MNT Approaches to Acute and Chronic Kidney Disease Nutrition and Kidneys MNT Approaches to Acute and Chronic Kidney Disease

What happens when Kidneys shut down? Waste products Water/fluids Parathyroid Electrolyte balance The diet of patients with compromised kidney function corrects the chemical imbalances

Key Labs to Watch BUN/Creatinine K Phos Albumin Hgb, Hct Calcium Body weight changes

Acute Renal Failure Short term kidney failure See rapid change in chemistry, water retention Cause: infection or trauma Diet Rx: support underlying disease process, keep comfortable, monitor for fluid buildup

Chronic Renal Failure Slow to occur – gradual onset Causes: uncontrolled HTN, DM, CA, Lupus, trauma Symptoms – yellowing of skin, retention of water, weight loss, appetite loss, “don’t feel good” usually brings to Dr OR product of long term monitoring

Diet Rx for CRF (predialysis) To retard kidney destruction, limit protein to .08g/kg/day. Sometimes losing too much water and electrolytes – base this on the chemistries

Going on Dialysis Types of treatments Hemodialysis Peritoneal In Center Home Peritoneal Continuous (CAPD) Intermittent (IPD) Continuous Cyclic (CCPD) Transplant

Diet for Hemodialysis 1 gm protein per kg body weight 2 gm K 2 gm Na Limited phosphorus 1500 cc fluid q d Kcalories to meet need or control blood glucose

Typical Lab Panels BUN – look for up to 100 pretx K - < 6.0 Alb - > 3.0 Wt changes – 2-3 kg Monitor weight trend by post tx when they are “dry”

Medications (lots) Calcium supplement (phosphate binder Multivitamin Iron supplement or antianemics Antihypertensives (usually) Control of other conditions eg, CA tx, oral agents, CVD

Pros/Cons of Hemodialysis Someone else controls tx Scheduled Control over cleansing of blood In center attention and often But Fluid buildup Constant control of external chemicals to prevent buildup BP drops Access infections

Peritoneal Dialysis Continuous exchanges of sugar fluids to remove waste Goods: feel better, better clearance of chemistries, less restrictive diet Bads: requires independence, weight gain, difficult protein balance, more difficult to control BGL, high susceptibility to infection of access

Diet Rx for Peritoneal Dialysis High protein – 2 gm/kg body weight Calorie controlled Balanced nutrients Phosphorus restriction

Meds for Peritoneal patients Multivitamin antianemics Support meds for underlying conditions

Labs for Peritoneal patients BUN – 40-50 Albumin > 3.0 Phos < 6.0 Spend lots of time counseling on balance between adequate protein and just enough kcalories to control weight (additional kcals from dialysate fluid)

Transplant – the end of Kidney Disease? Symptoms and ramifications of ESRD subside High doses of antirejection drugs result in weight gain (round face) Also they feel better, and eat more Diet Rx: kcalorie controlled, balanced (avoid weird stuff)

Issues with ESRD patients Noncompliance Denial Lose hope More and more elderly Family control of diet

What you do when you work with a patient with renal disease Assess: no question is high acuity level, start as you would anyone else with calculating nutrient needs and adjustment Plan: continous, they are going to be with you awhile Educate: ongoing, sometimes fruitless, develop a trust level with your patients Monitor: look for trends and real changes

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