Diet for Chronic Renal Failure

8/6/2019 Diet for Chronic Renal Failure

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Diet for Chronic Renal Failure

Ezekiel T. Arteta


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Kidney Function

Detoxify blood

Increase calcium absorption

Calcitriol

Stimulate RBC production

Erythropoietin

Regulate blood pressure and electrolyte

balance Renin


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Determinants of GFR

Other factors:

Rate of Plasma flow

Total Surface area of the glomerular capillaries


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Chronic Renal Failure

150200 cases per million people = new cases

each year

Chronic renal failure and ESRD affect morethan 2 out of 1,000 people in the U.S

Mortality = 20%

Progressive, irreversible damage to

the nephrons and glomeruli


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Acute Versus Chronic

Acute

sudden onset

rapid reduction in urine output

Usually reversible

Tubular cell death and regeneration

Chronic

Progressive

Not reversible

Nephron loss

75% of function can be lost before its noticeable


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Stages of CRF


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Chronic Renal Failure Causes

Diabetic Nephropathy

Hypertension

Glomerulonephritis

HIV nephropathy

Reflux nephropathy in children

Polycystic kidney disease Kidney infections & obstructions


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CRF Symptoms

Malaise

Weakness

Fatigue

Neuropathy

CHF

Anorexia

Nausea

Vomiting

Seizure

Constipation

Peptic ulceration

Diverticulosis

Anemia

Pruritus

Jaundice Abnormal hemostasis


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CRF Effects

Decreased: GFR, tubular function & tubularreabsorption capabilities.

Dysfunction of fluids & electrolytes,

Acid base disturbances, &

Systemic problems


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Protein Restriction

Protein = Malnutrition; Protein = urea

Protein Diet

Protein Metabolism

Product: AMMONIA

Urea Cycle Product: UREA

GFR Urea accumulates in the blood SUN

Uremia


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Protein Restriction

Other effects of High Protein diet

Severe acidosis (serum bicarbonate 7mg/dl)

severe azotaemia (blood urea nitrogen values

>120mg/dl)

Hyperuricaemia


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Protein Restriction


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Protein Restriction

BEFORE DIALYSIS: Low-protein diet

AFTER DIALYSIS: Increased-Protein diet

compared to the diet before dialysis. Recommended amount: 2 grams/kg weight

Good quality Proteins

eggs, milk, meat, fish and poultry.

Proteins of lower biological value

pulses, cereals, nuts, oilseeds and in some

vegetables like greenpeas and dried beans.


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Treatment Modalities

Decrease fluid 1000ml/day

Decrease protein (.5-1kg body weight)

Decrease sodium (1-4gm variable)

Decrease potassium

Decrease phosphorous (


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Fluid and Sodium Control

Impaired renal mechanisms for conservingsodium and water.


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GFR

Aldosterone

Na+

and water reabsorption

Intravascular fluid

Edema Hypertension

Further damageCadiovascular and

Respiratory effects

Renin,angiotensin


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Rise in body weight and Pressure

Retention of sodium and fluid

Decline in body weight and Pressure

Fluid loss

Water intake must not exceed the capacity for

free water clearance


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FOODSTUFFS HIGH IN SODIUM

Baking soda

Salt

Ajinomoto

Salted wafers, popcorns, salted biscuits.Papads all varieties.

Salted pickles, chutneys, curry powder commercial.

Commercial salad dressings and sauces.

Soup cubes.

Soft drinks containing sodium benzoate.

Bakery products, bread , biscuits.

Nuts such as salted cashewnuts, pistachio, walnuts, peanuts.

Commercial cheese.

Preservative containing foods.

Canned and tinned foods.

Sea food, chicken, dry fish, bacon, ham .

Meat and yeast extracts like marmite.

Proprietary drinks Bournvita , chocolate drinks , Horlicks.

Milk and curds.

Pulses and legumes all varieties.

Vegetables such as cauliflower , snakegourd , beetroot , carrot , coriander leaves,fenugreek(methi) leaves, lettuce ,spinach(palak) ,amaranth, radish


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Rich in Sodium


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Rich in Fluid


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Decrease potassium



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Potassium Control

GFR renal K+ excretion GI K+

excretion

Certain drugs inhibitK+

entry into cells orK+

secretion in the distal nephron.

Beta blockers,ACE inhibitors and angiotensin

receptor blockers, K-sparing diuretics (amiloride,

triamterene, spironolactone), and NSAIDs

HYPERKALEMIA


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Potassium Control

Leaching

Method 1: Wash, peel and cut vegetables into

small pieces. Soak in warm water for 2-3 hours.

Discard water. Add large volume of fresh water

and cook vegetables. Discard water.

Method 2:Peel vegetables and cut into small

pieces. Bring to a boil in a large quantity of water.Discard water and cook in a large volume of fresh

water. Discard excess water.


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Decrease potassium



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Phosphorus, Vitamin D and Calcium

Phosphorus and calcium

Slows down renal failure and prevent bone disease

renal function active Vit. D

phosphorus in the body

renal function active Vit. D calciumin the body

phosphorus + calcium = BONE RESORPTION


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List Of Foods High In Phosphorus

All-bran Cereal

Almonds

Beef

Brazil Nuts

Cashew Nuts

Cheese

Chicken

Dried Fruit

Egg Garlic

Halibut Fish

Hard Potatoes

Legumes

Lentils

Liver

Meat

Milk

Peanuts

Poultry

Roe

Salmon

Sesame Seeds

Sunflower Seeds

Turkey Wheat Bran

Wheat Germ

Whole Wheat

Bread Yogurt


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BALANCED INTAKE OF CALCIUM AND VIT. D

Too much calcium: HYPERCALCEMIA

Too much Vitamin D: VITAMIN D TOXICITY


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Caloric Intake

Patients with CHF needs enough energy

Prevent protein catabolism and to maintain a

desirable weight.

As renal failure progresses, consuming

adequate energy becomes difficult.

Energy needs are slightly lower once dialysis

begins.


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Other Considerations

Thiamin (B1)

Folate

Vitamin B6

Vitamin B12

Water-soluble vitamins

Fat-soluble vitamins

Iron

Erythropoietin

Zinc

AVOID

Aluminum

Magnesium

Documents

Diet for Chronic Renal Failure