Renal Diet Flashcards Preview

Renal Course > Renal Diet > Flashcards

Flashcards in Renal Diet Deck (23)
Loading flashcards...

What are the most common causes of CKD in the US?

Diabetes and HTN


At what stage of CKD does protein restriction in diets start?

Stage 3 both a and b

In additional to protein restrictions, phosphorus is also restricted

**in stage 5, if the patient is on dialysis you need to actually increase protein requirements**


What is the protein requirements for moderate protein restriction diet?

0.6-0.8g/kg of body weight
- is 100% indicated in any CKD patient with a GFR <50 and has NO diabetes and NO dialysis

**if diabetic = 0.8-0.9 protein/kg**


Nutritional secondary impacts of CKD and associated pathologies

Vitamin D active form and osteoporosis

Erythropoiesis and anemia

Iron and calcium deficiencies and osteoporosis/iron deficency anemia

Hyperlipdidemia and accelerated atherosclerosis/MIs


What dietary cautions should CKD patients experience?

Avoid high protein (except in dialysis) and low carbohydrate meals

Avoid herbal products

Plant-based diets relatively (just need to monitor minerals)

Regular monitoring of serum sodium, potassium and phosphorus

Sugar control (especially in glycemic controls)


What is the kcal/kg of body weight dietary values are seen in CKD patients

23-35 kcal/kg


Why is high dietary protein intake contraindicated in non-dialysis CKD?

High protein intake leads to increases GFR and increased intra glomerular pressures
- both of these leads to damage to glomerulus structures


What are the risk of a low protien diet for CKD patinets

Increased inflammation

Increased acidemia

Malnutrition with calories is possible



What is a very low protein diet?

0.3 g/kg

Likely not appropriate except in stage 4/5 without dialysis

Very challenging to adhere to and also causes essential amino acids to be too low
- need to give keto acid analogs to these patients


Plant based proteins and CKD

Research now suggests that mixing plant proteins into a CKD diet can actually decrease the glomerular pressure and decreases proteinuria

However, you cannot use only plant proteins since being on a low protein diet already will lead to amino acid deficiencies


Are DASH and Mediterranean diets okay for CKD?

- however they need to discuss with a nephrologist before starting


Potassium and CKD

Requires less than 2.4g/day
- starts on stage 3 CKD

**if there is no hyperkalemia, usually don’t need to restrict**

Sources of dietary K
- 2/3 = fruits and vegetables
- 1/3 = everything else
- **avoid salt substitutes


Organic vs inorganic phosphorus absorption

Organic phosphorus
- 40-70% absorbed
- includes dairy products, meat, poultry, fish, soy
- **phytates decrease organic P absorption**

Inorganic phosphorus
- 90% absorbed
- includes food additives supplements, dark colas

***can be difficult to measure the amount of phosphorus a food has since it is not required to be on a nutritional facts. Look for any ingredient that has “PHOS” in its name***


Because phosphorus is difficult to determine exact concentration, what is often given to CKD patients in order to make sure they dont over intake phosphorus?

Phosphorus binders
- includes calcium carbonate and sevelamer, ferric citrate, lanthanum

**is a MUST for any patient on dialysis**


What are high phosphate: protein ratio foods and low phosphate: protein ratio foods?

High ratio
- egg yolks
- beans/lentils/ dried peas
- cheese
- milk
- nuts/seeds
- organ meats (crabs/oysters/shrimp)
***must avoid these foods***

Low ratio
- egg whites
- white bread/pasta/crackers
- water based soups
- almond milk (be careful though)
***can eat these***


Why is over intake of phosphorus bad in CKD

Triggers secondary hyperparathyroidism since phosphorus is not excreted in CKD


Sodium and CKD

Dietary recommendation = <2.4g/day

As CKD progresses, the kidneys excrete less sodium and taste sensitivity to sodium is lowered.
- *because of the lowered taste sensitivity to sodium, it is very easy for CKD patients to become hypernatremic

Hypernatremia leads to increased ECF, increased HTN and increases risks of CAD


Calcium, vitamin D, iron and CKD

Calcium Should not exceed 2g/day

Vitamin B = based on DRI recommendations

Vitamin D supplementation is recommended only if 25-hydroxy D level <30ng/mL

Iron supplementation recommended if serum ferritin <100ng/mL and transferrin saturation < 20%


ESRD nutritional maintenance w/ dialysis

- > or equal to 1.2 g/kg
- > 50% of protein intake has to be high biologic value

- < 60 yrs = 35 kcal/kg
- >60 yrs = 30-35 kcal/kg

- <2.4 g/day

- < 2.4 g/day (for hemodialysis)
- 3-4 g/day (only peritoneal dialysis)

- 800-1000 mg/day

- <2 g/day


What is a patients dry weight?

Weight in a patient immediately after dialysis
- should limit weight go pain to no more than 2.2 lbs per day in between dialysis treatments


What a re the 4 major factors for determining fluid needed for acute renal failure?

1) treatment modality

2) hydration state

3) increased insensible losses w/ fever sepsis or burns

4) urine output


Kidney stones and certain nutrients to watch for

Oxalate high levels increase risk for kidney stone formation

Sodium in high levels increases risk

Proteins in excess of two 4-oz servings/day increases risks

Calcium in high levels increases risk


Nephrotic syndrome

Loss or urinary protein > 3 g/day

3 primary symptoms:
1) Hypoalbuminemia
2) Excessive protienuria
3) Dyslipidemia

Dietary restrictions
- protein = 0.8g/day - 1.0 g/day
*soy protein is especially food here as it decreases proteinuria

- sodium = 1000-2000 mg/day

- phosphate = <12 mg/kg

- low fat and cholesterol should be implemented

- calcium - don’t exceed 2,000