Nutrition & the renal patient

Question 1

Functions of the kidney

Answer 1

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

Question 2

Function of calcitriol

Answer 2

Conversion to active form of vitamin D

Question 3

Function of renin

Answer 3

BP control, RAS system

Question 4

What happens in CKD?

Answer 4

Uraemia and accumulation of waste products
Raised blood pressure/fluid retention
Anaemia
Low serum calcium
Raised potassium levels
Metabolic acidosis

Question 5

Major causes of CKD

Answer 5

Diabetes
Glomerulonephritis
Uncertain aetiology

Question 6

Stage 1 of CKD

Answer 6

Normal function

GFR >90ml/min

Question 7

Stage 2 of CKD

Answer 7

Mild reduction in function

GFR 60-80ml/min

Question 8

Stage 3 of CKD

Answer 8

Moderate decrease in function

GFR 30-59ml/min

Question 9

Stage 4 of CKD

Answer 9

Severe decrease in function

GFR 15-29ml/min

Question 10

Stage 5 of CKD

Answer 10

End stage renal disease

GFR <15ml/min

Question 11

Management of Stage 1 CKD

Answer 11

Manage risk factors, eg HT, DM, Obesity

Question 12

Management of Stage 2 CKD

Answer 12

Lower BP
Control DM
Lose weight

Question 13

Management of Stage 3 CKD

Answer 13

Treat complications of CKD
Lower BP
Control diabetes
K+, PO4 control

Question 14

Management of Stage 4 CKD

Answer 14

Manage BP
Control diabetes
Fluid restriction
Prevent / treat malnutrition
Control uraemia
Control mineral/electrolyte imbalances

Question 15

Management of Stage 5 CKD

Answer 15

Renal replacement therapy

Question 16

Nutritional intervention in CKD

Answer 16

Delay progression of CKD
Minimise symptoms of uraemia
Minimise effect of renal disease on blood biochemistry and fluid status
Identify and treat malnutrition

Question 17

How to delay progression of renal disease

Answer 17

Diabetic control
Monitor blood pressure
HbA1c

Question 18

HbA1c target for diabetic control and renal disease

Answer 18

48mmol/mol (nodrug therapy)

<53 mmol/mol with drug therapy

Question 19

Hypertension and delaying progression of renal disease

Answer 19

Aim for 120-139/90mm Hg

Aim for 120-129/80mm Hg in diabetes

Question 20

Symptoms of uraemia before dialysis

Answer 20

Fatigue, weakness
Anorexia and nausea
Muscle cramps
Bad taste in mouth

Question 21

When should dialysis start?

Answer 21

GFR <15ml/min and one or more of the following:
Uraemic symptoms
Inability to control fluid status or BP
Progressive deterioration in nutritional status

Question 22

What can fluid overload result in?

Answer 22

Peripheral oedema

Pulmonary oedema

Question 23

Treatment for osteodystrophy

Answer 23

active form of Vitamin D

Question 24

Treatment for pruritis/vascular calcification

Answer 24

give phosphate binders with food

dietary phosphate restriction

Question 25

Phosphate binders example (5)

Answer 25

sevelamer carbonate
sevelamer hydrochloride
lanthanum carbonate
calcium carbonate
calcium acetate

Question 26

What conditions can hyperkalaemia present in?

Answer 26

CKD, HD (hemodialysis) and PD (peritoneal dialysis) patients

Question 27

Non dietary causes of hyperkalaemia

Answer 27

Acidosis
Constipation
Drugs- K+ sparing diuretics, ARBs, ACE inhibitors
Blood transfusions
Poor blood sugar control

Question 28

Causes of malnutrition in renal disease

Answer 28

Uraemia
Anorexia
Acidosis
Infections
Dietary restriction
Depression

Question 29

Recommended protein intake in PD and HD

Answer 29

1.2g/kg/d

Question 30

Treatment of malnutrition

Answer 30

Enteral nutrition support- oral nutritional supplements/tube feeding
Parenteral nutrition support- Intra dialytic Parenteral Nutrition (HD only)/total parenteral nutrition (TPN)