learned that Lily believes that health is being well enough to garden, visit with friends, and enjoy good food. Without those things, Lily felt her quality of life would decline. It was clear to the visiting nurse that Lily did, in fact, know a great deal about her prescribed diet but her understanding about health and well being was driving her lifestyle choices and not her CFR values. Lily declined to take the pamphlets but said she would look forward to another visit by the nurse and stated, “I will have some nice fresh baked cake when you visit next”.