Nutrition in Kidney Disease (eBook)

Dedication 6
Foreword 8
Preface 10
Organization and Content 10
Features 10
Series Editor Page 12
About Series Editor 20
About Volume Editors 24
Acknowledgements 28
Contents 30
Contributors 34
Part IFoundations for Clinical Practice and Overview 37
Chapter 1: Kidney Function in Health and Disease 38
Introduction 38
Clinical Evaluation of Kidney Function 41
Kidney Function in Disease States 42
Summary 45
References 45
Chapter 2: Global Perspective of Kidney Disease 46
Introduction 46
Epidemiology of CKD and ESRD 47
Provision of Renal Replacement Therapy 48
Modality Use 51
Nutrition as a Risk Factor and Key Intervention 54
Summary 56
References 56
Chapter 3: Dietary Assessment in Kidney Disease 59
Introduction 60
Purpose and Utility of Dietary Intake Assessment 60
Methodology of Dietary Intake Assessment 62
24-h Recall 63
Automated Multiple-Pass Method 63
The Automated Self-Administered 24-h Recall 63
Food Frequency Questionnaire 66
Block FFQ 66
Willett FFQ 66
Diet History Questionnaire 67
FFQ Data Analysis 67
Diet Record or Diary 67
Application of Dietary Intake Assessment to Dietary Guidelines 68
Dietary Intake Assessment of Individuals 68
Dietary Intake Assessment of Groups 68
Evidence 70
Assessment of the 24-h Recall, the AMPM 70
Assessment of the FFQ 71
Use of Biomarkers in Assessing Dietary Intake 71
Doubly Labeled Water and Urine Urea Nitrogen for Dietary Energy and Protein Intake Assessment 72
Plasma Ascorbic Acid, Carotenoids, and Vitamin A Levels for Assessing Dietary Intake 72
Association of Serum Uric Acid Levels and Urinary Isoflavones with Dietary Intake 72
Applications to Kidney Disease Settings 73
Acute Kidney Injury 73
Chronic Kidney Disease 74
Nondialysis CKD 74
Small Studies 74
Large Cohort and Cross-Sectional Studies 75
Dialysis 76
The FFQ in Dialysis 76
Diet Records in Dialysis 76
Transplantation 77
The FFQ in Kidney Transplantation 77
Diet Records in Kidney Transplantation 77
Recommendations for Kidney Disease 77
References 78
Chapter 4: Anthropometric Assessment in Kidney Disease 83
Weight and Height Measurements 86
Skinfold and Circumference Measurements 87
Somatogram 88
Frame Size 88
Somatotyping 88
Reference Data 88
Summary 89
References 89
Chapter 5: Biochemical Nutritional Assessment in Chronic Kidney Disease 91
Introduction 91
Biochemical Assessment of Nutritional Status 92
Protein–Energy Nutritional Status 93
Serum Albumin 94
Serum Prealbumin 95
Serum Creatinine and Creatinine Index 95
Serum Total Cholesterol 96
Serum Transferrin 96
Markers of Inflammation 96
C-Reactive Protein and Proinflammatory Cytokines 97
Nutritional Adequacy and Management 98
Protein Intake 98
Metabolic Acidosis 98
Summary of Biochemical Assessment 99
References 100
Chapter 6: Nutrition Physical Assessment in Chronic Kidney Disease (CKD) 103
Rationale for Performing a Nutrition Physical Examination 103
Nutrition-Focused Physical Examination 104
Approach to Tissue-Specific Physical Assessment 105
Physical Examination 105
Observing Oral Tissues 105
Scalp, Hair, and Skin Findings 106
Examination of the Eyes 106
Examination of the Nails 106
Physical Findings and Functional Deficits in Niacin, B 6, and Zinc Imbalance 107
Niacin 107
Vitamin B 6 109
Vitamin B 6 Deficiency 109
Vitamin B 6 Toxicity 111
Zinc 111
Zinc Deficiency 111
Zinc Toxicity 115
Placing Physical Findings Within the Clinical Context of the Patient 115
Summary of the Nutrition Physical Assessment 115
References 118
Part IIChronic Kidney Disease Among Adults 124
Chapter 7: Hypertension 125
Introduction 125
Nutrients and Blood Pressure 126
Sodium 126
Potassium 126
Calcium and Dairy Foods 127
Magnesium 127
Protein 128
Fatty Acids 128
Vitamin C 128
The DASH Diet 129
Dietary Recommendations for Hypertension 130
The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) Recommendations 130
KDOQI Guidelines 130
Summary 131
References 131
Chapter 8: Diabetes Mellitus and Chronic Kidney Disease (Stages 1–5) 134
Introduction 134
Pathophysiology of Diabetic Nephropathy 135
Goals of Therapy 138
Microvascular Complication Prevention 138
Macrovascular Complication Prevention 138
Hypertension Management 140
CVD Risk Management 140
Medical Nutrition Therapy 141
Energy Needs and Weight Management 141
Dietary Strategies for Carbohydrate (CHO) Management 143
Glycemic Index 143
Fiber 145
Protein Guidelines for Diabetes and CKD 145
Dietary Fat Recommendations 147
Special Considerations 147
Hypoglycemia/Uremia 147
Hyperglycemia and Potassium 148
Dietary Changes 148
Alcohol 148
Nutritive and Non-nutritive Sweeteners 148
Vitamin D 149
MNT Summary 149
Medicare Reimbursement for MNT 150
Pharmacological Management of Diabetes Within CKD 150
Oral Anti-hyperglycemic Agents 150
Medications Targeting Insulin Resistance 151
Metformin 151
Thiazolidinediones 151
Medications Targeting Insulin Secretion 153
Sulphonylureas 153
Meglitinides 153
Incretin-Based Therapies 154
Medications Targeting Postprandial Glucose 154
Insulin 154
Other Medications 155
Self-Monitoring of Blood Glucose 155
ESRD and DM 155
Hemodialysis 156
Peritoneal Dialysis 156
Monitoring Glycemic Control 157
Medical Nutrition Therapy on Dialysis 158
Malnutrition 158
Fluid Control 159
Gastroparesis 159
Summary 159
Case Study 160
Questions 160
References 161
Chapter 9: Dyslipidemias 168
Introduction 168
Pathophysiology 169
Existing Clinical Practice Guidelines and Peer-Reviewed Recommendations 169
Assessment 170
Biochemical 170
Physical 170
Nutritional 171
Intervention 171
Lifestyle 171
Dietary 172
Determination of Nutrition Prescription 172
Amount and Type of Dietary Fat 173
Incorporation of Type of Carbohydrate, Dietary Fiber, and Plant Sterols 174
Pharmacological 175
Summary 176
References 176
Chapter 10: Implications and Management of Obesity in Kidney Disease 178
Introduction 178
Case Scenario 179
Defining Obesity 179
Measuring Kidney Parameters in Obese Individuals 180
Epidemiology and Trends in Obesity 181
Obesity and Clinical Risk 182
Chronic Kidney Disease Stages 1–4 182
End-Stage Renal Disease (Stage 5) 183
Kidney Transplant Recipients 185
Influence of Obesity on Kidney Function, Structure, and Health 185
Kidney Mass 186
Renal Hemodynamics 186
Proteinuria 186
Histologic Changes 186
Molecular Findings 187
Obesity-Related Glomerulopathy and Glomerulosclerosis 187
Animal Models of Weight Gain and Loss 188
Pathophysiology of Obesity-Related Kidney Disease 189
Dietary Protein 189
Podocyte Depletion 189
Intraglomerular Hemodynamics 190
Renin-Angiotensin-Aldosterone Axis 190
Sympathetic Activation 190
Obstructive Sleep Apnea 190
Insulin Resistance and the Metabolic Syndrome 190
Lipotoxicity 191
Fatty Kidney 191
Adipocyte Secretory Products 191
Prevalence of Obesity-Related Kidney Disease 191
Weight-Loss Strategies and Benefits 192
Chronic Kidney Disease Stages 1–4 192
End-Stage Renal Disease (Stage 5) 193
Kidney Transplant Recipients 193
References 193
Part IIIKidney Disease in Adults Treated by Renal Replacement Therapies 201
Chapter 11: Dialysis 202
Introduction 202
Factors Influencing Nutritional Status 203
Nutrient Recommendations in Dialysis 205
Energy 205
Hemodialysis 205
Peritoneal Dialysis 205
Nocturnal Hemodialysis/Short Daily Hemodialysis 206
Protein 208
Hemodialysis 208
Peritoneal Dialysis 208
PNA: Hemodialysis and Peritoneal Dialysis 208
Nocturnal Hemodialysis/Short Daily Hemodialysis 209
Nutrition Support 209
Sodium and Fluid 209
Hemodialysis 209
Peritoneal Dialysis 210
Nocturnal Hemodialysis/Short Daily Hemodialysis 210
Potassium 211
Hemodialysis 211
Peritoneal Dialysis 211
Nocturnal Hemodialysis/Short Daily Hemodialysis 212
Calcium/Phosphorus/Vitamin D 212
Hemodialysis and Peritoneal Dialysis 212
Nocturnal Hemodialysis/Short Daily Hemodialysis 213
Lipids 214
Hemodialysis 214
Peritoneal Dialysis 214
Nocturnal Hemodialysis/Short Daily Dialysis 214
Vitamins, Minerals, and Trace Elements 215
Water-Soluble Vitamins 215
Fat-Soluble Vitamins 216
Minerals and Trace Elements 217
Summary 218
Case Study 218
Case Questions and Answers 219
References 220
Chapter 12: Transplantation 225
Introduction 225
The Pre-transplant Phase 226
The Acute Post-transplant Period 227
Nutritional Requirements 227
Protein 227
Energy 229
Carbohydrate 229
Fat 229
Sodium 229
Potassium 229
Vitamins, Minerals, and Trace Elements 230
Herbals 230
Common Problems Post-transplant in the Acute Care Setting 230
Inadequate Intake 230
Hyperglycemia 231
Gastrointestinal Issues 231
Mineral and Bone Disorders 231
Hyperkalemia 232
The Chronic Post-transplant Phase 232
Nutritional Requirements 232
Calcium and Phosphorus 233
Vitamins and Other Minerals 233
Pharmacology Update 233
Cyclosporine A or CsA (Sandimmune/Neoral) 233
Tacrolimus (Prograf/FK506) 235
Mycophenolate Mofetil or MMF (CellCept/RS-61443) 236
Sirolimus (Rapamycin/Rapamune) 236
Azathioprine (Imuran) 236
Corticosteroids (Prednisone, Prednisolone, Methylprednisolone, Solu-Medrol, Solu-Cortef) 236
Other Agents 237
Long-Term Care Challenges 237
Cardiovascular Disease 237
Obesity 238
New-Onset Diabetes After Transplantation (NODAT) 239
Hypertension 239
Mineral and Bone Disorder 239
General Considerations 239
Interactions 239
Food Safety 240
Summary 240
Case Study 240
Case Study Questions 241
References 243
Chapter 13: Protein-Energy Wasting 246
Introduction 246
Protein-Energy Wasting (PEW): Definition and Etiology 247
Assessment of Protein-Energy Wasting 249
Inflammation and Kidney Disease Wasting 251
Consequences of PEW 251
Refractory Anemia 251
Atherosclerotic Cardiovascular Disease 252
Reverse Epidemiology 253
Management of PEW 253
Summary 254
References 255
Chapter 14: Acute Kidney Injury 258
Function of the Kidneys 258
Acute Kidney Injury 259
Renal Replacement Therapy 260
Nutrition Management of the AKI Patient 260
Nutrition Assessment 260
Oral Intake and Supplements 261
Specialized Nutrition Support 262
Tube Feeding Formulas 263
Tube Feeding Management 263
Guidelines for Administration 264
Parenteral Nutrition Support 265
Use of Parenteral Nutrition (PN) 265
Intradialytic Parenteral Nutrition Support 265
Nutrient Substrates 266
Protein 266
Carbohydrate 266
Fat 266
Parenteral Additives 267
Fluid and Electrolytes 267
Vitamins and Trace Minerals 267
Initiation and Monitoring of Parenteral Nutrition Support 268
Discontinuing Parenteral Nutrition 268
Monitoring Clinical and Laboratory Parameters 268
Nutritional Requirements in AKI 268
Energy Requirements 269
Protein Requirements 269
Fat Requirements 270
Vitamins and Trace Elements 270
Fluid, Electrolytes, and Mineral Needs 271
Summary 271
References 271
Chapter 15: Bone and Mineral Disorders 274
Introduction 274
Pathogenesis of Bone and Mineral Abnormalities in CKD 277
Bone Manifestations 279
Bone Biopsy 281
Radiography, Pulse Pressure, and Electron Beam Computed Tomography 281
Bone Mineral Density 282
Biochemical Markers of Bone and Mineral Metabolism in CKD 282
Treatment of CKD-MBD 284
Dietary Modification 285
Outline Placeholder 287
Nutritional Vitamin D 289
Calcimimetics 290
Alternative Dialysis Therapies 291
Patient Education 291
Parathyroidectomy 291
Treatment Options for Adynamic Bone 291
Summary 292
Case Presentation 292
References 293
Chapter 16: Physical Activity and Exercise 297
Introduction 297
Physical Activity, Exercise, and Their Classification 298
Benefits of Exercise in the General Population 298
Potential Benefits of Increased Physical Activity Among Patients with CKD 299
Risks of Physical Activity 304
Approach to Prescribing and Promoting Physical Activity in the CKD Population 305
Case Study 308
Physical Function Evaluation (Fig.  16.4) [ 1 ] 308
Recommended Activity 310
Follow-Up Evaluation (6 Months) 310
Physical Function Testing 310
References 311
Part IVNutrition in Chronic Kidney Disease Among Special Needs Populations 314
Chapter 17: Pregnancy 315
Background 315
Confirmation of Pregnancy 316
Dialysis Regimen 316
Energy and Protein Needs 317
Vitamins and Minerals 318
Weight Gain and Serum Albumin 318
Medications 319
Breastfeeding 319
Summary 319
Case Study 320
Questions 321
References 321
Chapter 18: Infancy, Childhood, and Adolescence 323
Introduction 324
Etiology of CKD* 324
Treatment Modalities* 324
Linear Growth 325
Adequacy of Weight Gain and Nutritional Intake 325
Assessment 327
Nutrient Requirements 330
Energy 331
Protein 332
Carbohydrate, Fats, and Lipid Management 333
Vitamins and Minerals 334
Sodium 336
Potassium 337
Phosphorus and Calcium 338
Fluid 340
Age-Related Intervention and Monitoring 340
Infants and Toddlers (Ages 0–3) 340
Children (Ages 4–12) 342
Adolescents* (Ages 13 and Older) 343
Enteral Nutrition 343
Oral Supplementation 343
Tube Feeding 344
Parenteral Nutrition 346
Intradialytic Parenteral Nutrition 346
Intraperitoneal Amino Acid Dialysis* 347
Transplant 347
Transition 349
Summary* 350
Case Study* 350
Questions 350
References 351
Chapter 19: The Aging Adult 357
Introduction 357
Profile of Older American 358
Marital Status and Living Arrangements 358
Economic Status 358
Normal Physiological Changes 358
Sensory 359
Skin 359
Respiratory 359
Cardiovascular 359
Gastrointestinal 359
Musculoskeletal 360
The Kidneys 360
Aging and Kidney Function 360
Aging and CKD Risk Factors 361
Heightened Risks in Older Adults with CKD 361
Hypotension 362
Increased Falls Risk 362
Vascular Dementia 362
Protein Energy Wasting 362
Anemia Management 363
Bone Disease Management 363
Geriatric Focus 363
Barriers to Care 363
Geriatric Assessment 364
Summary 365
Case Study 366
Questions 366
References 367
Chapter 20: Nephrotic Syndrome 369
Definition of Nephrotic Syndrome 369
Causes of Nephrotic Syndrome 370
Complications of Nephrotic Syndrome 371
Sodium Retention (Edema) 371
Hypercoagulability (Thrombophilia) 372
Hyperlipidemia 372
Progressive Renal Injury 372
Infection 373
Nutritional Depletion 373
Treatment of Nephrotic Syndrome 373
Specific Treatment 374
Nonspecific Treatment 374
Pharmacologic Management 374
Nutritional Management 375
Summary 375
References 376
Chapter 21: Nephrolithiasis 378
Introduction 378
Symptoms and Diagnosis [ 9 ] 379
Evaluation of New Stones 379
Evaluation of Recurrent Stones and Follow-up 380
Stone Formation 380
Supersaturation (SS) and Stone Formation 380
Interpretation of Biochemical and Urine Tests 381
The 24-h Urine Collection 381
Risk Factors for Kidney Stone 383
Urine Volume 384
Hypercalciuria 384
Hyperoxaluria 385
Hypocitraturia 385
pH 386
Uric Acid 386
Dietary Factors 387
Sodium 387
Potassium 387
Protein 388
Calcium 388
Magnesium 388
Vitamin C 389
Other Dietary Factors 389
Nutrition Assessment and Recommendation 389
Common Mistakes 389
Practical Rule of Thumb 389
General Recommendations 391
Summary 393
Case Studies 393
Case #1 (Table  21.10) 393
Case #2 (Table  21.11) 394
References 395
Part VAdditional Nutritional Considerations in Kidney Disease 397
Chapter 22: Public Policy and Renal Nutrition Practice: Past, Present, and Future 398
Public Policy and Renal Nutrition Practice: Past, Present and Future 398
The Role of Federal and State Governments 399
Direct Payment to Nutrition and Dietetics Practitioners 399
The MNT Benefit 400
What You Can Do to Promote Patient Access to Nutrition Care Provided by RD/Ns 401
References 401
Chapter 23: Dietary Supplements 402
Introduction 402
Dietary Supplements 403
Box 23.1 Definition of Dietary Supplement [ 3 ] 403
Efficacy and Safety of CAM Therapies 403
Box 23.2 Deciding For or Against the Use of Dietary Supplements 404
Box 23.3 404
Dietary Supplements and Kidney Disease 404
Dietary Supplements with Potential Protective Effects 405
Dietary Supplements to Avoid in Kidney Disease 405
Dietary Supplements and Kidney Dysfunction 406
Considerations for Healthcare Providers 406
Summary 407
Resources 407
References 408
Chapter 24: Vitamin and Trace Element Needs in Chronic Kidney Disease 409
Introduction 409
Vitamin B1: Thiamin 410
Vitamin B2: Riboflavin 410
Niacin: Vitamin B3 411
Vitamin B6: Pyridoxine 412
Folic Acid 412
Cyanocobalamin: B12 413
Homocysteine 413
Pantothenic Acid 414
Vitamin C 414
Fat-Soluble Vitamins 415
Vitamin A 415
Vitamin E 416
Vitamin K 417
Minerals and Trace Elements 418
Copper 418
Molybdenum 418
Magnesium 419
Manganese 419
Selenium 419
Zinc 420
Summary 420
References 421
Chapter 25: Issues Affecting Dietary Adherence 425
Introduction 425
Definitions 425
Dietary Adherence 426
Factors Affecting Dietary Adherence 426
Social and Economic Factors 426
Health-Care Team and System-Related Factors 427
Condition-Related Factors 428
Therapy-Related Factors 428
Patient-Related Factors 428
Behavior Change Models 428
Stages of Change 429
Strategies for Achieving Dietary Adherence 429
Summary 431
References 431
Chapter 26: Counseling Approaches 432
Introduction 432
The Transtheoretical Model 433
Inquiries and Responding to Patients 434
Closed-Ended Questions 434
Leading Questions 435
Open-Ended Questions 435
Respond Using Reflective Listening 436
Social Learning Theory and Self-Efficacy 437
Behavior Modification and Cognitive Behavioral Therapy 437
Cognitions 438
Cognitive Distortions 438
Cognitive Restructuring 439
Goal Setting 439
Motivational Interviewing 440
Special Considerations for Patients Receiving Hemodialysis 441
Future Directions 442
Summary 442
Case Study 442
Questions for Case Study 443
Answers to Case Study 443
References 444
Chapter 27: Outcomes Research 446
Introduction and Overview 446
Challenges for Nutrition 447
Outcomes Research Defined 448
Types of Outcomes 449
Evidence-Based Practice Guidelines 450
Practice Guidelines and Patient Care 451
Dialysis Outcomes and Practice Patterns Study 451
Summary 452
References 452
Chapter 28: Suggested Resources for the Practitioner 455
Introduction 455
Evidence-Based Practice Guidelines 455
NKF KDOQI Practice Guideline Statements 456
Academy of Nutrition and Dietetics Chronic Kidney Disease (Non-dialysis) Medical Nutrition Therapy Protocol 465
Diet-Related Resources and Food Lists 467
Nutrition Composition of Foods 467
Food Sources of Potassium 467
Food Sources of Phosphorus 468
Protein Quality in Foods 468
Oxalates in Food 470
Vitamin Recommendations and Supplementation in CKD 470
Assessment Tools 470
Internet Sites 476
Tablet and Smartphone Applications 476
Summary 478
References 478
Index 480