Renal Disease - Exam 2 Flashcards
What is an acute kidney injury?
acute decrease in kidney function as manifested by a decrease in estimated glomerular filtration rate (GFR) levels
What happens to a person’s protein needs in an acute kidney injury?
need more protein intake if AKI is prolonged!
From 1.5 g/kg/day to as high as 2.5 g/kg/day (normal - 0.8 g/kg/day)
What is chronic kidney disease?
The presence of persistently abnormal kidney function, as manifested by…
Decreased glomerular filtration rate (GFR) of <60 mL/min for 3+ months
What are the top 2 causes of CKD?
DM and HTN
What 2 things if well controlled can help decrease the probability of developing CKD?
Blood pressure
blood sugar
_______ can also contribute to the development and progression of CKD
atherosclerosis
_____ is recommended to slow down deterioration of kidney function in adult CKD patients. Why?
protein restriction
Reduces glomerular flow and pressures
Slows accumulation of waste products (urea, creatinine) in CKD
**What kind of protein is recommended in CKD patients? Why?
plant based protein is recommended!!
**Animal-based proteins have two problematic traits:
More bioavailable phosphate for absorption
Higher potential acid load (PRAL)
What CKD population is most at risk for nutritional deficiencies due to protein restriction?
pediatric CKD patients- consult dietician!!
do not resist protein in kids
What are the protein requirements for stage 1-2?
(GFR >60) - no need for outright restriction
recommended intake 0.8g/kg/day
encourage plant based proteins
What are the protein requirements for stages 3-5 of CKD?
GFR < 60
protein restriction to help slow CKD progression
More aggressive restriction as CKD gets worse - 0.6-0.8 g/kg/d
Higher proportion of plant-based proteins as CKD gets worse
What are the protein requirements for a CKD pt who is stage 5 and on dialysis? Hemodialysis vs peritoneal dialysis?
actually require increased protein intake from previous diet plans, especially on days they are receiving dialysis
Hemodialysis - 1.0 - 1.2 g/kg/day, Peritoneal Dialysis - up to 1.3 g/kg/day
The ____ diet is recommended for pt with CKD. What are the general guidelines?
Plant-Dominant Low Protein Diet (PLADO)
Protein Intake - 0.6-0.8 g/kg/day
Protein Sources - >50% of protein from plant sources: Tofu, chickpeas, nuts, mushrooms, beans, lentils, legumes, quinoa
B12 supplementation may be needed due to lower meat intake
Sodium - restricted to < 4 g/day
<3 g/day if HTN or edema
Fiber - high fiber intake (>25 g/day)
Caloric Intake - adequate (30-35 cal/kg/day)
What are 2 potential challenges of a low protein diet?
high glycemic index
high potassium load leading to hyperkalemia
What are the guidelines for a very low protein diet with supplementation?
Protein Intake - 0.28-0.43 g/kg/day (about 1/3 of the normal amount of protein)
Protein Sources - encourage protein from plant sources
B12 and/or iron supplementation may be needed
Special Supplements - amino acids, keto acids, hydroxy acids
Greatly reduces nitrogenous waste load by reducing amount of amino groups
Less nitrogenous waste → less hyperfiltration in the kidney → less CKD progression
Sodium - restricted to < 3-4 g/day
Fiber - high fiber intake (>25 g/day)
Caloric Intake - adequate (30-35 cal/kg/day)
What special supplements are needed in a very low protein diet? Why?
amino acids, keto acids, hydroxy acids
Greatly reduces nitrogenous waste load by reducing amount of amino groups
CKD patients, especially later-stage, are vulnerable to malnutrition!
May develop overt ____ and ____
wasting
cachexia
What are the big 3 that can cause kidney disease?
DM
HTN
heart disease
What is the fat recommendation?
Limit saturated fats, trans fats
Promote intake of polyunsaturated and monounsaturated fats, especially omega-3
What is the effect of fiber on a CKD pt? **What is the recommended intake?
Promotes fecal nitrogen excretion
Lowers the amount of waste products that have to be dealt with by kidney
Decreases serum urea (BUN) and creatinine levels
lowers inflammation levels in the body
**25-30 grams/day
What is the recommended salt intake for a pt with CKD?
Similar levels to general population limits - < 3-4 g/day
or if more severe CKD: < 2300 mg/d often recommended)
**What is the recommended fluid intake for an average CKD pt? What about if there are complications?
About 1.5 L/day for average patients
1.0 L/day or less if complications
What is important to know about CKD and potassium?
diseased kidneys tend to lose ability to excrete potassium especially later stage 4-5
consider potassium restriction of less than 3 grams/day in the later stage of CKD
What are some pt education points to offer to those later stage CKD pts who need to monitor potassium intake?
Offer patients a list of high and low potassium foods
Boiling fruits/vegetables - reduces potassium by 50-70%
Regular serum potassium checks
Medications to reduce potassium if neede
CKD patients often lose ability to manage ______. What does it lead to ?
acid-base balance
metabolic acidosis secondary to impaired renal function
_____ contribution of food or dietary pattern to net endogenous acid (H+) production. Give some examples of food high and low
Potential Renal Acid Load (PRAL)
high PRAL: Hard cheeses and egg yolks (animal-based foods)
low PRAL: Raisins and spinach (plant-based foods)
What are 2 ways to reduce acid levels in a pt with CKD?
sodium bicarbonate or 2-4 cups of fruits/veg per day
CKD pts also have a hard time excreting _______. Give an example of food that should be avoided. Why?
phosphorus
dark sodas, processed foods as a preservative
inorganic phosphorus is 90% absorbed vs organic phosphorus is only 30-60% absorbed
What is the recommendation with regards to stage 3-5 CKD and phosphorus?
800 mg/day (more restricted as more severe)
Encourage organic phosphorus in fruits/vegetables to meet dietary needs
What is the recommendation for Vit D/calcium and CKD? Why? What will happen to the calcium levels as vit D is replaced?
Vitamin D supplement is generally indicated in all stages of CKD
CKD → less circulating active vitamin D → less calcium absorption in the GI tract
Calcium levels will generally increase when vitamin D is replaced
CKD pts are also at risk of ______ and ______. What is the solution?
water-soluble vit def (Bs and Cs)
iron
give kidney-friendly multivitamin +/- iron supplementation
Why is iron low sometimes in CKD pts?
Decreased absorption due to hepcidin, less heme-based iron in CKD diet
In CKD pts _____ supplementation may help with lipid levels
Carnitine
___ and ____ are often deficient in CKD pts on dialysis. Need to avoid _____ based medications
zinc/selenium
aluminum
