Chronic Kidney Disease

Question 1

CKD Definition

Answer 1

CKD: Gradual worsening of kidney function over >3 months.

Question 2

CKD Symptoms

Answer 2

PEW: Protein-energy wasting, insufficient energy, and muscle wasting.

Albuminuria: Excess albumin in urine; predictor of CKD progression. Symptoms: foamy urine, oedema.

Renal Osteodystrophy: Bone issues secondary to kidney disease.

Vascular Calcification: Hardening of blood vessels.

Anaemia: Due to reduced erythropoietin production.

CVD Risk: CKD increases strain on the heart, leading to heart failure.

Question 3

Stages of CKD

Answer 3

Stage 1: >90 (normal or increased GFR).
Stage 2: 60-89 (mild reduction).
Stage 3: 30-59 (moderate reduction).
Stage 4: 15-29 (severe reduction).
Stage 5: <15 or on dialysis (kidney failure).
(Mnemonic: Stage 3 = eGFR 30, ±29 for other stages)

Question 4

CKD FU Times

Answer 4

Stages 1-2: Every 6 months.
Stages 3-5: Every 3 months.
Stage 5D: Monthly.

Question 5

CKD MNT Goals

Answer 5

1. Maintain nutrient intake to prevent PEW.
2. Stabilize biochemical markers (e.g., electrolytes, albumin).
3. Achieve/maintain desirable weight.

Question 6

Dietary Prescription for CKD

Answer 6

Energy:
<60 years: ~35 kcal/kg IBW/day.
60 years: ~30 kcal/kg IBW/day.

Protein:
Stable CKD 3-5: 0.55-0.6 g/kg IBW/day.
Dialysis: 1.2-1.4 g/kg IBW/day.

Electrolytes:
Sodium: 80-100 mmol/day (reduce processed foods).
Potassium: 40-70 mmol/day (if restriction needed).
Phosphate:
CKD 3-5: <800 mg/day.
Dialysis: 1000-1200 mg/day.

Fluid: Urine output (UO) + 500 ml/day

Question 7

CKD Nutrition Considerations by Stage

Answer 7

CKD Stages 1-2:
Encourage fruits and vegetables to reduce net acid production.
Energy: 25-35 kcal/kg/day.

CKD Stages 3-5:
Protein: 0.55-0.6 g/kg IBW/day.
Restrict sodium (<100 mmol/day) and phosphorus (<800 mg/day).

Dialysis (Stage 5D):
Increased protein (1.2-1.4 g/kg IBW/day) to offset losses.
Monitor fluid intake to control interdialytic weight gain (<4-4.5% dry weight).

Transplant Patients:
Acute Phase: High protein needs (>4 g/kg/day).
Long-term Phase: Maintain protein at 0.75-1.0 g/kg/day.

Question 8

High Phosphorus Foods

Answer 8

Sources: Meat, dairy, legumes, cereals, nuts, seeds.

Toxicity: Excess intake (e.g., supplements, sodas) causes diarrhea, tissue calcification, and bone weakening.

Deficiency: Rare; symptoms include anaemia, bone pain, and infections.

Question 9

AKI

Answer 9

Energy: 20-30 kcal/kg/day.

Protein:
Non-catabolic: 0.8-1.0 g/kg/day.
Dialysis: 1.0-1.5 g/kg/day.
CRRT: Up to 1.7 g/kg/day.

Electrolytes: Monitor and adjust sodium, potassium, and phosphorus.

Question 10

General Nutrition Guidelines for CKD

Answer 10

Dietary Patterns: Mediterranean diet for lipid control and BP management.

Smoking Cessation: Reduces CKD progression and CVD risk.

Activity: 30 minutes/day moderate exercise.