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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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Fluid and Sodium Control
GFR
Aldosterone
Na+
and water reabsorption
Intravascular fluid
Edema Hypertension
Further damageCadiovascular and
Respiratory effects
Renin,angiotensin
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Fluid and Sodium Control
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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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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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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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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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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Phosphorus, Vitamin D and Calcium
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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Phosphorus, Vitamin D and Calcium
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Phosphorus, Vitamin D and Calcium
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
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