CKD + Cardiac

Question 1

How does muscle wasting influence creatinine?

Answer 1

(If a patient is muscle wasted, creatinine will be lower which can mask CKD, need to look at the whole picture/trends)

Question 2

What dietary factors can increase BUN?

Answer 2

(High protein diets so if you have a patient with elevated BUN, make sure they aren’t on a high protein diet before jumping to conclusions)

Question 3

What is a dietary modification you can suggest to an owner whose CKD pet is not consuming enough water?

Answer 3

(Switch to a wet food or soak kibble in water)

Question 4

Protein should be restricted/supplemented (choose) in a CKD diet.

Answer 4

(Restricted)

Question 5

Why should you take caution when prescribing a kidney diet to a patient with a history of pancreatitis or lymphangiectasia?

Answer 5

(Kidney diets are higher in fat content to make up for lower protein)

Question 6

Which fatty acids should be enhanced in CKD diets?

Answer 6

(Omega 3s, particularly EPA and DHA)

Question 7

What can result from hyperphosphatemia subsequent to CKD?

Answer 7

(Soft tissue calcification, avoided by restricting phosphorus is CKD diets)

Question 8

When does the use of phosphorus binders become more important in cases of kidney disease?

Answer 8

(When you have tried to limit dietary P and they are still hyperphosphatemia or if the patient is resistant to eating a low phosphorus diet)

Question 9

What ingredient in an ingredient list should you look for when trying to determine if a treat has phosphorus or not?

Answer 9

(Phosphate)

Question 10

What supplemental food types should be avoided in a hyperkalemic kidney patient (i.e. besides choosing a low in potassium kidney diet, what else should be avoided)?

Answer 10

(Fruits and vegetables)

Question 11

Sodium intake in CKD patients should be supplemented/limited/restricted (choose).

Answer 11

(Limited, i.e. avoid high sodium diets but don’t necessarily needs to seek a low sodium diet)

Question 12

Why is it generally recommended that antioxidants should be supplemented in CKD diets?

Answer 12

(Bc CKD patients have fewer nephrons, the leftover nephrons have to do more work and it can lead to increased free radical generation, antioxidants combat that; and enhancing vitamin E specifically is important when enhancing EPA/DHA to prevent PUFA oxidation)

Question 13

(T/F) The AAFCO statement on a renal diet meant for kidney disease patients will have your typical “formulated to meet the requirements of an adult animal”.

Answer 13

(F, it should not have that statement if it is a true renal diet because these diets are intentionally deficient in certain things, should say “substantiated by feeding test” or “for intermittent or supplemental feeding”)

Question 14

What dietary modifications would you recommend to an owner with a CKD pet who developed hypercalcemia while on a CKD diet?

Answer 14

(Recommend switching to another brand and/or supplementing fiber)

Question 15

What is the primary justification for feeding a homemade renal care diet to a CKD patient?

Answer 15

(The patient won’t eat a commercial renal diet)

Question 16

(T/F) Protein should be limited in a cardiac disease patients’ diet.

Answer 16

(F, do not limit protein)

Question 17

What substance should be enhanced in the diet of cardiac disease patients because it shuttles fatty acids across the mitochondrial membrane?

Answer 17

(L-carnitine)

Question 18

What is the issue with entirely restricting the sodium consumption of a cardiac disease patient?

Answer 18

(The body will just hold onto the sodium already present and any sodium it can get so it can be counterintuitive to entirely get rid of sodium, goal is to limit (< 1.5 g/Mcal) /possibly restrict (0.5-0.8 g/Mcal) if needed)

Question 19

Taurine deficiency in grain-free or BEG diets is thought to be the cause of DCM in what breed of dog specifically?

Answer 19

(Goldens, so taurine supplemented grain free diets are possibly fine for them but this is the only breed with an actual study linking the breed to taurine deficiency causing DCM)