Nutrition for Renal and Cardiac Disease

Question 1

What is the goal for nutritional management of CKD?

Answer 1

SLOW the progression of CKD (stabilize the serum creatinine and UPC)
and start management early.

Question 2

T/F: cachexia can develop in later stages of CKD

Answer 2

true!
this is typically why higher BCSs are ok for these types of chronic diseases because weight loss is inevitable.

Question 3

We should (restrict/limit/ enhance) protein for CKD patients.

Answer 3

limit ideally. limiting will help control uremic toxins and reduce protein fermentation in the colon. but patients with kidney disease also need high quality protein sources to reduce muscle loss.

restrict protein if proteinuria is present.

Question 4

We should (restrict/limit/ enhance) fat within the diet of a CKD patient.

Answer 4

enhance
high fat diets = more energy dense which is helpful for patients with poor appetite
also when CKD patients have diets that are protein-restricted, they need to replace these calories somehow (through fat)

just caution in patients that have a history of pancreatitis or lymphangiectasia

Question 5

We should (restrict/enhance) omega-3s in CKD patients diets.

Answer 5

enhance! (esp EPA and DHA)

Question 6

We should (restrict/enhance) phosphorus in the diet of a CKD patient.

Answer 6

restrict!

helps control secondary renal hyperparathyroidism (which can lead to soft tissue calcification)

consider adding phosphate binders if dietary phosphorus restriction is not working or if the patient will not eat a P-restricted diet.

Question 7

We should (restrict/limit/enhance) potassium in the diet of a CKD patient.

Answer 7

Limit only if hyperkalemic; avoid or limit fruits and vegetables.

Question 8

We should (restrict/limit/ enhance) sodium in a CKD patient’s diet.

Answer 8

limit!

avoid diets that are high in Na (royal canin SO)
monitor BP!

Question 9

We should (restrict/limit/ enhance) antioxidants in a CKD patient’s diet.

Answer 9

enhance!

they increase free-radical generation

Question 10

T/F: AAFCO formulated adult maintenance diets are appropriate for CKD patients

Answer 10

false – you should NOT see “adult maintenance” on any renal diet that you are feeding to CKD patients. They should state “for intermittent or supplemental feeding”

Question 11

Hypercalcemia occurs in 20-31% of cats with CKD. What diet change can help with this imbalance?

Answer 11

fiber supplementation.

Question 12

What monitoring should you include for a CKD patient?

Answer 12

1. BCS/BW/MCS
2. creatinine
3. UPC

Question 13

What are the KEY nutritional factors for cardiac disease and whether you should limit/restrict or enhance each?
(there are 7)

Answer 13

1. protein (do not limit)
2. taurine (enhance)
3. L-carnitine (enhance)
4. fat (enhance)
5. omega-3s (enhance)
6. sodium (restrict/limit)
7. potassium and magnesium (prevent deficiency)

Question 14

What is the purpose of supplementing CoQ10 in dogs with heart disease?

Answer 14

reduce inflammation in dogs with MMVD and CHF

Question 15

what is the purpose of supplementing melatonin in dogs with heart disease?

Answer 15

reduce oxidative stress in dogs with MMVD, but will not improve cardiac structure or function.

Question 16

T/F: the cause of diet-associated DCM is unknown at this time

Answer 16

true

Question 17

What should you do if you suspect a diet-associated DCM case?

Answer 17

report it to the FDA

Question 18

How do you manage diet-associated DCM?

Answer 18

change diet to grain-inclusive diet

if client wants to remain on grain-free diet, monitor troponin and fractional shortening with cardiologist.