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

2. 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

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

4. 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

5. 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

6. 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

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

8. 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

9. 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”

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

11. 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

12. 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

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

14. Meds for Peritoneal patients
Multivitamin
antianemics
Support meds for underlying conditions

15. 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)

16. 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)

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

18. 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

19. Practice working with case information in packet