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Nutrition > Diet and Renal Disease* > Flashcards

Diet and Renal Disease* Flashcards

1
Q

Acute decrease in kidney function as manifested by a decrease in estimated GFR levels

A

acute kidney injury

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2
Q

what abnormalities does acute kidney injury cause?

A

abnormal volume status (fluid overload or dehydration), electrolyte and acid-base derangements, build up of waste products in blood

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3
Q

What are important things to consider with nutrition in acute kidney injury?

A

may need fluid replacement if hypovolemic
electrolytes often self-correct
AKI patients have accelerated protein breakdown and may need more protein intake if prolonged

should consult a dietitian if AKI persists more than a few days

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4
Q

Presence of persistently abnormal kidney function, as manifested by decreased glomerular filtration rate of <60 mL/min for 3+ months
and
structural or functional markers of kidney damage

A

Chronic kidney disease

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5
Q

What are the main two diseases that contribute to the majority of chronic kidney disease in the US?

A

DM and HTN

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6
Q

In patients without CKD, better BP/BS control means _____; in patients with CKD, better BP/BS control means _____

A

less likelihood of developing CKD; less likelihood of CKD progression

Note: CKD can also cause HTN in patients who don’t have it already

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7
Q

What can contribute to the development and progression of CKD that can be mitigated by dietary changes?

A

atherosclerosis

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8
Q

What are metabolic derangements in CKD?

A

altered feedback mechanisms: altered appetite, thirst, and taste
altered protein homeostasis and catabolism
altered energy homeostasis: especially in dialysis patients, may develop cachexia
altered nutrient metabolism: impaired gut absorption of calcium and iron, frequent vitamin deficiencies, frequent mineral deficiencies, at risk for aluminum toxicity

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9
Q

What are recommendations for protein with CKD?

A

Protein restriction is recommended to slow down deterioration of kidney function in adult CKD patients –> reduces glomerular flow and pressures and slows accumulation of waste products in CKD

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10
Q

In pediatric CKD patients, protein restriction may contribute to _____ and often has net _____ so it is recommended to have _____

A

nutritional deficiencies, adverse effects, close follow-up by dietician

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11
Q

Do you think patients who don’t currently have CKD should restrict their protein intake?

A

If they do not have CKD, do not need to

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12
Q

What type of protein is recommended in CKD diet if protein is consumed and why?

A

plant-based

animal based proteins have more bioavailable phosphate for absorption and higher potential acid load

plant based proteins generally have more vitamins and minerals and higher fiber intake

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13
Q

If patients are in stage 1-2 of CKD, what is the recommendation in regards to protein?

A

No outright restriction, recommended .8 g/kg/day
encouragement of plant-based proteins

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14
Q

if patients are in stage 3-5, what is the recommendation in regards to protein?

A

protein restriction, more aggressive restriction as CKD gets worse to .6-.8 g/kg/d
higher proportion of plant-based proteins as gets worse

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15
Q

What are recommendations regarding protein in stage 5 CKD?

A

increased protein intake from previous diet plans, especially on dialysis days

may also need increased protein intake if very heavy protein loss in urine

Need 1.0-1.2 g/kg/day if hemodialysis, up to 1.3 g/kg/day if peritoneal dialysis

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16
Q

What is the name of the general diet guidelines recommended for all adult CKD patients, regardless of underlying etiology

A

PLADO (plant-dominant low protein diet)

Restricted protein, plant sources (>50%), restricted sodium, high fiber, adequate caloric intake

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17
Q

What is an alternative diet plan that is associated with better CKD outcomes and lower average blood pressure than standard restricted diets?

A

very low protein diet with supplementation

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18
Q

CKD patients, especially later stage, are vulnerable to _____

A

malnutrition, overt wasting, and cachexia

appetite is poor and therapeutic diet is often not palatable

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19
Q

what is the general recommendation for caloric intake in CKD?

A

30-35 g/kg/day

20
Q

What condition is related to dietary fats and can contribute to kidney disease?

A

Atherosclerosis

21
Q

This is a major contributor to HTN and may cause or worsen CKD

A

sodium

22
Q

what level should sodium be kept at in CKD?

A

similar to general population- 3-4 g/day

greater reduction as CKD worsens

Often also need diuretic and other anti hypertensive to control HTN

23
Q

What are recommendations for fluid intake with CKD?

A

encourage non-carbonated, non-sugary, non-caffeinated beverages
thirst is good indicator of hydration in younger patients with mild-moderate CKD, but diminishes in older patients and later-stage CKD

1.5 L/day average patients, 1 L/day if complications to avoid fluid overload or hyponatremia

24
Q

What are recommendations related to potassium with CKD?

A

Diseased kidneys lose ability to excrete potassium
later-stage CKD patients often have difficulty with higher levels

Potassium restriction of <3 g/day if later-stage CKD or hyperkalemia
can boil fruits/vegetables to reduce, regular serum potassium checks, medications to reduce potassium if needed

25
Q

CKD patients commonly have metabolic ____

A

acidosis

26
Q

contribution of food or dietary pattern to net endogenous acid production

A

potential renal acid load

27
Q

what food tend to have high acid production? Low?

A

animal-based foods, plant-based foods (tend to produce bases)

28
Q

how are acid levels in CKD reduced?

A

supplementation with sodium bicarbonate or eat 2-4 cups of fruits/vegetables daily

29
Q

are CKD patients often high or low in phosphorus?

A

high, have trouble excreting

30
Q

What foods are recommended/should be avoided with CKD patients in regards to phosphorus?

A

cut back on dietary phosphorus, from fruits and vegetables is not usually a problem because not well absorbed

dark sodas, processed foods should be avoided and 800 mg/day is recommended

31
Q

Vitamin D is absorbed in the ____ or made in the ____ and activated by the liver or ____

A

GI tract, skin, kidneys

32
Q

patients with CKD have less circulating active vitamin ____ and less ___ absorption in GI tract

A

D, calcium

33
Q

Vitamin ___ supplement is indicated in all stages of CKD, as it’s generally accepted these patients are insufficient or deficient; ___ levels generally increase when Vitamin D is replaced

A

D, calcium

34
Q

What other vitamins (other than vitamin D) are patients at risk for deficiency of with CKD?

A

B vitamins and vitamin C (a general multivitamin, preferably kidney friendly is appropriate)

35
Q

what happens to iron levels in CKD patients?

A

decreased due to hepcidin, less heme-based iron in CKD diets
May need iron supplementation

36
Q

what supplement may help with lipid levels in CKD patients?

A

carnitine

37
Q

what mineral is often deficient in CKD patients, especially on dialysis but supplementation is not recommended

A

zinc/selenium

38
Q

this has a risk of toxicity with CKD so patients should avoid ___ based medications

A

aluminum

39
Q

What are the metabolic derangements present in CKD?

A

Altered feedback mechanisms: appetite, thirst, taste
Altered protein homeostasis and catabolism
Altered energy homeostasis
Altered nutrient metabolism

40
Q

Which patients are especially prone to altered energy homeostasis?

A

Dialysis patients

41
Q

How is nutrient metabolism impacted by CKD?

A

Gut absorption of calcium and iron impaired
Vitamin deficiencies (B vitamins, C, active form of D)
Mineral deficiencies (zinc, selenium, manganese)
At risk for aluminum toxicity

42
Q

What are recommendations for dietary fat with chronic kidney disease?

A

Limit saturated fats, trans fats
Promote intake of polyunsaturated and monounsaturated fats, especially omega-3

43
Q

What can high saturated fat consumption increase related to CKD

A

Glomerular pressure, albuminuria —-> long-term kidney damage and CKD progression

44
Q

How is dietary fiber related to chronic kidney disease?

A

Promotes fecal nitrogen excretion to lower waste products for kidney and serum urea and creatinine
Lowers inflammation levels in the body
Better mortality

45
Q

What is the recommended intake of fiber for patients with CKD?

A

25-30 g/day

May recommend higher in later stage CKD

Nutrition (4 decks)

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