Nutritional management of the renal patient Flashcards
What are the normal kidney functions and state what a problem with each leads to?
Excretion of waste products (urea, creatinine and phosphate etc)- uraemia and accumulation of waste products
Volume and composition of body fluids- raised blood pressure/oedema
Erythropoietin production- anaemia
Controls blood pressure
Activation of 25-OH cholecalciferol to 1,25-dihydroxycholecalciferol- low calcium
Maintain potassium balance- raised potassium levels
Acid/base balance- excrete H+ and reabsorption of bicarbonate ions- metabolic acidosis
What are the aims of diet therapy in renal disease?
Delay progression:
Minimise symptoms of uraemia (in CKD)
Minimise effects of renal disease on blood biochemistry and fluid status
How is progression of renal disease delayed?
- Diabetic (aim for HbA1c <7.5%)
- BP control
- Reduced obesity
- Healthy eating balanced diet- low total and sat fat, high fruit and veg, low GI foods, low salt and sugar
How are symptoms of uraemia minimised in CKD?
Dialysis should commence when:
GFR<15ml/min and one of following:
-Symptoms- uraemic symptoms such as tiring easily, weakness, anorexia and nausea, muscle cramps and bad taste in mouth
-Clinical signs- inability to control fluid status or blood pressure
-Nutritional status- Progressive deterioration in nutritional status
Recommended protein intake of 0.75/kg ideal body weight/day
What causes hyperphosphataemia in CKD?
Hyperphosphataemia caused by decreased excretion, suboptimal dialysis, hyperparathyroidism, excess intake or suboptimal use of tablets to chelate phosphate intake
What high phosphate foods are there?
Fish with small bones, dairy products, hard and processed cheese, chocolate, nuts and seafood
What causes hyperkalaemia?
Hyperglycaemia Blood transfusion Constipation Medications Diet - fruit juices, coffee, bananas, spinach, mushrooms etc Acidosis
How do you treat hyperkalaemia with diet?
Reduce K+ to <6mmol/L by advising to reduce intake of spinach and other high potassium foods and drinks, suggest alternative veg, boil instead of steam and fry
What is the recommended daily salt intake and what is normal?
Recommended <6g.day
Normal 9g/day
How can sodium be reduced in food?
Don't add salt at table Reduce salt in cooking Add herbs and spices Reduce processed foods Beware of substitutes
What are the causes of malnutrition in renal disease?
Disease related- Uraemia, anorexia and acidosis
Treatment related- infections, dietary restrictions, tiredness due to treatment, nutrient losses and hypercatabolism
Person related- depression and family suppport
How is malnutrition treated?
Enteral nutrition support -Oral supplements - Tube feedings Parenteral nutrition support -Intra-dialytic parenteral nutrition- HD only -Total parenteral nutrition
What are the renal considerations of treatment?
Volume- is fluid restriction needed?
Electrolytes- are phosphate and potassium restrictions necessary?
Protein- How much protein does the patient need depending on renal function and type of dialysis treatment
What should the diet of someone in CKD be like?
APpropriate protein intake Tailor to phosphate and potassium levels Fluid restrict if necessary Aim for healthy weight Glycaemic control if diabetic Salt intake reduced to general population guidelines Prevent malnutrition
What should the diet of someone with HD be like?
Ensure adequate protein intake Advise on fluid restriction 6g/day salt intake Tailor to phosphate and potassium levels Treat malnutrition where present
