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Nutrition > Lecture 9: Diet and Renal Disease > Flashcards

Lecture 9: Diet and Renal Disease Flashcards

1
Q

What is an AKI? Characteristics?

A

Acute Kidney Injury

  • Decreased eGFR
  • Abnormal volume status
  • Electrolyte imbalances
  • Buildup of waste products in blood
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2
Q

What is heavily affected in AKI patients? What do they need?

A

Accelerated protein breakdown, not suppressed by exogenous protein provision.

Need more protein intake for prolonged AKI.

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3
Q

What is CKD? Characteristics?

A
  • Persistently abnormal kidney function by either eGFR < 60 or structural/functional markers of kidney disease.
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4
Q

What are the stages of CKD and how are they determined?

A
  • Stage 1: eGFR > 90 with kidney damage
  • Stage 2: eGFR 60-90 with kidney damage
  • Stage 3a: eGFR 45-59
  • Stage 3b: eGFR 30-44
  • Stage 4: eGFR 16-29
  • Stage 5: eGFR <=15

Can also be staged by presence and amount of proteinuria

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5
Q

What are the two main causes of CKD?

A
  • HTN
  • DM
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6
Q

How are metabolic pathways affected in CKD?

A
  • Altered feedback mechanisms
  • Altered protein homeostasis and catabolism
  • Altered energy homeostasis
  • Altered nutrient metabolism
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7
Q

How do we manage protein intake for CKD patients?

A
  • Adults: restrict protein intake for chronic CKD.
  • Pediatric: monitor closely, restriction may cause nutritional deficiencies.
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8
Q

What kind of proteins are recommended if you have CKD?

A

Plant-based proteins.

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9
Q

Why are animal proteins not recommended?

A
  • Much more bioavailable phosphate
  • Higher potential acid load (PRAL)
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10
Q

When do we begin protein restriction recommendations in terms of CKD stages?

A
  • Stage 1-2 (GFR > 60), no need for restriction, simply aim for 0.8g/kg/day.
  • Stage 3-5 (eGFR < 60), restrict intake to 0.6-0.8 with increasing proportion of plant-based proteins.
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11
Q

How do you treat stage 5/ESRD on dialysis in terms of protein intake?

A

Increased protein intake, especially if on peritoneal dialysis.
They have increased metabolic demands.

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12
Q

What is the PLADO diet?

A

Plant-Dominant Low Protein Diet

  • Protein intake: 0.6-0.8
  • > 50% of protein intake from plants
  • Sodium < 4g/day, < 3g if htn or edema
  • High fiber
  • Normal caloric intake
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13
Q

What electrolyte abnormality could present with a PLADO diet?

A

Hyperkalemia

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14
Q

What other diet is good for CKD that is low protein?

A

Very low protein diet with supplementation (good outcomes)

  • Protein intake down to 0.23-0.43.
  • Supplementation with AAs, ketoacids, and hydroxy acids to reduce nitrogenous waste load.
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15
Q

What are CKD patients prone to in terms of energy intake states?

A

Anorexia and Cachexia

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16
Q

What cardiac disease may contribute to CKD? How would we counsel a patient regarding it?

A

Atherosclerosis.
Avoid sat/trans fats, eat more PUFAs and MUFAs, esp omega-3.

17
Q

Why is dietary fiber good for CKD patients?

A
  • Promotes fecal nitrogen excretion
  • Lower inflammation
  • Better mortality
  • 25-30g/day
18
Q

Why do we want lower sodium in CKD patients?

A

Contributes heavily to HTN, which contributes and worsens CKD.
Aim for 3-4g/day or < 2300mg

19
Q

How much fluids should CKD patients drink?

A

1.5L on average, with 1.0L if complicated.

20
Q

Why does hyperkalemia occur in CKD? How can we prevent it?

A
  • Occurs because late-stage CKD patients can’t excrete potassium.
  • Eating low-potassium foods or boiling them is best to reduce potassium intake.
  • Aim for < 3g/day.
21
Q

What blood pH condition may occur in CKD? Why?

A

Metabolic acidosis, due to inability to excrete H+ and resorb HCO3-.
PRAL also contributes, especially if animal protein.

22
Q

How do we reduce acid levels in CKD?

A
  • Sodum bicarb supplementation.
  • Eat fruits/veggies
23
Q

What other mineral should CKD patients be restricted in terms of intake?

A

Phosphorus, < 800mg/day if stages 3+.

24
Q

What vitamin supplementation is recommended in all stages of CKD?

A

Vitamin D, which will also boost calcium.

25
Q

What other vitamins/minerals are CKD patients commonly deficient in?

A
  • B vitamins
  • Vitamin C
  • Iron
26
Q

What metal should we avoid eating in CKD?

A

Aluminum-based medications

27
Q

What trace mineral, when ingested, may help with lipid levels in CKD?

A

Carnitine

28
Q

What two trace elements are also deficient in CKD patients on dialysis? What is the recommendation regarding supplementation of them?

A

Zinc/Selenium.
Not recommended to routinely supplement.

Nutrition (12 decks)

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