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
what is the general recommendation for caloric intake in CKD?
30-35 g/kg/day
What condition is related to dietary fats and can contribute to kidney disease?
Atherosclerosis
This is a major contributor to HTN and may cause or worsen CKD
sodium
what level should sodium be kept at in CKD?
similar to general population- 3-4 g/day
greater reduction as CKD worsens
Often also need diuretic and other anti hypertensive to control HTN
What are recommendations for fluid intake with CKD?
encourage non-carbonated, non-sugary, non-caffeinated beverages
thirst is good indicator of hydration in younger patients with mild-moderate CKD, but diminishes in older patients and later-stage CKD
1.5 L/day average patients, 1 L/day if complications to avoid fluid overload or hyponatremia
What are recommendations related to potassium with CKD?
Diseased kidneys lose ability to excrete potassium
later-stage CKD patients often have difficulty with higher levels
Potassium restriction of <3 g/day if later-stage CKD or hyperkalemia
can boil fruits/vegetables to reduce, regular serum potassium checks, medications to reduce potassium if needed
CKD patients commonly have metabolic ____
acidosis
contribution of food or dietary pattern to net endogenous acid production
potential renal acid load
what food tend to have high acid production? Low?
animal-based foods, plant-based foods (tend to produce bases)
how are acid levels in CKD reduced?
supplementation with sodium bicarbonate or eat 2-4 cups of fruits/vegetables daily
are CKD patients often high or low in phosphorus?
high, have trouble excreting
What foods are recommended/should be avoided with CKD patients in regards to phosphorus?
cut back on dietary phosphorus, from fruits and vegetables is not usually a problem because not well absorbed
dark sodas, processed foods should be avoided and 800 mg/day is recommended
Vitamin D is absorbed in the ____ or made in the ____ and activated by the liver or ____
GI tract, skin, kidneys
patients with CKD have less circulating active vitamin ____ and less ___ absorption in GI tract
D, calcium
Vitamin ___ supplement is indicated in all stages of CKD, as it’s generally accepted these patients are insufficient or deficient; ___ levels generally increase when Vitamin D is replaced
D, calcium
What other vitamins (other than vitamin D) are patients at risk for deficiency of with CKD?
B vitamins and vitamin C (a general multivitamin, preferably kidney friendly is appropriate)
what happens to iron levels in CKD patients?
decreased due to hepcidin, less heme-based iron in CKD diets
May need iron supplementation
what supplement may help with lipid levels in CKD patients?
carnitine
what mineral is often deficient in CKD patients, especially on dialysis but supplementation is not recommended
zinc/selenium
this has a risk of toxicity with CKD so patients should avoid ___ based medications
aluminum
What are the metabolic derangements present in CKD?
Altered feedback mechanisms: appetite, thirst, taste
Altered protein homeostasis and catabolism
Altered energy homeostasis
Altered nutrient metabolism
Which patients are especially prone to altered energy homeostasis?
Dialysis patients
How is nutrient metabolism impacted by CKD?
Gut absorption of calcium and iron impaired
Vitamin deficiencies (B vitamins, C, active form of D)
Mineral deficiencies (zinc, selenium, manganese)
At risk for aluminum toxicity
What are recommendations for dietary fat with chronic kidney disease?
Limit saturated fats, trans fats
Promote intake of polyunsaturated and monounsaturated fats, especially omega-3
What can high saturated fat consumption increase related to CKD
Glomerular pressure, albuminuria —-> long-term kidney damage and CKD progression
How is dietary fiber related to chronic kidney disease?
Promotes fecal nitrogen excretion to lower waste products for kidney and serum urea and creatinine
Lowers inflammation levels in the body
Better mortality
What is the recommended intake of fiber for patients with CKD?
25-30 g/day
May recommend higher in later stage CKD
