Week 9 Chronic Renal Disease II: Renal Transplantation Flashcards

1
Q

Nutrition goals for renal transplant

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Post Transplant Nutritional Concerns

A
  • 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)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Protein requirements post kidney transplant

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Calorie requirements post kidney transplant

A

individual
* can range from 25-35kcal/kg/day

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Fluid requirements post kidney transplant

A
  • 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 well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

How can kidney transplant effect the electrolytes?

A

Potential for:
* hypophosphataemia
* hypomagnesiumia
* hyperkalemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Issues of hypophosphatemia

A

Usually <0.7 mmol/L if severely low? (worried about hyper pre-transplant)
* Cardiac
* Hematologic
* Neuromuscular
* Pulmonary
* Skeletal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Issues of hypomagnesiumia

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Roles of magnesium

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Repletion of phosphate and magnesium

A
  • 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)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is an important caution of phosphate and magnesium supplements?

A

Caution: Both supplements can = diarrhea. Diarrhea will result in further depletion of both phosphorus and magnesium.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What might result in hyperkalemia post kidney transplant?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What needs to be considered with bone health post kidney transplant?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What needs to be considered with lipids post kidney treatment?

A

hyperlipidemia
* Immunosuppressive meds = elevations in LDL and TG levels
* 1st intervention - heart healthy diet!
* 2nd intervention = drug therapy with diet and lifestyle modification

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Hypertension recommendations for post kidney transplant

A
  • NAS diet (2.0-2.3 gm sodium/d max) recommended
  • Weight Management
  • Caffeine >400 mL/d may affect BP
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

How might post kidney transplant effect diabetes onset?

A

Latrogenic (steroid-induced) Diabetes:
* Tacrolimus & corticosteroids can increase BG by causing insulin resistance, upregulated TG resistance, glucose abnormalities
* Adequate intake of carbohydrate throughout the day emphasized
* Glucose levels hardest to manage during the first 4-6 weeks when medication doses are at their highest (greatest risk for rejection)

17
Q

What is the recommendation vitamin supplement for people posy kidney transplant?

A

Replavite daily:
* vitamin A can stay elevated years post transplant
* Research shows that the average Canadian does not meet the DRI for folic acid
* hyperhomocysteinemia is prevalent in people who have kidney disease and folic acid, vitamin B6 and vitamin B12 are involved with it’s metabolism
* Also for pre-transplant/ patients with kidney disease/ dialysis

18
Q

Use of herbal medications post kidney transplant

A

Caution people to avoiding herbal preparations:
* lack of research regarding interactions with immunosuppressant medications
* Herbal products are not regulated
* Some herbal products are thought to boost immune response (ie: ginsing)

19
Q

Grapefruit and grapefruit juice post kidney transplant

A

Should be avoided post transplant
* Grapefruit and Grapefruit juice inhibit P450 3A (CYP3 A) activity and therefore raise the levels of tacrolimus (prevents it from breaking down) in the blood. This can be harmful for the new organ.
* Potential Interaction also exhibited with Pomegranate, Starfruit, Bergamot Orange (oil found in Earl Grey Tea)

20
Q

What is the major complication for renal transplant recipients?

A

CVD and weight gain after transplantation can contribute to:
* high blood pressure
* high blood cholesterol
* the development of diabetes
* heart disease
* loss of function in your transplanted kidney

21
Q

How can the immunosuppressive drugs affect weight gain?

A

Drugs can increase appetite and so sometime eat more food post transplant

22
Q

Mr. JR case study

A

Notes

23
Q

Dialysis Case Study I

A

Notes

24
Q

Dialysis case study II

A

Notes

25
Q

What needs to be included in nutrition prescriptions?

A
  • Energy
  • Protein
  • potassium
  • phosphorous
  • sodium
  • fluid
26
Q

Nutrition education options

A
  • Phosphorous and your kidney diet handout provided and reviewed
  • Binder timing and compliance reviewed
  • Healthy diet and lifestyle choices
  • Reading labels for phosphorous additives
27
Q

Monitoring and Evaluation with kidney disease/ transplant

A
  • anthropometrics (body weight)
  • biochemical data (lytes)
  • food and nutrition (recommendations)
  • medications (adherence/ dosage)
28
Q

Developing nutrition diagnosis

A
  • PES statement
  • goals
  • nutrition prescription
  • nutrition intervention (nutrition education and food and nutrient delivery)
  • monitoring and evaluation