Renal Transplant Flashcards
Why do we suspect kidney disease is on the rise?
As the etiologies leading to CKD, such as diabetes and hypertension are also on the rise
Patients who get a kidney transplant before dialysis live an average of ____ years longer than if they stayed on dialysis
10-15 years
What is the nutritional pre-transplantation goal?
To optimize nutritional status to decrease:
- Surgical risk
- Post surgical complications
- Length of hospital stay
Both ____ and ______ nutrition can increase risk of post-surgical complications
Under and over
In over nutrition, obese patients have what disadvantaged?
- Higher mortality rate
- Lower graft function
- Incr. incidence of wound complications
- More frequent ICU admissions
- More frequent intubations
- Increased incidence of post-transplant diabetes
In the acute post-transplant phase, what is the nutritional priority?
- To manage the increased metabolic demands of surgery
- And to address unwanted side effects of immunosuppressive drugs (Which patients will be on for life)
The immunosuppressive drug, cyclosporin, has what undesirable side-effects?
- Gingival hyperplasia
- GI disturbances
- HyperG
- Gynecomastia
- Hepatotoxicity
- Nephrotoxicity
Which side effect of immunosuppresive drugs will decrease glycogen synthesis?
Hepatoxicity
What is used to inhibit the production of lymphokines?
Corticosteroids
Side effects of corticosteroids?
- Impaired wound healing
- Avascular necrosis of long bones
- Upper GI ulceration
- Protein catabolism
- Hypertension
- Steroid induced diabetes
- Stimulation of appetite, weight gain
What are the typical post-transplant protein and energy needs?
Will increase for up to 6-8 weeks post-op dye to stress and excessive doses of corticosteroids
Discuss CHO implications in the post-transplant patient
-Often glucose intolerance and insulin resistance secondary to hyperglycemia by corticosteroids and immunosuppressive drugs
How can we adjust CHOs to minimize the risk of developing steroid-induced diabetes?
Emphasize on complex carbohydrates, dietary fibres etc
Fat in post-transplant patients?
25-25% of total energy
- Max SFA of 7%
- Remaining are MUFA and PUFA
Should sodium be restricted in renal transplants?
Yes, as HTN is common
What is the implication of potassium and transplants?
Hyperkalemia can be induce by poor graft function, impaired potassium excretion and potassium-sparing diuretics
When should potassium be spared?
In the acute period and chronic period if hyperkalemia
what should be avoided if taking immunosuppressive drugs tacrolimus and cyclosporine?
Avoid grapefruit and grapefruit juice
When is the acute phase?
Up to 8 weeks post-transplant and during acute rejection
When is the chronic phase?
After 8 weeks
Acute phase protein?
1.3-2.0 g/kg/day
Chronic phase protein?
0.8-1.0 g/kg/day with functioning transplant
Acute phase kcals?
30-35 kcal/kg
Chronic phase kcals?
25-35 kcal/kg to maintain desirable weight
Acute phase CHO?
50-70% non-protein calories
Chronic phase CHO? How many g of fibre in female? Males?
- 45-50% of kcals with focus on complex CHO
- 25g/day female
- 30 g/day male
Acute phase fat?
30-50% non-protein calories
Chronic phase fat?
25-35% of total kcal with SFA <7% total kcal
Acute phase potassium?
Unrestricted, if hyperK <2.4 g/day
Chronic phase potassium?
No restriction unless hyperK
Acute phase calcium?
1000-1500 mg
Chronic phase calcium?
2000 mg
Phosphorusm, vitamins/minerals and trace elements during the acute and chronic phase?
To meet RI
Acute phase fluids?
- Ad lib
- 1ml/kg dry weight
- Match output unless diuresis is goal
Chronic fluid ?
-Ad lib with functioning transplant
Two common side-effects in the post-transplant patient?
- CVD
- Hypomagensemia
- Obesity
- CKD-BMD
- Rejection
Why is CVD risk increased post-transplant?
Dyslipidemia’s are common in 70% of patients
Why is hypomg common post-transplant?
- Often associated with cyclosporine and tacrolimus use
- IV replacement may be required
Nutritional intervention in CKD BMD?
-Calcium supplementation, vitamin D and anti-resorptive agents may be needed
What is needed early posttransplant?
Phosphate supplementation, as hypophosphatemia occurs in 50% of patients
What happens during rejection?
Many corticosteroids administered, which means protein and energy requirements increase
What is the bottom line role of dietitians in renal transplant patients?-
1) Prevent and treat PEM
2) Prevent and treat mineral and electrolyte disorders
3) Reduce the impact of other co-morbidities
4) Improve patient quality of life
