Diet and Renal Disease* Flashcards
Acute decrease in kidney function as manifested by a decrease in estimated GFR levels
acute kidney injury
what abnormalities does acute kidney injury cause?
abnormal volume status (fluid overload or dehydration), electrolyte and acid-base derangements, build up of waste products in blood
What are important things to consider with nutrition in acute kidney injury?
may need fluid replacement if hypovolemic
electrolytes often self-correct
AKI patients have accelerated protein breakdown and may need more protein intake if prolonged
should consult a dietitian if AKI persists more than a few days
Presence of persistently abnormal kidney function, as manifested by decreased glomerular filtration rate of <60 mL/min for 3+ months
and
structural or functional markers of kidney damage
Chronic kidney disease
What are the main two diseases that contribute to the majority of chronic kidney disease in the US?
DM and HTN
In patients without CKD, better BP/BS control means _____; in patients with CKD, better BP/BS control means _____
less likelihood of developing CKD; less likelihood of CKD progression
Note: CKD can also cause HTN in patients who don’t have it already
What can contribute to the development and progression of CKD that can be mitigated by dietary changes?
atherosclerosis
What are metabolic derangements in CKD?
altered feedback mechanisms: altered appetite, thirst, and taste
altered protein homeostasis and catabolism
altered energy homeostasis: especially in dialysis patients, may develop cachexia
altered nutrient metabolism: impaired gut absorption of calcium and iron, frequent vitamin deficiencies, frequent mineral deficiencies, at risk for aluminum toxicity
What are recommendations for protein with CKD?
Protein restriction is recommended to slow down deterioration of kidney function in adult CKD patients –> reduces glomerular flow and pressures and slows accumulation of waste products in CKD
In pediatric CKD patients, protein restriction may contribute to _____ and often has net _____ so it is recommended to have _____
nutritional deficiencies, adverse effects, close follow-up by dietician
Do you think patients who don’t currently have CKD should restrict their protein intake?
If they do not have CKD, do not need to
What type of protein is recommended in CKD diet if protein is consumed and why?
plant-based
animal based proteins have more bioavailable phosphate for absorption and higher potential acid load
plant based proteins generally have more vitamins and minerals and higher fiber intake
If patients are in stage 1-2 of CKD, what is the recommendation in regards to protein?
No outright restriction, recommended .8 g/kg/day
encouragement of plant-based proteins
if patients are in stage 3-5, what is the recommendation in regards to protein?
protein restriction, more aggressive restriction as CKD gets worse to .6-.8 g/kg/d
higher proportion of plant-based proteins as gets worse
What are recommendations regarding protein in stage 5 CKD?
increased protein intake from previous diet plans, especially on dialysis days
may also need increased protein intake if very heavy protein loss in urine
Need 1.0-1.2 g/kg/day if hemodialysis, up to 1.3 g/kg/day if peritoneal dialysis
What is the name of the general diet guidelines recommended for all adult CKD patients, regardless of underlying etiology
PLADO (plant-dominant low protein diet)
Restricted protein, plant sources (>50%), restricted sodium, high fiber, adequate caloric intake
What is an alternative diet plan that is associated with better CKD outcomes and lower average blood pressure than standard restricted diets?
very low protein diet with supplementation
CKD patients, especially later stage, are vulnerable to _____
malnutrition, overt wasting, and cachexia
appetite is poor and therapeutic diet is often not palatable