Renal/Cardiac Flashcards
Clinical signs of CKD
PU/PD
Weight loss
What lab abnormalities can be seen with CKD?
Azotemia
Low USG
Elevated UPC (proteinuria)
How are MCS and creatinine related?
Creatinine is influenced by muscle mass
If a patient is muscle wasted, creatinine may appear normal
What factors might influence BUN?
Increased dietary protein may increase BUN
Liver disease may decrease BUN
What is the ultimate nutritional goal with CKD?
Slow the progression of disease by stabilizing serum creatinine and UPC
What is one of the most important nutritional factors in managing CKD patients?
Fucking water
Protein should be ________ in patients with CKD
Limited
How can dietary protein affect CKD patients?
Proteins are broken down into urea, limiting proteins helps control uremic toxins and reduce protein fermentation in the colon
When should protein be restricted?
Proteinuria
T/F: while protein is limited in cases of CKD, fat is prioritized
True - fat is more energy dense and can be helpful for patients with poor appetite
Energy from fat replaces a portion of protein calories
In what cases of CKD might you need to extra cautious when increasing dietary fat with kidney diets?
Pancreatitis
Lymphangiectasia
What is the target EPA+DHA for CKD patients?
100-150mg/kg metabolic body weight (BWkg^0.75)
Why is it important to restrict phosphorus?
Control hyperparathyroidism and soft tissue calcification
Increased P leads to increased PTH (P excretion, Ca reabsorption). Increased Ca can lead to calcification of tissues
When to consider phosphate binders?
When dietary P restriction isn’t working OR patient won’t eat a phosphorus restricted diet
Why is it important to include antioxidants in a kidney diet?
Increased free radical generation as fewer nephrons pick up more work
Protects PUFAs from oxidization
T/F: Cardiac disease patients need to be on a restricted protein diet
False - do NOT limit protein
Taurine is good for cardiac dz b/c can improve ________
Cardiomyocyte contraction
Why should L-carnitine be enhanced in patients with cardiac disease?
Shuttles fatty acids across the mitochondrial membrane
Why is sodium limitation/restriction important in patients with cardiac disease?
Water retention - especially for those in CHF
T/F: In cardiac patients, avoid diets with >2g Na/Mcal, but also don’t want to completely restrict to less than 0.5-0.8g Na/Mcal
True - if sodium is too LOW, renin will be stimulated and RAAS will happen and sodium will be reabsorbed and then water will be reabsorbed and then its just a mess and the heart doesn’t like that
Also food sucks when its not salty
What are the main ingredients that have been linked with DCM?
Peas, lentils, legumes, potatoes
What is the cause of diet-associated DCM?
We don’t really know, but there are lots of theories
A patient presents with DCM and the owner reveals he eats Rachel Ray’s grain free dog food. The owner is keto and its really benefited her, so she figured eliminated grains from her dog’s diet would help him live longer. What is your recommendation?
Stop the diet - switching to a grain-inclusive diet sooner rather than later can improve survival and cardiac parameters
DCM patient’s owner really doesn’t want to stop giving Rachel Ray her money, so she keeps him on the same diet. A few months later, he presents in CHF. How has his prognosis changed?
Outcome is worse the longer the grain-free diet was fed so prognosis has greatly worsened
