Nutrition and Kidney Disease Flashcards
- Outline the impact of malnutrition in patients with kidney disease.
an important and modifiable risk for the mortality of ESRD, as metabolic waste products build up it may cause nausea, vomitting, fatigue and anorexia
overweight and obesity are important risk factors in the development of chronic kidney disease related to the stress of hyper filtration and associated HTN, however weight can be protective in dialysis
- Discuss the importance of albumin as an indicator of malnutrition and inflammation.
while not an ideal indicator, it decreases with increasing inflammation
strong correlation between low serum albumin and mortality in CKD (to the degree of 2- 20x risk)
subjective global assessment is another nutritional screening tool used to predict malnutrition (validated in CKD pop)
- Describe dietary recommendations for protein and calories in acute kidney injury. Identify guidelines for modification of sodium, potassium and fluid intake.
provide adequate energy (25-30kcal/kg)
protein at level suitable for dialysis therapy (should not be restricted as a means to avoid or delay dialysis): 1.2 -1.5 g/kg
control fluid intake if the patient has anuria or oliguria
provide electrolytes that keep serum levels within normal range (Na, K 2-3g unless on dialysis and Ph 8-15mg/kg
- Describe dietary recommendations for protein and calories in chronic kidney disease. Identify guidelines for modification of sodium, potassium and fluid intake.
- 8-1.4 g/kg in CKD stage 1 and 2
- 6-0.8 g/kg CKD stage 3 and 4 (depending on whether patient has nephrotic proteinuria) with 50% coming from high biological value/ complete protein (ie. those from animal and soy protein); more added if malnourished while monitoring kidney status and BUN (increase of 1g/d of HBV for each gram urinary protein loss)
many calories from sugars and fats; modified for DM (protein only 10-15 calories)
sodium 2-3g, patients are more sensitive
water restriction only with hyponatremia or reduced urine output
potassium restriction only if serum potassium exceeds 5.5 mg/dL;
P restricted if serum levels high and recommended in later stages CKD; Ca supplements mostly as a P binder
possible vit. D or iron supplement
- Describe dietary recommendations for protein and calories for peritoneal and hemodialysisIdentify guidelines for modification of sodium, potassium and fluid intake.
generally dialysis patients high in energy (30-35 kcal/kg IBW/d)
high protein (loss of amino acids and stimulation of inflammatory response) (1.2-1.3g/k/d)
reduced in phosphorus (difficult with protein), sodium, potassium
reduced fluid (less severe in PD- urine output)
multivitamin (water soluble vitamins, avoids excessive Vit A)
- Describe dietary recommendations for protein and calories for after transplant. Identify guidelines for modification of sodium, potassium and fluid intake.
goals:
normalize electrolyte imbalances
promote BP control
prevent weight gain (immunosuppressives stimulate appetite), increased protein only in acute rejection time frame
max. bone density (steroids lessen density)
control blood glucose
serum lipids (40% death due to CV, 60% develop disease) emphasis in low saturated fat
- Describe dietary recommendations for protein and calories for avoiding kidney stones. Identify guidelines for modification of sodium, potassium and fluid intake.
identify the type of stone and risk based on composition- supplement or restrict problematic nutrients
ensure adequate fluid intake to maintain dilute urine
- List nutritional adjustments recommended for patients with nephrolithliasis. Be specific about calcium oxalate stones.
reduce hypercalcuric stones: low calcium diet increase potential for absorption oxalate, increasing risk of CaOxalate stones (meet but do not exceed 1000-1200 mg/d + citric acid inhibits growth
high protein may increase acidity, increase calcium excretion
reduce oxalate containing foodsL spinach, rhubarb, beets, nuts, chocolate (alt. supplemental fish oil, supplemental pyridoxine and elimination of excessive ascorbic acid)
probiotics may increase oxalate degradation by bacteria
urinary sodium increases urinary calcium
Describe the differences in absorbability between organic phosphate and inorganic phosphate.
organic is bound to protein or phytate
inorganic used in food additive is 90-100% absorbed
- Describe dietary recommendations for protein and calories for nephrotic syndrome. Identify guidelines for modification of sodium, potassium and fluid intake.
muscle wasting and edema due to low serum protein
sodium and fluid restriction (edema)
hyperlipidemia and hypercholesterolemia due to altered liver synthesis of cholesterol
goals to protect kidney function, reduce atherosclerotic risk and maintain good nutrition status
CKD similar + control of hyperlipidemia
evaluation for iron, zinc and vitamin D deficiency supplement
