ch 23 kidney disorders

Decrease risk of developing chronic kidney failure by:

• Lose weight if overweight; be physically active

• Consume a healthy eating pattern

  • Dietary Approaches to Stop Hypertension (DASH)

  • Mediterranean-Style Eating Pattern

• Do not use tobacco

• Control blood glucose levels

• Maintain normal BP

• Maintain normal serum cholesterol

DASH diet is high in:

• Fruits, veggies, whole grains, nuts and legumes, and low-fat dairy products

  • plant proteins are ideal

• Low in red and processed meats, sugar-sweetened beverages, and sweets

• Lowers BP and inflammation

• Lowers risk for kidney disease

Mediterranean Diet

• Primarily plant-based

  • Whole grains, fruit, veggies, nuts, legumes, and olive oil

  • frequent intake of fish

• Limited red meat, processed meats, and sweets

• Favorable effects on endothelial function, inflammation, lipid levels, and BP

• Shown to lower the risk of CVD and type 2 DM which are major risk factors for CKD

Nephrotic Syndrome

• Alterations in the kidneys glomerular basement membrane

  • Large urinary losses of albumin and other plasma proteins

• May occur due to any kidney disease that damages the glomeruli (diabetes, autoimmune diseases, infection)

• Major symptoms: proteinuria, hypoalbuminemia, hyperlipidemia, edema

• Risks include: anemia, increased risk of infection, vitamin D deficiency, malnutrition

Nephrotic Syndrome - Nutrition therapy

• Goals:

  • minimize edema, proteinuria, and hyperlipidemia

  • replace nutrients lost in the urine

  • reduce the risk of progressive renal damage and atherosclerosis

  • reduce risk/slow progression of disease

• Sodium restriction to 2 g/day begins when fluid retention occurs

  • Restrict fluid only in patients with hyponatremia

• Limit protein to 0.8 g/kg/day

• Supplemental vitamin D as needed

• Adequate calories

Chronic Kidney Disease

• A syndrome of progressive kidney damage and loss of function

• Decrease in the number of functioning nephrons

  • overburdens remaining nephrons

  • kidney’s ability to filter blood deteriorates

• nutrients are building up to unhealthy levels (particularly electrolytes)

  • increased BP, weight gain, edema, SOB, and lung crackles

• Acidosis occurs

  • Anorexia (bc of poor appetite), N/V, breakdown of muscle proteins

  • plant foods yield bicarbonate (reversing the acidosis)

• symptoms of overhydration

• Measured by a decrease in GFR

  • <60 for 3 months or longer

  • 5 stages based on eGFR

• Progresses slowly

• Risk factors: diabetes, hypertension and CVD, obesity, advancing age, family history

  • African American, Native American, Hispanic ethnicities

• Closely linked to increased inflammatory response of the body

• Accelerated atherosclerosis

Chronic Kidney Disease - Nutrition therapy

• Mediterranean diet has recently been suggested for stages 1 to 5 not on dialysis or post-transplantation, to improve lipid profiles

• balanced protein (plant based) diet, no excess and no deficiencies

  • high protein would progress the disease, low protein may contribute to muscle/LBM loss/Sarcopenia, delayed wound healing, malnutrition

  • Ideal intake not known but ~0.6-1 g/kg

• Sodium restriction controls fluid retention and hypertension

• Potassium = risk of hyperkalemia due to reduced urinary excretion

  • <3 g/day is recommended

  • fruit, vegetable, and high fiber intake ideally not compromised

• Phosphorus = <800 mg/day

• Calcium = 800-1000 mg/day in clients with moderate to advanced

• High fiber = more favorable microbiome and help prevent constipation

Dialysis presents an increased risk of morbidity and mortality related to:

• Persistent inflammation

• Malnutrition

• Metabolic abnormalities

Dialysis - goal of nutrition therapy

• Match dietary intake with renal replacement therapy (RRT) while preventing nutrition deficiencies

• Protein recommendation increases to 1.0-1.2 g/kg/day or higher (depending on client needs)

• Loss of serum proteins and amino acids

• calcium = <800 mg/day

• Fluid (restricted) to 1000 mL, plus volume of any urine produced

  • ex: if they produce 500mL of fluid per day, their fluid intake can be 1500mL per day

Kidney Transplantation

• the use of immunosuppressive drugs requires ongoing nutrition therapy to reduce the risks of obesity, hyperlipidemia, HTN, DM, osteoporosis

• Arterial sclerosis leading cause of death in kidney transplant clients so a heart-healthy eating pattern is indicated

Kidney Transplantation - nutrition in immediate postop period

• Calorie and protein needs are increased

  • Protein: 1.3-2 g/kg during the first 1 to 2 months

• Protein and calorie needs gradually decrease after the initial postoperative period

  • Steroids may increase appetite → weight gain

Kidney Stones

• Form when insoluble crystals precipitate out of urine

• Most common: calcium oxalate

• Risk factors: dehydration or low urine volume, urinary tract obstruction, gout, chronic inflammation of the bowel, and intestinal bypass or ostomy surgery

Kidney Stones - Nutrition therapy

• increase fluid intake to dilute urine

• to minimize incidence: maintain a healthy BMI, drink at least 2 L/day, DASH diet, consume adequate calcium, avoid frequent intake of sugar-sweetened beverages