Nutrition & the renal patient Flashcards
Functions of the kidney
Regulation of RBC production
Regulation of blood pressure
Influences on blood pH acid-base-metabolism
Regulation of bone-mineral metabolism
Excretion of metabolic waste products and water
Hormone production- EPO, calcitriol, renin
Function of calcitriol
Conversion to active form of vitamin D
Function of renin
BP control, RAS system
What happens in CKD?
Uraemia and accumulation of waste products Raised blood pressure/fluid retention Anaemia Low serum calcium Raised potassium levels Metabolic acidosis
Major causes of CKD
Diabetes
Glomerulonephritis
Uncertain aetiology
Stage 1 of CKD
Normal function
GFR >90ml/min
Stage 2 of CKD
Mild reduction in function
GFR 60-80ml/min
Stage 3 of CKD
Moderate decrease in function
GFR 30-59ml/min
Stage 4 of CKD
Severe decrease in function
GFR 15-29ml/min
Stage 5 of CKD
End stage renal disease
GFR <15ml/min
Management of Stage 1 CKD
Manage risk factors, eg HT, DM, Obesity
Management of Stage 2 CKD
Lower BP
Control DM
Lose weight
Management of Stage 3 CKD
Treat complications of CKD
Lower BP
Control diabetes
K+, PO4 control
Management of Stage 4 CKD
Manage BP Control diabetes Fluid restriction Prevent / treat malnutrition Control uraemia Control mineral/electrolyte imbalances
Management of Stage 5 CKD
Renal replacement therapy
Nutritional intervention in CKD
Delay progression of CKD
Minimise symptoms of uraemia
Minimise effect of renal disease on blood biochemistry and fluid status
Identify and treat malnutrition
How to delay progression of renal disease
Diabetic control
Monitor blood pressure
HbA1c
HbA1c target for diabetic control and renal disease
48mmol/mol (nodrug therapy)
<53 mmol/mol with drug therapy
Hypertension and delaying progression of renal disease
Aim for 120-139/90mm Hg
Aim for 120-129/80mm Hg in diabetes
Symptoms of uraemia before dialysis
Fatigue, weakness
Anorexia and nausea
Muscle cramps
Bad taste in mouth
When should dialysis start?
GFR <15ml/min and one or more of the following:
Uraemic symptoms
Inability to control fluid status or BP
Progressive deterioration in nutritional status
What can fluid overload result in?
Peripheral oedema
Pulmonary oedema
Treatment for osteodystrophy
active form of Vitamin D
Treatment for pruritis/vascular calcification
give phosphate binders with food
dietary phosphate restriction
Phosphate binders example (5)
sevelamer carbonate sevelamer hydrochloride lanthanum carbonate calcium carbonate calcium acetate
What conditions can hyperkalaemia present in?
CKD, HD (hemodialysis) and PD (peritoneal dialysis) patients
Non dietary causes of hyperkalaemia
Acidosis Constipation Drugs- K+ sparing diuretics, ARBs, ACE inhibitors Blood transfusions Poor blood sugar control
Causes of malnutrition in renal disease
Uraemia Anorexia Acidosis Infections Dietary restriction Depression
Recommended protein intake in PD and HD
1.2g/kg/d
Treatment of malnutrition
Enteral nutrition support- oral nutritional supplements/tube feeding
Parenteral nutrition support- Intra dialytic Parenteral Nutrition (HD only)/total parenteral nutrition (TPN)
