Renal Diet Part 2

Protein-energy wasting (PEW)

Protein-energy wasting prevalent in dialysis patients.

ESRD

End-stage renal disease, GFR <15 ml/min/1.73 m².

Hemodialysis

Blood filtration through an artificial kidney machine.

Peritoneal dialysis

Dialysis using the peritoneum as a membrane.

EPO

Erythropoietin, hormone for red blood cell production.

Vitamin D supplementation

Essential for patients with stage 1 or 2 CKD.

Hyperparathyroidism

Endocrine disorder causing calcium imbalance in CKD.

Metabolic acidosis

Acid-base imbalance increasing protein breakdown.

Indications for RRT

Conditions necessitating renal replacement therapy.

Arteriovenous fistula (AVF)

Preferred vascular access for hemodialysis.

Arteriovenous graft (AVG)

Alternative vascular access for hemodialysis.

Dialysates

Solutions used in dialysis to remove waste.

Dialyzer

Special filter used in hemodialysis for blood cleaning.

Fistula

Access created by joining artery and vein in arm.

Graft

Access using soft tube to connect artery and vein.

Cardiovascular instability

Potential heart issues during hemodialysis treatment.

Post-dialysis fatigue

Energy depletion after dialysis procedure.

Protein losses

6-8 g lost per hemodialysis treatment.

Continuous ambulatory PD (CAPD)

Performed 3-4 times daily for dialysis.

Continuous cyclic PD (CCPD)

Automated dialysis performed at night.

Peritonitis

Infection of the peritoneal cavity during PD.

Renal Transplantation

Surgical procedure to replace damaged kidneys.

MHC antigens

Markers that trigger immune response to transplant.

Immunosuppressive medications

Drugs preventing kidney transplant rejection.

Standard Body Weight (SBW)

Weight at 50th percentile for height.

%SBW formula

%SBW = (actual weight / SBW) × 100.

Adjusted Edema-Free Body Weight (aBWef)

Weight adjustment for patients with edema.

aBWef formula

aBWef = BWef + ([SBW - BWef] × 0.25).

Protein requirement for HD

1.2 g/kg SBW and 50% HBV protein.

Energy requirement for HD

35 kcal/kg SBW for patients under 60.

30-35 kcal/kg SBW for patients over 60.

Sodium intake for HD

1-3 g based on medical history.

1 L fluid output-2000-4000 mg

<1 L fluid output- 2000 mg

No urine output- 2000 mg

Potassium intake

2-3 g, adjusted to serum levels.

Calcium intake

<2-2.5 g including binder load.

Fluid intake

Urine output plus 1000 ml daily.

Vitamin C requirement

75-90 mg for dialysis patients.

Iron

Recommended intake is 10-15 mg daily.

Fiber

Daily intake should be 20-25 g.

Protein Needs for PD

1.2-1.3 g/kg SBW for PD patients.

Energy Needs for PD

35 kcal/kg SBW for patients under 60.

30-35 kcal/kg SBW >60 y.o.

Sodium (Na+)

Limit intake to 2-3 g daily.

Potassium (K+)

2-4 g daily; adjust per serum levels.

Phosphorus (PO42-)

800-1000 mg/day or 10-12 mg/g protein.

Calcium (Ca2+)

Intake should be less than 2 g.

Fluid Intake

Maintain balance of 1-2 L allowance.

Vitamins

B6: 10 mg, Vitamin C: 60-100 mg.

Zinc

Recommended intake is 15 mg, adjust as needed.

Monitoring Nutritional Adequacy—Anthropometrics

Monitor changes in dry weight.

Monitoring Nutritional Adequacy-Biochemical Monitoring

Includes BUN/Cre, albumin, potassium, phosphorus.

Monitoring Nutritional Adequacy-Diet Recall

Assess appetite, nausea, vomiting, and satiety.

Hemo Dialysis (HD) Diet

High protein; restrict potassium, phosphorus, fluids.

Peritoneal Dialysis (PD) Diet

More liberalized; higher in protein, sodium, potassium, and fluids.

Daily Weight Monitoring

Daily weight gain should not exceed prescribed limits.

Calcium Acetate

Common phosphate binder used in treatment.

Anemia in CKD

Low hemoglobin due to inadequate erythropoietin.

EPO Treatment

Common therapy for anemia in CKD patients.

Posttransplant Nutrition

Varies between acute and chronic phases.

Acute Phase Duration

Lasts up to 8 weeks post-transplant.

Chronic Phase Nutrition

Requires RDA protein and low saturated fat.

Acute Kidney Injury (AKI)

Abrupt decline in GFR affecting balance.

Prerenal AKI Causes

Results from reduced kidney perfusion.

Intrinsic AKI Causes

Damage within kidney cells from toxins.

Postrenal AKI Causes

Blockage of ureter or bladder neck.

AKI Clinical Manifestations

Fluid and electrolyte disorders, azotemia common.

Nutrition Therapy for AKI

Depends on dialysis type; no protein restriction.

Nephrolithiasis

Condition of kidney stone formation in urine.

Calcium oxalate

Common type of kidney stone formed from calcium.

Struvite stones

Stones formed from magnesium, ammonium, and phosphate.

Cystine stones

Stones formed from the amino acid cystine.

Uric acid stones

Stones formed from high uric acid levels.

Risk factorsfor kidney stones

Family history, hypercalciuria, and low urine volume.

Hypercalciuria

Excess calcium in urine, increasing stone risk.

Hyperuricosuria

Excess uric acid in urine, increasing stone risk.

Hyperoxaluria

Excess oxalate in urine, increasing stone risk.

Extracorporeal shock wave lithotripsy (ESWL)

Common procedure to break kidney stones externally.

Fluid intake recommendation

Increase to 3 L/day to prevent stones.

Vitamin C intake limit

Avoid >200 mg/day to reduce stone risk.

Probiotics

Beneficial bacteria that may aid in kidney health.

Nephrotic syndrome

Kidney condition causing protein leakage into urine.

Proteinuria

Excess protein in urine, >3 g/day in nephrotic syndrome.

Hypoalbuminemia

Low albumin levels in blood, <3.0 g/dL.

Peripheral edema

Swelling due to fluid leakage into interstitial space.

Goals of MNT for nephropathy

Minimize edema, control proteinuria, and prevent malnutrition.

Diet for Nephropathy

0.8-1 g protein/kg ideal body weight.

Protein replacement

Replace protein lost if >10 g excreted daily.

Energy requirement

35 kcal per kg ideal body weight

Sodium intake

Limit to 2,300 mg daily or less

Potassium restriction

No specific limit unless advised by doctor

Fluid intake

Determined by medical team recommendations

Healthy fats

Include unsaturated fats, limit saturated and trans fats

Sodium in food labels

Low sodium: 5% or less Daily Value

High sodium foods

20% or more Daily Value of sodium

Sugar intake

Limit added sugars, prefer natural sources

Sugar in food labels

4 grams of sugar equals 1 teaspoon

Low added sugar

5% or less Daily Value of added sugar

High added sugar

20% or more Daily Value of added sugar