Assessment of Kidneys
- Microalbuminuria
- GFR (WNL: 135-200)
Irreversible is GFR <60 ml/min
Stage 1 CKD
> 90 ml/ min
Stage 2 CKD
60-89 ml/min
Stage 3 CKD
30-59 ml/min
Stage 4 CKD
15-29 ml/min
Stage 5 CKD (End Stage Renal Disease )
<15 ml/min (or dialysis )
S/Sx of CKD
- Na retention
- edema, HTN
- Hyperphosphatemia
- metabolic acidosis
- oliguria, uremia, azotemia
- bone and mineral disorders
Etiology of CKD
Diabetes
Hypertension
Glomerulonephritis
Risk factors: AA M w/ DM , smoking, obesity
Comorbid conditions
Anemia :
- bone marrow failure (lack of EPO production)
- Poor iron intake
- GI bleeding
Secondary Hyperparathyroidism
- overstimulated parathyroid
- bone disease = fractures
- supplement Vit D and restrict phosphorus
CVD
- inflammation
- Ca/ Phos imbalan
Assessment of CKD (Cr)
- Creatinine (Cr) : 0.6-1.2 mg/dl
- increases with renal failure and dehydration and catabolism
- decreases if muscle mass is low
Assessment of CKD (BUN)
Blood Urea Nitrogen
Normal: 10-20 mg/dl , as long as less than 50
Increase:
- renal failure or inadeq. dialysis
- dehydration or malnurtition
- high pro intake
decrease:
- low pro intake, overhydration, liver damage
MNT goals for CKD
- prevent nutrient deficiencies or excesses
- electrolyte balance
- prevent renal ostedystrophy
- control edema
MNT for Stages 1 + 2
Focus on DM, HTN, Hyperlipidemia, slow the progression
MNT for Stages 3-5 (Nutrient needs)
Energy: 30-35 kcals
Pro: 0.6-0.8 g/ kg
Vitamins + minerals: Na, K , P, Ca
Phosphorus : 3-4.5 mg, restrict to 800-1000 mg/d
How to Calculate PD glucose kcals - STEP 1
# of exchanges x vol of exchange x (% dialysate x 10) = g
ex:
CCPD/APD
2 exchanges of 1.5% -D
(1 exchange = 1.5 L )
2 x 1.5 x (1.5x10) = 45 g
calculate for CAPD and CCPD/APD separately , and total
How to Calculate PD glucose kcals - STEP 2
Calculate amount of glucose absorbed from each method
CAPD: 60-70% (~65%)
CCPD/ APD: 30-50% (~40%)
ex:
CCPD/APD
0.4 x 45 g glucose = 18 g glucose absorbed
How to Calculate PD glucose kcals - STEP 3
Add together total grams of glucose absorbed from ALL methods
CCPD/APD (g) + CAPD (g) = total glucose absorbed
How to Calculate PD glucose kcals - STEP 4
Calculate kcals from g glucose absorbed (always use monohydrous dextrose which is 3.4 kcals/g)