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Diet in CKD
Transcript of Diet in CKD
Chronic Kidney Disease by.. Amr Hussein
Ahmed Basyoni Protein-Energy malnutrition (PEM) Daily protein intake in CKD eGFR <50 ml/min (no DM, not on dialysis) 0.6 to 0.8 g/kg/d eGFR <20 ml/min (no DM, not on dialysis) 0.3 to 0.5 g/kg/d Post-transplantation 0.8 to 1.0 mg/kg/d Diabetic nephropathy 0.8 to 0.9 g/kg/d Energy intake in CKD 23 to 35 kcal/kg/d Adjustment
Body weight and goals
Age and gender
Metabolic stressors Mineral and bone disorders Ca P Vit. D Total Ca intake (diet, supplements and Ca-based P binders) shouldn't exceed.. 2,000 mg/d CKD (stages III-IV) 800 to 1000 mg/d 10-12 mg/g ptn/d P binders are sometimes needed P supplements maybe needed post transplantation or Supplementation is needed if serum level drops below 30 ng-ml Na and K 2.4 mg/d intake shouldn't exceed.. Adjustment
GI issues e.g., vomiting Anemia Fe B12 and Folic Others Supplementation is needed if
Serum ferritin <100ng/ml
Transferrin saturation <20% Supplementation is needed if
MCV >100 ng
Low serum levels Vit. C
(improves Fe absorbtion) L-carnitine
(not recommended) Glycemic control Hb A1c should be kept below.. 7% prescribed to those who are at risk of malnutrition Miscellaneous Fish oil/omega-3 fatty acids physical activity Multivitamins Decrease oxidative stress and improve lipid profile Not recommended in
Ig A nephropathy
post-transplantation Decreases catabolic effects of protein restriction and improves quality of life Monitoring Biochemical parameters
Mineral & bone disorders
Electrolyte and acid-base balance Also check..
Adherence to diet plan
Patient's behavior More information?
Kidney Kitchen (National Kidney Foundation)
A Clinical Guide to Nutrition Care in Kidney Disease, Second Edition (American Dietetic Association)
Chronic kidney disease evidence-based nutrition practice guideline. [June, 2010]