Week 9 Chronic Renal Disease II: Renal Transplantation Flashcards
Nutrition goals for renal transplant
Preserve & maintain renal function which includes:
* Blood Pressure within target
* Blood Glucose levels within target
* Healthy weight
Minimize side effects of the immunosupressive therapy medications
Post Transplant Nutritional Concerns
- Maintenance lean body mass (usually see loss so want to prevent this)
- Adequate hydration (need to keep kidney perfused and working well)
- Hypophosphatemia
- Hypomagnesemia (drugs/meds)
- Hyperkalemia
- Hypertension
- Diabetes
- Food Safety, Food/Drug Interactions (some foods cannot take with immunosuppressive drugs)
Protein requirements post kidney transplant
Generally 1.3-1.4 g/kg/day of protein within the first 6-8 weeks post transplant
* can be up to 1.5 g/kg/d in the ICU
* 0.8g/kg/day acceptable onwards for protein
Calorie requirements post kidney transplant
individual
* can range from 25-35kcal/kg/day
Fluid requirements post kidney transplant
- In immediate post-operative period patients may still have a TFI (particularly in the ICU). Patients may still have ongoing edema that they experienced pre-treatment and hence fluid restrictions may be slowly lifted.
- By 2-3 months post-treatment; most patients will need 10- 12 cups (2.5-3L) required daily; often by this time no restriction if the new organ is completely working.
- Watch for edema and BP; monitor urine output
How can kidney transplant effect the electrolytes?
Potential for:
* hypophosphataemia
* hypomagnesiumia
* hyperkalemia
Issues of hypophosphatemia
Usually <0.7 mmol/L if severely low? (worried about hyper pre-transplant)
* Cardiac
* Hematologic
* Neuromuscular
* Pulmonary
* Skeletal
Issues of hypomagnesiumia
Can tolerate low levels down to 0.6 mmol/L is else is stable, but less than 0.5 mmol/L is too low
* Cardiac
* Gastrointestinal
* Neuromuscular
Roles of magnesium
Functions as a cofactor in manyintracellular reactions
* 20% of the Mg in plasma is protein bound (correct for low Alb)
* Regulated by gut, kidney and bone
Repletion of phosphate and magnesium
- If serum phosphorous level low, consider supplement and/or encourage PO4-rich foods (dairy, etc.)
- If serum magnesium level low, consider supplement and/or encourage Mg rich foods (legumes, nuts, whole grains)
What is an important caution of phosphate and magnesium supplements?
Caution: Both supplements can = diarrhea. Diarrhea will result in further depletion of both phosphorus and magnesium.
What might result in hyperkalemia post kidney transplant?
If graft is working well, K+ levels usually normal, yet, Tacrolimus (potassium sparing diuretics) can cause hyperkalemia
* Monitor for other causes of hyperkalemia including hyperglycemia, metabolic acidosis & catabolism
What needs to be considered with bone health post kidney transplant?
1500mg Calcium & 1000-2000 IU/D vitamin D daily via diet and/or supplementation should be suggested as long term steroid use increases the risk of developing osteoporosis:
* Direct inhibition of osteoblast function
* Direct enhancement of bone resorption
* Inhibition of gastrointestinal calcium & phos absorption
* Increases in urine calcium loss
What needs to be considered with lipids post kidney treatment?
hyperlipidemia
* Immunosuppressive meds = elevations in LDL and TG levels
* 1st intervention - heart healthy diet!
* 2nd intervention = drug therapy with diet and lifestyle modification
Hypertension recommendations for post kidney transplant
- NAS diet (2.0-2.3 gm sodium/d max) recommended
- Weight Management
- Caffeine >400 mL/d may affect BP