Nutrition and Kidneys MNT Approaches to Acute and

Nutrition and Kidneys MNT Approaches to Acute and Chronic Kidney Disease

What happens when Kidneys shut down? w Waste products w Water/fluids w Parathyroid w Electrolyte balance w The diet of patients with compromised kidney function corrects the chemical imbalances

Key Labs to Watch w BUN/Creatinine w. K w Phos w Albumin w Hgb, Hct w Calcium w Body weight changes

Acute Renal Failure w Short term kidney failure w See rapid change in chemistry, water retention w Cause: infection or trauma w Diet Rx: support underlying disease process, keep comfortable, monitor fluid buildup

Chronic Renal Failure w Slow to occur – gradual onset w Causes: uncontrolled HTN, DM, CA, Lupus, trauma w Symptoms – yellowing of skin, retention of water, weight loss, appetite loss, “don’t feel good” usually brings to Dr OR product of long term monitoring

Diet Rx for CRF (predialysis) w To retard kidney destruction, limit protein to. 08 g/kg/day. w Sometimes losing too much water and electrolytes – base this on the chemistries

Going on Dialysis Types of treatments n Hemodialysis l l n Peritoneal l n In Center Home Continuous (CAPD) Intermittent (IPD) Continuous Cyclic (CCPD) Transplant

Diet for Hemodialysis w 1 gm protein per kg body weight w 2 gm K w 2 gm Na w Limited phosphorus w 1500 cc fluid q d w Kcalories to meet need or control blood glucose

Typical Lab Panels w BUN – look for up to 100 pretx w K - < 6. 0 w P - < 6. 0 w Alb - > 3. 0 w Wt changes – 2 -3 kg w Monitor weight trend by post tx when they are “dry”

Medications (lots) w Calcium supplement (phosphate binder w Multivitamin w Iron supplement or antianemics w Antihypertensives (usually) w Control of other conditions eg, CA tx, oral agents, CVD

Pros/Cons of Hemodialysis w w w Someone else controls tx Scheduled Control over cleansing of blood In center attention and often But n n Fluid buildup Constant control of external chemicals to prevent buildup BP drops Access infections

Peritoneal Dialysis w Continuous exchanges of sugar fluids to remove waste w Goods: feel better, better clearance of chemistries, less restrictive diet w Bads: requires independence, weight gain, difficult protein balance, more difficult to control BGL, high susceptibility to infection of access

Diet Rx for Peritoneal Dialysis w High protein – 2 gm/kg body weight w Calorie controlled w Balanced nutrients w Phosphorus restriction

Meds for Peritoneal patients w Multivitamin w antianemics w Support meds for underlying conditions

Labs for Peritoneal patients w BUN – 40 -50 w Albumin > 3. 0 w Phos < 6. 0 Spend lots of time counseling on balance between adequate protein and just enough kcalories to control weight (additional kcals from dialysate fluid)

Transplant – the end of Kidney Disease? w Symptoms and ramifications of ESRD subside w High doses of antirejection drugs result in weight gain (round face) w Also they feel better, and eat more w Diet Rx: kcalorie controlled, balanced (avoid weird stuff)

Issues with ESRD patients w w w Noncompliance Denial Lose hope More and more elderly Family control of diet

What you do when you work with a patient with renal disease w Assess: no question is high acuity level, start as you would anyone else with calculating nutrient needs and adjustment w Plan: continous, they are going to be with you awhile w Educate: ongoing, sometimes fruitless, develop a trust level with your patients w Monitor: look for trends and real changes

Practice working with case information in packet