![Objectives ,[object Object],[object Object],[object Object]](data:image/gif;base64,R0lGODlhAQABAIAAAAAAAP///yH5BAEAAAAALAAAAAABAAEAAAIBRAA7)
Recommended
More Related Content
What's hot
What's hot (20)
Viewers also liked
Viewers also liked (20)
Similar to Nutrition Therapy For CKD: A Case Study Approach
Similar to Nutrition Therapy For CKD: A Case Study Approach (20)
Nutrition Therapy For CKD: A Case Study Approach
- 1. Nutrition Therapy for CKD: A Case Study Approach
- 23. Renal Resources National Kidney Disease Education Program http://nkdep.nih.gov/ Free downloadable materials!!! RD Reference: CKD and Diet National Kidney Foundation www.kidney.org Free CEUs available American Association of Kidney Patients www.aakp.org AAKP Nutrition Counter
Editor's Notes
- The purpose of diet therapy for CKD is to maintain good nutritional status, slow progression of CKD, and treat complications. The key diet components to slowing progression of CKD are: controlling BP by reducing sodium intake, reducing protein intake, if excessive, and managing diabetes. As dietetic professionals, it is our job to be sure that CKD patients are well-versed in these areas in order to be successful.
- Chronic kidney disease is classified based on the glomerular filtration rate (GFR). These tables show the ranges used to determine CKD stage based on glomerular filtration rate. Symptoms of CKD may not appear until over 75% of kidney function is lost. As GFR declines, complications become more common and more severe. The table to the right provides a list of clinical side effects of CKD. Source: Rolfes SR, Pinna K, Whitney E. Understanding Normal and Clinical Nutrition, p 881. Wadsworth: Belmont, CA, 2009.
- As GFR declines, appetite may decline and taste may be altered. This is a physiological response to increasing toxins in the blood – a survival mechanism. Patients with CKD often develop protein-energy malnutrition and wasting. Clinical studies have suggested that renal patients may have inadequate protein and energy intakes, even during the early stages of disease. Anorexia is thought to contribute to poor food intake and may result from hormonal disturbances, nausea and vomiting, restrictive diets, uremia and medications. Nutrient losses also contribute to malnutrition and may be a consequence of vomiting, diarrhea, GI bleeding and dialysis. In addition, many of the illnesses that lead to chronic kidney disease can induce a catabolic state that contributes to protein losses. Source: Rolfes SR, Pinna K, Whitney E. Understanding Normal and Clinical Nutrition, p 881. Wadsworth: Belmont, CA, 2009.
- See Nutrition Recommendations Form for specific nutrient calculations
- In the Nurses Health Study, the risk of losing kidney function in women with mild kidney insufficiency was related primarily to animal meat intake Regardless of the level of protein intake, 50% to 75% of the protein should be of high biological value, derived predominantly from lean poultry, fish, and soy- and vegetable-based proteins. KDOQI Clinical Practice Guidelines and Clinical Practice Recommendations for Diabetes and Chronic Kidney Disease, Guideline 5: Nutritional Management in Diabetes and Chronic Kidney Disease. http://www.kidney.org/professionals/KDOQI/guideline_diabetes/guide5.htm
- Tomson, CRV. Advising dialysis patients to restrict fluid intake without restricting sodium intake is not based on evidence and is a waste of time. Nephrol. Dial. Transplant. (2001) 16 (8): 1538-1542.
- In the past, people on dialysis have been told to soak potatoes overnight to lower the potassium. Research shows there is a better (and faster!) way to remove some potassium. These steps will help decrease the amount of potassium in these vegetables by about a third, but it will not take away all of the potassium. These vegetables should still be considered a high-potassium food. Burrowes JD. Leaching potassium from tuberous root vegetables. Renal Nutrition Forum, Summer 2007, Vol. 26, No. 3
- Phosphorus additives are added to convenience and fast foods for many reasons. Unlike phosphorus that naturally occurs in meats, dairy products, whole grains and nuts, phosphorus from additives is completely absorbed by the body. Sullivan C, Sayre SS, Leon JB et al. Effect of Food Additives on Hyperphosphatemia Among Patients with End-Stage Renal Disease: A Randomized, Controlled Trial. JAMA, 301(6): 629-635, 2009.
- www.phosfoods.org Sullivan C, Sayre SS, Leon JB et al. Effect of Food Additives on Hyperphosphatemia Among Patients with End-Stage Renal Disease: A Randomized, Controlled Trial. JAMA, 301(6): 629-635, 2009.
- There are three main types of vascular access: Fistula Graft Catheter A fistula is made by sewing an artery to a vein, usually in the arm. A fistula is the best type of access for two reasons: 1. Your veins and arteries are part of your body, so a fistula is less prone to infections or blood clots than other types of access. 2. Your veins and arteries self-heal after each needle stick, so a fistula can last a long time. A graft is like a fistula, because it hooks a vein and an artery together. The difference is that a graft uses a piece of tubing to bridge the two. Compared to a fistula, a graft is more likely to: 1. Become infected and/or clotted, because the synthetic material is foreign to your body 2. Develop holes, because the synthetic material does not self-heal after needle punctures The third type of vascular access is a central venous catheter . A catheter is a plastic tube that is surgically placed in the neck, chest, or groin, and connected to a "central" vein. The other end of the tubing is outside the skin and used for hooking up to the dialysis tubing. Of the three types of vascular access (fistula, graft, catheter), the catheter is the poorest option because: 1. Blood flow rates are often poor, so it is hard to get enough dialysis to feel your best. 2. It extends outside of the body, so it is the most prone to infection—and it is so close to the heart that infections can be serious. 3. Catheters are very likely to clot. Source: www.kidneyschool.org
- Due to the complexity of the diet for CKD, patients may benefit from more than one education session during the hospital stay in addition to an outpatient referral. The initial encounter for this patient was followed by a refresher that included his wife several days later. The patient was also urged to schedule an appointment with the outpatient dietitian. The Medicare benefit for MNT is underutilized, at least in part because clinicians including RDs feel inadequately educated on the topic. Currently, Medicare coverage for CKD MNT includes 3 hours in the first year and 2 hours in each subsequent year.
- Serum phosphorus may not rise until the late stages of kidney disease. Some nephrologists recommend using fractional excretion of phosphorus in the urine. A normal level is less than 12%. When the level reaches 20%, it suggests that phosphorus excretion is decreasing. This would be an opportune time to start phosphorus binders whether the serum phosphorus has increased beyond normal levels or not.
- The renal diet is difficult to adhere to. To find helpful, printable handouts for patients, look at the National Kidney Foundation and NKDEP (National Kidney Disease Education Program).