Nutrition for Clients with Kidney Disorders

Flashcards for NURS240 Kidney Disorders Lecture

What are general nutrition recommendations for nephrotic syndrome?

Minimize edema, proteinuria, and hyperlipidemia; replace nutrients lost in the urine; reduce the risk of progressive renal damage and atherosclerosis.

What nutrition and lifestyle interventions may help prevent chronic kidney disease (CKD)?

Weight loss if overweight, healthy eating pattern (DASH or Mediterranean), physical activity, no tobacco, control blood glucose, maintain normal blood pressure and cholesterol.

Why are sodium, protein, phosphorus, and potassium restricted as kidney disease progresses?

To manage fluid retention, blood pressure, electrolyte imbalances, and prevent further kidney damage.

Why is it important to consume adequate calories when protein intake is restricted for kidney disease?

To spare protein from being used for energy, allowing it to be used for protein synthesis.

Give examples of foods to eat or avoid when sodium is restricted for kidney disease.

Avoid processed foods, canned soups, and salty snacks. Eat fresh fruits, vegetables and whole grains with no added salt.

Give examples of foods to eat or avoid when protein is restricted for kidney disease.

Limit meat, poultry, fish, dairy, beans. Focus on incorporating more vegetables and grains into the diet.

Give examples of foods to eat or avoid when phosphorus is restricted for kidney disease.

Limit dairy, nuts, seeds, and dark cola. Focus on incorporating fruits and vegetables into the diet.

Give examples of foods to eat or avoid when potassium is restricted for kidney disease.

Limit bananas, oranges, potatoes, tomatoes. Focus on incorporating other fruits and vegetables that are lower in potassium into the diet.

What are the characteristics of the Mediterranean-Style Eating Pattern that may benefit clients with CKD?

Emphasis on whole grains, fruits, vegetables, nuts, legumes, olive oil; frequent intake of fish; limited red meat, processed meats, sweets; wine in moderation with meals.

How do nutrient recommendations differ for clients with CKD after renal replacement therapy begins?

Protein intake typically increases; fluid and electrolyte allowances are adjusted based on dialysis type and individual needs.

What are the nutrient recommendations for post-transplant clients?

Initially increased calorie and protein needs due to surgery, gradually decreasing; heart-healthy eating pattern to manage risks of obesity, hyperlipidemia, hypertension, diabetes, and CVD.

What nutrition and lifestyle strategies may help prevent kidney stones from forming?

Maintain normal BMI, drink adequate fluids (at least 2 L/day), consume a DASH-style eating pattern, consume adequate calcium, avoid frequent intake of sugar-sweetened beverages.

What risk factors increase the risk of kidney disease?

Obesity, diabetes, hypertension, and cardiovascular disease (CVD).

What does the DASH diet consist of?

High in fruits, vegetables, whole grains, nuts and legumes, and low-fat dairy products; low in red and processed meats, sugar-sweetened beverages, and sweets.

What is the main characteristic of the Mediterranean Diet?

A plant-based pattern that emphasizes whole grains, fruit, vegetables, nuts, legumes, and olive oil; frequent intake of fish.

What are the major symptoms of nephrotic syndrome?

Proteinuria, hypoalbuminemia, hyperlipidemia, edema.

What are some causes of nephrotic syndrome?

Diabetes, autoimmune diseases (e.g., lupus, IgA nephropathy), infection, and certain chemicals and medications.

What are some possible complications related to the loss of plasma proteins in nephrotic syndrome?

Anemia (loss of transferrin), increased risk of infection (loss of immunoglobulins), vitamin D deficiency (loss of vitamin D–binding protein), and increased blood clotting (loss of anti–blood clotting proteins).

What are the benefits of minimizing proteinuria in nephrotic syndrome?

An increase in serum albumin, a decrease in serum lipid levels, a slower progression of kidney disease, and less edema.

How much sodium should be restricted in nephrotic syndrome patients to control edema and blood pressure?

Restrict sodium to 2 g/day

How much protein should be limited to with nephrotic syndrome?

Limit protein to 0.8 g/kg/day

How many calories are required to spare protein and maintain weight in nephrotic syndrome?

35 cal/kg

What is Chronic Kidney Disease?

A syndrome of progressive kidney damage and loss of function measured by a decrease in GFR.

At what eGFR is Chronic Kidney Disease diagnosed?

Diagnosed when eGFR is <60 for 3 months or longer

What is the impact of Chronic Kidney Disease on Nutrition?

As urine output decreases, fluid and electrolytes accumulate in the blood, producing symptoms of overhydration, such as increased blood pressure, weight gain, edema, shortness of breath, and lung crackles plus uremic syndrome and acidosis.

What is persistent albuminuria?

Defined as >30 mg of urine albumin per gram of urine creatinine

What modifiable risk factors increase the risk of early death, heart disease, and stroke for people with Chronic Kidney Disease?

Smoking cessation, an increase in physical activity, and controlling blood lipid levels.

What are the leading causes of Chronic Kidney Disease?

Diabetes and hypertension

What should be avoided and what is the ideal intake of protein for clients with CKD?

Excesses and deficiencies of protein should be avoided, the ideal intake of protein for clients with CKD is not known although it is slightly higher for diabetic clients

How much sodium is generally recommended for Chronic Kidney Disease patients?

<2300 mg/day is recommended

How much potassium intake is recommended for Chronic Kidney Disease patients?

Limiting potassium intake to <3 g/day is recommended with the caveat that fruit, vegetable, and high fiber intake not be compromised

What is the calorie recommendation for all stages of Chronic Kidney Disease?

Calorie recommendations are 25 to 35 cal/kg

How much calcium is recommended per day in moderate to advanced Chronic Kidney Disease?

800 to 1000 mg/day

How many calories are recommended for adults younger than 60 years with Chronic Kidney Disease?

35 cal/kg

How many calories are recommended for adults older than 60 years with Chronic Kidney Disease?

30 to 35 cal/kg

If a patient undergoes dialysis what chronic risks do they face?

persistent inflammation, malnutrition, metabolic abnormalities

What is the protein recommendation when someone is on dialysis?

1.0 to 1.2 g/kg/day or higher depending on client needs

What should the total calcium intake be when someone is on dialysis?

<800 mg/day

What is the fluid allowance when someone is on dialysis?

equals the volume of any urine produced plus 1000 mL

What are kidney transplant clients at risk of?

obesity hyperlipidemia hypertension diabetes osteoporosis Arterial sclerosis

What eating pattern is indicated in kidney transplant clients?

A heart-healthy eating pattern is indicated

What is the protein need for kidney transplant patients during the first 1 to 2 months posttransplant?

1.3 to 2.0 g/kg of body weight

What is Acute Kidney Injury?

Acute kidney injury (AKI) is the sudden loss of renal function characterized by an acute increase in serum creatinine and decrease in urine output

What are some causes of Acute Kidney Injury?

shock, severe infection, trauma, medications, and obstruction

What is the primary focus of treating Acute Kidney Injury?

to correct the underlying disorder

What is the calorie recommendation for treating Acute Kidney Injury?

20 to 30 cal/kg

What is the protein recommendation when treating Acute Kidney Injury without dialysis?

gradually increase to 1.3 g/kg/day or possibly 1.7 g/kg/day

What is the protein recommendation when treating Acute Kidney Injury on intermittent renal replacement therapy?

1.0 to 1.5 g/kg/day

What is the protein recommendation when treating Acute Kidney Injury on continuous renal replacement therapy?

up to 1.7g/kg/day

What are Kidney Stones?

Form when insoluble crystals precipitate out of urine

What are kidney stones often made of?

calcium oxalate

What are some risk factors for Kidney Stones?

Dehydration or low urine volume, urinary tract obstruction, gout, chronic inflammation of the bowel, and intestinal bypass or ostomy surgery

What is the result of high fluid intake with Kidney Stones?

High fluid intake dilutes the urine

What percentage of kidney stones contain calcium?

Approximately 80% to 85%

What should kidney stone patients maintain and consume to minimize the incidence of Kidney Stones?

Maintain a normal BMI, Drink an adequate amount of fluid—at least 2 L/day, Consume a DASH-style eating pattern, Consume adequate calcium, Avoid frequent intake of sugar-sweetened beverages

What is the goal of nutrition therapy during dialysis?

To match dietary intake with renal replacement therapy (RRT) while preventing nutrition deficiencies