2.3.2 Nutritional Management

Question 1

What are the stages of CKD? What are the GFR levels of each?

Answer 1

Stage I: 90 or above

Stage II: 60-89

Stage III: 30-59

Stage IV: 15-29

Stage V: Less than 15

Oh darn, I have stage I CKD. I’m dying….

Question 2

What are the two possible aspects of CKD?

Answer 2

Reduction in GFR

and/or

Albuminuria (more than 30mg albumin per gram of urinary creatinine)

Question 3

What are some nutritional consequences of kidney failure?

Answer 3

Decreased active Vit D

Decreased EPO prod

Decreased glucose prod in starvation

Decreased degradation of bioactive peptides

Question 4

What dietary profile would be effective in CKD patients (stage III and IV)?

Answer 4

Dash

Question 5

What are the important managment aspects from CKD patients with diabetes? with HTN?

Answer 5

Diabetes: tight glycemic control

HTN: BP below 130/80

Question 6

What is the suggested diet for CKD (stage IV)?

Answer 6

Same as stage III

Plus possibly including low potassium; low phosphorus; moderate Ca; Individualize vit D, iron, and zinc; monitor potassium

Question 7

What is often given to dialysis patients to supplement their diet?

Answer 7

Renal multivitamin containing Vit B, VitC, sometimes iron and zinc

Question 8

What are some ways to control phosphorous levels?

Answer 8

Restrict processed foods and colas

Phosphate binders

Question 9

Why do we monitor iron?

Answer 9

Since EPO is often reduced in CKD patients, we supplement with iron to make sure that all erythroid precursor cells have adequate supply of iron (this can be an issue due to protein restrictions)

Question 10

Answer 10

D

Question 11

Answer 11

D

Question 12

Why do we lower sodium?

Answer 12

Control BP, Prevent fluid retention, slow progression of renal failure

Question 13

Why do we control phosphorous?

Answer 13

Kidney has reduced capacity to excrete phosphate

Can lead to secondary hyperparathyroidism

Question 14

What is the suggested diet for a patient on dialysis (stage V)?

Answer 14

Energy intake: 35 kcal/kg

Protein: 1.2-1.3 protein/kg/day

Low sodium: 1500-2000

Fluid restriction: B/t 750-1500 mL

Low-Phos Nutrition

Moderate Ca

Moderate K

Individualize Vit D, iron, and zinc

Question 15

Answer 15

C

Question 16

Imma leave this here for the Crossfiters of the world…

*Cough, cough Miles

Answer 16

Question 17

Answer 17

1. Stage III
2. Diabetes and HTN
3. GET HIM ONE
4. Yo dude, you should eat right
5. You can’t love your wife if you’re dead

Question 18

Why do we lower protein intake?

Answer 18

Minimize nitrogenous waste, indirectly limit phosphorous, less protein-induced hyperfiltration, lowers intraglomerular pressure

Question 19

What is the suggested diet for CKD (stage 3):

Energy intake, Protein, Sodium, Fluid Restriction?

Answer 19

Energy intake: 23-35 kcal/kg

Low-protein: 0.6-0.8 protein/kg/day

Low sodium: 1500-2000 mg

No fluid restriction

Question 20

What are some signs of kidney failure?

Answer 20

Accumulation of nitrogenous waste

Decreased buffering capacity

Decreased regulation of BP and regulate water accumulation

Accumulation of endogenous metabolic end products

Question 21

What are the fat soluble vits?

Answer 21

A,D,E,K

Question 22

What are the water soluble vits?

Answer 22

B and C

Question 23

What are some of the major causes of kidney failure in the US?

Answer 23

1. Diabeetus
2. HTN
3. GN
4. Cystic Kidney
5. Other/Unknown
6. Urologic Dz

Question 24

What are the two most common causes of chronic kidney disease (CKD)?

Answer 24

Diabetes and HTN