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Helical noncontrast-enhanced CT showing calcification involving the left main coronary artery. Example of Coronary Calcification.

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Presentation on theme: "Helical noncontrast-enhanced CT showing calcification involving the left main coronary artery. Example of Coronary Calcification."— Presentation transcript:

1 Helical noncontrast-enhanced CT showing calcification involving the left main coronary artery. Example of Coronary Calcification

2 Age, y Dietary Calcium Limit, mg/d > IOM website. [1] Upper Level Calcium Intake: Adults

3 *Many raw meats now contain phosphate additives to enhance their flavor. Phosphorus content may vary depending on the product brand or manufacturer. Sullivan K, et al. J Renal Nutr. 2007;17: [3] ; NKF [4] ; Kalanter-Zadeh RA, et al. Clin J Am Soc Nephrol 2010;5: [5] ; Sherman RA, et al. Clin J Am Soc Nephrol. 2009;4: [6] Phosphorus in Foods Phosphorus-Rich Foods Phosphorus Level, mg Lower-Phosphorus Substitutes Phosphorus Level, mg Chicken breast, breaded, flavor-enhanced (3.5 oz)* 242Chicken breast, fresh, not flavor-enhanced (3.5 oz) 182 Pork chop, flavor- enhanced (3.5 oz)* 340Pork chop, not flavor- enhanced (3.5 oz) 210 Milk (8 oz)230Nondairy creamer (8 oz)100 Peanuts (2 oz)200Popcorn (1.5 c)35 Hard cheese (1 oz)145Cream cheese (1 oz)30 Oatmeal (2/3 c)130Cream of wheat or grits (2/3 c) 40 Pinto beans (1/2 c)100Green beans (1/2 c)35 Ice cream (1/2 c) 80Sherbet (1/2 c)0 Egg (1 large)72Egg white (1 large)5 Dark cola (12 oz)55Ginger ale (12 oz)3

4 Phosphate BinderAvailable Forms Aluminum hydroxide*Liquid, capsule, tablet Calcium acetate † Capsule, tablet Calcium carbonate † Liquid, tablet, capsule, chewable, gum Lanthanum carbonateWafer, chewable Sevelamer hydrochlorideTablet Sevelamer carbonateTablet, powder Sucroferric oxyhydroxideTablet *Prolonged administration may increase the risk for aluminum intoxication. † May increase risk of soft-tissue calcification. KDIGO. CKD-MBD Work Group. Kidney Int. 2009;76:S1-S130. [2] Phosphate Binders Commonly Used to Manage Hyperphosphatemia in Patients With CKD

5 Patient Education Resources Sources (clockwise from left): Medscape Education [7] ; USDHHS Reproduced with permission. [8] ; NKDEP Reproduced with permission. [9] ; NKDEP Reproduced with permission. [10]

6 Making Food Choices Convenience and fast foods often contain phosphorus additives The breading on many fried foods may substantially increase phosphorus content Dietitians should work closely with patients to help them make appropriate food choices Sullivan K, et al. J Renal Nutr. 2007;17: [3]

7 Kalanter-Zadeh RA, et al. Clin J Am Soc Nephrol 2010;5: [5] Dicalcium phosphate Disodium phosphate Monosodium phosphate Phosphoric acid Sodium hexameta-phosphate Sodium tripolyphosphate Tetrasodium pyrophosphate Trisodium phosphate P-H-O-S-phorus-containing Food Additives Common in Processed, Preserved, or Enhanced Foods and Soft Drinks

8 Motivational Interviewing: Steps for Success Engage the patient Build rapport Partner to set goals Identify barriers to change Support self-efficacy Affirm successes Martino S. Blood Purif. 2011;31: [13]


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