Renal Diet Flashcards
What are the most common causes of CKD in the US?
Diabetes and HTN
At what stage of CKD does protein restriction in diets start?
Stage 3 both a and b
In additional to protein restrictions, phosphorus is also restricted
in stage 5, if the patient is on dialysis you need to actually increase protein requirements
What is the protein requirements for moderate protein restriction diet?
- 6-0.8g/kg of body weight
- is 100% indicated in any CKD patient with a GFR <50 and has NO diabetes and NO dialysis
if diabetic = 0.8-0.9 protein/kg
Nutritional secondary impacts of CKD and associated pathologies
Vitamin D active form and osteoporosis
Erythropoiesis and anemia
Iron and calcium deficiencies and osteoporosis/iron deficency anemia
Hyperlipdidemia and accelerated atherosclerosis/MIs
What dietary cautions should CKD patients experience?
Avoid high protein (except in dialysis) and low carbohydrate meals
Avoid herbal products
Plant-based diets relatively (just need to monitor minerals)
Regular monitoring of serum sodium, potassium and phosphorus
Sugar control (especially in glycemic controls)
What is the kcal/kg of body weight dietary values are seen in CKD patients
23-35 kcal/kg
Why is high dietary protein intake contraindicated in non-dialysis CKD?
High protein intake leads to increases GFR and increased intra glomerular pressures
- both of these leads to damage to glomerulus structures
What are the risk of a low protien diet for CKD patinets
Increased inflammation
Increased acidemia
Malnutrition with calories is possible
Sarcopenia
What is a very low protein diet?
0.3 g/kg
Likely not appropriate except in stage 4/5 without dialysis
Very challenging to adhere to and also causes essential amino acids to be too low
- need to give keto acid analogs to these patients
Plant based proteins and CKD
Research now suggests that mixing plant proteins into a CKD diet can actually decrease the glomerular pressure and decreases proteinuria
However, you cannot use only plant proteins since being on a low protein diet already will lead to amino acid deficiencies
Are DASH and Mediterranean diets okay for CKD?
YES
- however they need to discuss with a nephrologist before starting
Potassium and CKD
Requires less than 2.4g/day
- starts on stage 3 CKD
if there is no hyperkalemia, usually don’t need to restrict
Sources of dietary K
- 2/3 = fruits and vegetables
- 1/3 = everything else
- **avoid salt substitutes
Organic vs inorganic phosphorus absorption
Organic phosphorus
- 40-70% absorbed
- includes dairy products, meat, poultry, fish, soy
- phytates decrease organic P absorption
Inorganic phosphorus
- 90% absorbed
- includes food additives supplements, dark colas
can be difficult to measure the amount of phosphorus a food has since it is not required to be on a nutritional facts. Look for any ingredient that has “PHOS” in its name
Because phosphorus is difficult to determine exact concentration, what is often given to CKD patients in order to make sure they dont over intake phosphorus?
Phosphorus binders
- includes calcium carbonate and sevelamer, ferric citrate, lanthanum
is a MUST for any patient on dialysis
What are high phosphate: protein ratio foods and low phosphate: protein ratio foods?
High ratio
- egg yolks
- beans/lentils/ dried peas
- cheese
- milk
- nuts/seeds
- organ meats (crabs/oysters/shrimp)
- must avoid these foods*
Low ratio
- egg whites
- white bread/pasta/crackers
- water based soups
- almond milk (be careful though)
- can eat these*
