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Clinical Nutrition 3 > Renal Nutrition in ESRD - Part 2 > Flashcards

Renal Nutrition in ESRD - Part 2 Flashcards

1
Q

What is CKD-MBD?

A

Chronic Kidney Disease Mineral Bone Disease

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2
Q

What is CKD-MBD characterized by?

A
  • Abnormal levels of Ca, Phos, PTH and active Vit D
  • Abnormal bone morphology
  • Calcification of blood vessels and other soft tissues
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3
Q

What is renal osteodystrophy

A
  • Abnormal bone morphology

- Calcification of the joints

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4
Q

What is metastic calcification?

A

The calcification of blood vessels and other soft tissues

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5
Q

Prevalence of renal osteodystrophy (RO)?

A

0More than 50% of patients with CKD by the time GFR <50 ml/min

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6
Q

What is the leading cause of RO?

A

-Hyperphosphatemia

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7
Q

What is metastic calcification?

A

The deposition of calcium crystals in soft tissues

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8
Q

Why does phosphate influence the crystallization of calcium?

A

PO4 will bind to Calcium, forming an insoluble precipitate, therefore high levels of PO4 can lead to metastic calcification and RO

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9
Q

What is calciphylaxis?

A

When blood vessels are calcified, and can develop severe ulcers and amputations

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10
Q

How must phosphate be controlled?

A

Almost always in excess in blood

  • Diet
  • Phosphate binders
  • Dialysis
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11
Q

How much phos does dialysis remove/session?

A

800 mg

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12
Q

What is the phosphorus recommendation per day?

A

800-1200 mg day, which is very difficult to achieve with high protein requirements

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13
Q

What is organic phosphate? How much is typically absorbed?

A

From whole foods

50-60%

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14
Q

What is inorganic phosphate? How much is typically absorbed?

A

From food additives
100% absorbed
We will be focused on reducing phosphorus from food additives first

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15
Q

Discus the risk:benefit of lowering phosphate

A
  • Lowering phosphate by decreasing protein intake may lead to increased death risk in HD patients
  • Controlling phosphorus while maintaining high dietary protein intake may be associated with the best survival in HD patients
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16
Q

Organic plant protein phosphorus absorption and examples?

A
  • Nuts, seeds, chocolate, beans

- 20-40&

17
Q

Organic animal protein phosphorus absorption and examples?

A
  • Fish, meat, chicken, eggs, milk and dairy

- 60-60%

18
Q

What are the two types of phos binders?

A

Calcium and non-calcium based

19
Q

Calcium based phos binders?

A
  • Calcium carbonate

- Tums

20
Q

Regular 500 mg phos binder =

A

200 mg elemental calcium

21
Q

Extra strength 750 mg phos binder =

A

300 mg elemental calcium

22
Q

Ultra 1000 mg phos binder =

A

400 mg elemental calcium

23
Q

Key concept with phos binders?

A

MUST be taken with food

24
Q

What is a non-calcium, non-metal, 800 mg phos binder which will lower LDL?

A

-Renagel

25
Q

What is a non-calcium 800 mg phos binder which will lower LDL and may improve bicarbonate levels? Which population may this be recommended for?

A
  • Renvela

- Pre-dialysis to correct bicarbonate levels

26
Q

What is a non-calcium, chewable phos binder which may risk lanthanum accumulation?

A

Fosrenol

27
Q

How can we nutritionally intervene with phos binders?

A
  • Suggest crushing and mixing up into liquids
  • Ensure that they are taken with their meals, and prescribed customized to their usual-intake (i.e. 3 vs 5 meals per day)
28
Q

Provide some practical steps to control serum phosphate levels

A
  • Limit dietary phos while meeting protein needs
  • Titrate binder dosage to meal and snack
  • Evaluate actual P intake to plan the initial and subsequent phos binder doses
29
Q

What is contraindicated for constipation intervention in ESRD?

A

-We cannot suggest increasing fibres, fluids or exercise

30
Q

What may be attributed to constipation?

A

Phos binders

31
Q

How can we attenuate and pre-emptively address constipation in PD?

A

-Will immediately have stool softeners and laxatives, even if there is normal BM

32
Q

Why is preventing constipation crucial in PD?

A

Constipation can cause increased pressure in the peritoneum, which can (1) displace the catheter and (2) increase risk of bacterial translocation and infection of the perioneal membrane

33
Q

Which commonly used laxatives are contraindicated?

A
  • Milk of magnesia
  • Magnolax
  • Citro-mag
  • Fleet Phospho-soa
34
Q

Examples of stool softners?

A
  • Docusate sodium
  • Docusate calcium
  • Laculose
35
Q

Examples of bulking agents?

A
  • Unifibre
  • Benefibre
  • -> Not used very foten
36
Q

Which bulking agents are contraindicated?

A

Metamucil and Prodiem

Clinical Nutrition 3 (30 decks)

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