-
Diseases of the Renal System
KNH 413
-
CKD - Renal Replacement Therapy
Hemodialysis (HD) or Peritoneal Dialysis (PD) Type based on underlying kidney disease and co-morbid
factors
Both require selective, permeable membrane Allows passage of water and small molecules
-
CKD - Renal Replacement Therapy
Hemodialysis (HD) Membrane is manmade dialyzer Preferred access site – AVF, AVG Typical regimen
-
CKD - Renal Replacement Therapy
Peritoneal dialysis (PD) Lining of patient’s peritoneal wall is the selective
membrane Types
CAPD CCPD
Access via catheter into peritoneal cavity
Dwell time and number of exchanges
-
CKD - Stages 1 & 2 Nutrition Therapy
Focus on co-morbid conditions: diabetes, hypertension, hyperlipidemia, progression of CVD
K/DOQI guidelines for GFR ≤ 20 SGA every 1–3 mo. Dietary interviews and food intake
Protein: .6-.75 g/kg Energy: 30-35 kcal/kg
-
CKD - Stages 3 & 4 Nutrition Therapy
See ADA guidelines Nutrition assessment recommendations Nutrient recommendations
Protein, energy, sodium, potassium, phosphorus, calcium, vitamins, minerals, fluid may need adjustment
Emphasize usual foods
-
CKD - Stages 3 & 4 Outcome measures
Clinical Biochemical Anthropometrics
Clinical signs and symptoms
Behavioral Meal planning, meeting nutrient needs, awareness of food/drug
interactions, exercise
-
CKD - Stage 5 Nutrition Assessment
On dialysis – measures not different Dietary intake Biochemical: serum albumin
Goals: meet nutritional requirements, prevent malnutrition, minimize uremia, minimize complications
Maintain blood pressure, fluid status
-
© 2007 Thomson - Wadsworth
-
CKD - Stage 5 Nutrition Intervention
HD – high in protein, control intake of potassium, phosphorus, fluids and sodium
PD – more liberalized; higher in pro., sodium, potassium and fluid, limit phosphorus
nutrients to monitor
-
CKD - Stage 5 Nutrition Intervention
Protein - 1.2 g/kg (HD), at least 50% HBV
PD same except during peritonitis
-
CKD - Stage 5 Nutrition Intervention
Energy to prevent catabolism; needs slightly higher PD - account for kcal in dialysate Caloric load 24-27 kcal/kg/day average intake
-
CKD - Stage 5 Nutrition Intervention
Adjusted Edema-Free Body Weight should be used to calculate body weight for calculating protein and kcal For those < 95% or > 115% median standard weight NHANESII For maintenance in HD and PD pts.
Obtained postdialysis for HD pts., and after drainage for PD patients
-
CKD - Stage 5 Nutrition Intervention
Fat - increased risk for CAD and stroke HD typically have normal LDL, HDL, TG PD higher TC, LDL, TG Recommend TLC diet guidelines for both
-
CKD - Stage 5 Nutrition Intervention
Fluid and Sodium highly individualized based on residual urine output and dialysis modality Interdialytic weight gain (HD) should not exceed 5% of body
weight
2 gram sodium diet
Not more than 1 L fluid daily If urine output > 1 L/day sodium and fluid can be liberalized to
2-4 g and 2 L
-
CKD - Stage 5 Nutrition Intervention
Fluid and Sodium PD – based on ultrafiltration; 2 -2.5 kg fluid/day Fluid 2 L
Sodium 2-4 g
Fluid overload: shortness of breath, htn., CHF, edema
-
CKD - Stage 5 Nutrition Intervention
Phosphorus Hyperphospatemia - GFR 20-30 mL/min Dietary phosphorus restriction: 800-1000 mg/day, < 17 mg/kg
body IBW Phosphate binders; calcium salts Limit calcium intake
-
© 2007 Thomson - Wadsworth
-
CKD - Stage 5 Nutrition Intervention
Calcium requirements higher in CKD Restrict foods high in calcium Take supplements on empty stomach Limit to 2000 mg/day from all sources
-
CKD - Stage 5 Nutrition Intervention
Vitamin Supplementation Water-soluble vitamins Daily requirements “Renal” vitamins include B12, folic acid, vitamin C Avoid high doses of vitamins A & C May need vitamin K if on antibiotics
-
CKD - Stage 5 Nutrition Intervention
Mineral supplementation Avoid Mg-containing phosphate binders, antacids, and
supplements Iron Zinc