Macro- and Micronutrient Homeostasis in the Setting of Chronic Kidney Disease. T. Alp Ikizler, MD Vanderbilt University Medical Center
|
|
- Amie Jemimah Newman
- 5 years ago
- Views:
Transcription
1 Macro- and Micronutrient Homeostasis in the Setting of Chronic Kidney Disease T. Alp Ikizler, MD Vanderbilt University Medical Center
2 Nutrition and Chronic Kidney Disease What is the disease itself and how it is managed? What is the biological mechanism(s) that is disturbed in this specific disease state and how does it lead to the special nutritional requirement? What is the evidence that there is a nutritional requirement that is different from that of the healthy population? Is the disease state (or nutrition status or health related outcomes) responsive to a specific nutritional intervention in a dose dependent manner? What are the gaps in information? Are there pressing research issues?
3 Nutrition and Chronic Kidney Disease What is the disease itself and how it is managed? Appr. 20M individuals with CKD Appr. 500,000 patients on maintenance dialysis Apprx. 125,000 incident ESRD patients Approx. 60,000 new transplants a year Approx. 4-5% of all Medicare expenses What is the biological mechanism(s) that is disturbed in this specific disease state and how does it lead to the special nutritional requirement?
4 PEW is present in 12-18% of stages 3 and 4 CKD patients 2 studies reported PEW prevalence up to 18% in patients with early-stage CKD (3 and 4) 18% prevalence in CKD stages 3 and 4 patients in Brazil using SGA (n=122, age 55 ±11) 1 12% prevalence in CKD stage 4 patents in Australia, using SGA (n=56, age 70 ±14) 2 1. Sanches FM, et al. Am J Kidney Dis. 2008;52: Campbell KL, et al. Clin Nutr. 2008;27:
5 PEW is present in 30 to 65% or more of maintenance dialysis patients around the world Hemodialysis patients, USA, 47% (MIS) Hemodialysis patients, Sweden: 30 to 43% (SGA) Netherlands: 28% (SGA) Peritoneal dialysis patients, China 29 to 44% (SGA) 60% (MIS) Peritoneal dialysis patients, Brazil, 36 to 65% (SGA) Peritoneal dialysis patients, Korea, 40% (SGA) Adapted from TNT Renal
6 Simplified flow schedule of uremia and its complications Slide courtesy of Peter Stenvinkel
7 Etiology and Consequences of Protein Energy Wasting in CKD Loss of Kidney Function Uremic Toxins Co-Morbid Conditions (Diabetes, CVD, Depression) Dialysis-Associated Catabolism Infection Dietary Nutrient Intake Protein-Energy Wasting Sarcopenia CVD Inflammation Metabolic Derangements (Insulin Resistance, Metabolic Acidosis, IGF-1/GH Resistance) Frailty Carrero JJ et al on behalf of ISRNM; JREN 2013
8 Nutrition and Chronic Kidney Disease What is the disease itself and how it is managed? What is the biological mechanism(s) that is disturbed in this specific disease state and how does it lead to the special nutritional requirement? What is the evidence that there is a nutritional requirement that is different from that of the healthy population?
9 Summary of Requirements Non-dialysis CKD Haemodialysis Peritoneal Dialysis Energy kcal/kg/day 35 kcal/kg/day 35 kcal/kg/day Incl kcal from dialysate Protein g/kg/day Illness 1.0g/kg >1.2 g/kg/day >1.2 g/kg/day Peritonitis >1.5 g/kg Sodium mmol/day mmol/day mmol/day Potassium <1mmol/kg If elevated <1mmol/kg If elevated Not usually an issue Phosphorus mg & binders if elevated mg & binders if elevated mg & binders if elevated NKF/KDOQI 2000 & 2002; Fouque et al NDT (2007) 22(Supp 2);pp45-87; Cano et al Clin Nutr (2006) 25;pp :
10 Considerations for Nutritional Requirements in Chronic Kidney Disease Protein intake CKD - Progression ESRD - Protein wasting Calorie intake CKD - Obesity; Insulin Resistance; Diabetes Mellitus ESRD - Wasting-Obesity Paradox Common Derangements in CKD and ESRD Na/K/PO4 (HTN; Hyperkalemia; Bone Mineral Disorders) Metabolic Disorders (Inflammation; Oxidative Stress)
11 Etiology and Consequences of Protein Energy Wasting in CKD Loss of Kidney Function Uremic Toxins Co-Morbid Conditions (Diabetes, CVD, Depression) Dialysis-Associated Catabolism Infection Dietary Nutrient Intake Protein-Energy Wasting Sarcopenia CVD Inflammation Metabolic Derangements (Insulin Resistance, Metabolic Acidosis, IGF-1/GH Resistance) Frailty Carrero JJ et al on behalf of ISRNM; JREN 2013
12 Appetite decreases as CKD progresses Starts when egfr <10-25% of normal Retention of uremic toxins suppress appetite Initiation of dialysis improves feeding behavior Appetite egfr egfr egfr egfr <90 ml/min<60 ml/min<30 ml/min <15 ml/min Dialysis begins Carrero JJ. J Ren Nutr. 2009;19:10-15.
13 Uremic Toxins Mitch and Ikizler Handbook of Nutrition and The Kidney 13
14 Significant Amount of Amino Acids are Lost Into Dialysate during Dialysis total g/dialysis CU PMMA PS PD/Day Ikizler & Hakim 1994 Kidney Int
15 Hemodialysis Causes Net Whole-body Protein Loss proteolysis synthesis net balance PreHD HD PostHD Ikizler et al, AJP, 2002
16 Hemodialysis Activates Inflammatory Signals IL-6 (pg/ml) Fibrinogen FSR (%/day) * δ * δ * 58% 68% 14% 34% PreHD B HD D PostHD PD Caglar, Pupim, Ikizler, KI, 2002
17 IL-6 Predicts Poor Outcome in ESRD Bologa et al. AJKD 1998 NDT 2002 NDT 2004 AJKD 2005 JASN 2006
18 Metabolic Effects of Inflammation MUSCLE LOSS ANOREXIA COMPLEMENT ACTIVATION INFLAMMATION UREMIA INCREASED REE FEVER APP SYNTHESIS INCREASED SNS ACTIVITY IMMUNE SYSTEM MODULATION
19 Distribution of Skeletal Muscle Protein Turnover Components by hs-crp Quintiles p<0.001 p<0.001 p<0.001 hs-crp QUINTILES hs-crp QUINTILES hs-crp QUINTILES Deger et al, JCI insight 2018
20 Nutrition and Chronic Kidney Disease What is the disease itself and how it is managed? What is the biological mechanism(s) that is disturbed in this specific disease state and how does it lead to the special nutritional requirement? What is the evidence that there is a nutritional requirement that is different from that of the healthy population? Is the disease state (or nutrition status or health related outcomes) responsive to a specific nutritional intervention in a dose dependent manner?
21 Rationale for Dietary Protein Restriction in CKD Ameliorate Uremic Syndrome (delay initiation) Decrease load on remaining nephrons (preserve RF) Improve proteinuria/albuminuria Additive effect of ACE inhibitors Improve Metabolic Profile Improve insulin Resistance, Acidosis and Oxidative Stress Decrease likelihood of patient death Lack of serious objective reasons for not recommending Adapted from Fouque & Aparicio., Nature Neph. Reviews 2007
22 22
23 Intradialytic Nutrition (Oral or Parenteral) Leads to Robust Whole-Body Protein Anabolism * P<0.05 versus Control, # P<0.05 versus PO
24 Oral nutrition supplementation provides benefits for HD or PD patients Hemodialysis and peritoneal patients using ONS experience: Increased calorie and protein intake Improved serum albumin, serum prealbumin levels Improved nutritional status (SGA) Increased body weight or BMI Increased lean body mass and bone density Improved physical function (grip strength) Improved quality of life and mental health scores Over the past 3 decades, 10 studies have shown outcome benefits of ONS therapy for CKD patients on dialysis Ikizler TA, et al. Kidney Int. 2013;84: TNT Renal Session 7 24
25 Insulin Sensitivity and Muscle Metabolism
26 Mitochondrial Morphology and Function in ESRD Mitochondrial volume density (%) A p=0.002 Frequency distribution (%) B Control ESRD Control ESRD Mitochondrial volumen density (%) Gamboa et al, 2017 Physiology Reports
27 Special Considerations for Fat Intake in CKD CKD patients are recommended to follow general advice for hearth health, including: Saturated fat <7% of total calories; Unsaturated fat to substitute saturated fat Omega 3 fatty acids demonstrate promising benefits: triglyceride levels, dialysis access patency, and cardiovascular risk factors Kris-Etherton et al Circulation (2002) 106: p ; Allomon & Moe CJASN (2006) 2: p
28 Vitamins and Trace Elements Water-soluble vitamins (esp B6, C and folate) Losses: Dialysis removal > normal urinary losses Fat-soluble vitamins Usually only Vit D supplemented Vit A & E (risk of toxicity), intake should meet RDI Trace elements Zinc, selenium, copper, aluminium & magnesium Iron (oral supplements not recommended)
29 Summary of Requirements Non-dialysis CKD Haemodialysis Peritoneal Dialysis Energy kcal/kg/day 35 kcal/kg/day 35 kcal/kg/day Incl kcal from dialysate Protein g/kg/day Illness 1.0g/kg >1.2 g/kg/day >1.2 g/kg/day Peritonitis >1.5 g/kg Sodium mmol/day mmol/day mmol/day Potassium <1mmol/kg If elevated <1mmol/kg If elevated Not usually an issue Phosphorus mg & binders if elevated mg & binders if elevated mg & binders if elevated NKF/KDOQI 2000 & 2002; Fouque et al NDT (2007) 22(Supp 2);pp45-87; Cano et al Clin Nutr (2006) 25;pp :
30 Nutrition and Chronic Kidney Disease What are the gaps in information? Are there pressing research issues? Specific role of uremic toxins? Human microbiome Better dialysis? Optimal level of supplementation? Abnormal metabolic fate? Role of anabolic or anti-catabolic strategies Obesity in the setting of chronic kidney disease
31 VUMC Nephrology Clinical Research Group Funding/Other Support NIH/NIDDK/NHLBI/NIEHS RCG/FMC/Abbott/Baxter NKF/AKF/ASN/ISRNM SatelliteHealth grant program Vanderbilt Clinical and Translational Research Award
Dietary practices in patients with chronic kidney disease not yet on maintenance dialysis: What are the relevant components?
Dietary practices in patients with chronic kidney disease not yet on maintenance dialysis: What are the relevant components? 3 rd International Conference of European Renal Nutrition Working Group of ERA-EDTA
More informationNutritional support in advanced kidney disease: Role of oral and parenteral nutrition. T. Alp Ikizler, MD Vanderbilt University Medical Center
Nutritional support in advanced kidney disease: Role of oral and parenteral nutrition T. Alp Ikizler, MD Vanderbilt University Medical Center Goals To delineate the mechanisms through which wasting syndrome
More informationISN Mission: Advancing the diagnosis, treatment and prevention of kidney diseases in the developing and developed world
ISN Mission: Advancing the diagnosis, treatment and prevention of kidney diseases in the developing and developed world Nutrition in Kidney Disease: How to Apply Guidelines to Clinical Practice? T. Alp
More informationNeed for specialized nutrition to prevent accelerated muscle loss in CKD
Need for specialized nutrition to prevent accelerated muscle loss in CKD Prof. Daniel Teta Head Service of Nephrology Hôpital du Valais, Sion CHUV, Université de Lausanne 21st September 2017 Conflicts
More informationNutritional Management of Criticallly Ill Patients with Acute Kidney Injury
Nutritional Management of Criticallly Ill Patients with Acute Kidney Injury 3 rd International Conference of European Renal Nutrition Working Group of ERA-EDTA T. Alp Ikizler, MD Catherine McLaughlin-Hakim
More informationIntradialytic Parenteral Nutrition in Hemodialysis Patients. Hamdy Amin, Pharm.D., MBA, BCNSP Riyadh, Saudi Arabia
Intradialytic Parenteral Nutrition in Hemodialysis Patients Hamdy Amin, Pharm.D., MBA, BCNSP Riyadh, Saudi Arabia Disclosure Information Intradialytic Parenteral Nutrition in Hemodialysis Patients Hamdy
More informationMalnutrition in advanced CKD
Malnutrition in advanced CKD Malnutrition Lack of proper nutrition, caused by not having enough to eat, not eating enough of the right things or being unable to use the food that one does eat Jessica Stevenson
More informationEnd stage renal disease and Protein Energy wasting
End stage renal disease and Protein Energy wasting Dr Goh Heong Keong MBBS,MRCP(UK) www.passpaces.com/kidney.htm Introduction Chronic kidney disease- increasing health burden in many countries. The estimated
More informationTO EAT OR NOT TO EAT DURING HEMODIALYSIS TREATMENT?
TO EAT OR NOT TO EAT DURING HEMODIALYSIS TREATMENT? Rana G. Rizk, PhD, MPH, LD Maastricht University, The Netherlands November, 2017 Learning objectives Review the evidence behind benefits and concerns
More informationAspetti nutrizionali nel paziente in emodialisi cronica
Aspetti nutrizionali nel paziente in emodialisi cronica Enrico Fiaccadori enrico.fiaccadori@unipr.it Università degli Studi di Parma Agenda Diagnosis of protein-energy wasting (PEW) in ESRD on HD Epidemiology
More informationPrevalence of malnutrition in dialysis
ESPEN Congress Cannes 2003 Organised by the Israel Society for Clinical Nutrition Education and Clinical Practice Programme Session: Nutrition and the Kidney Malnutrition and Haemodialysis Doctor Noël
More informationNutrition and Renal Disease Update
Nutrition and Renal Disease Update Denis FOUQUE Department of Nephrology Centre de Recherche en Nutrition Humaine University Claude Bernard Lyon - France What have we learned? 1. Chronic kidney disease:
More informationNutrition Dilemmas, Controversies & Issues CHRONIC KIDNEY DISEASE (CKD)
Nutrition Dilemmas, Controversies & Issues CHRONIC KIDNEY DISEASE (CKD) Objectives To discuss the role of nutrition in clinical outcomes of chronic kidney disease (CKD) To discuss and update on the nutrition
More informationNutrition in hemodialysis patients with focus on Intradialytic Parenteral Nutrition (IDPN)
Nutrition in hemodialysis patients with focus on Intradialytic Parenteral Nutrition (IDPN) Enrico Fiaccadori enrico.fiaccadori@unipr.it Acute and Chronic Renal Failure Unit Medicine & Surgery Dept. Parma
More informationPediatric Nutrition and Kidney Disease
Pediatric Nutrition and Kidney Disease Loai Eid, MD, MSHS, FAAP Consultant Pediatric Nephrologist Pediatric Nephrology & Hypertension Division Chief Dubai Hospital - DHA 26 th October, 2017 Objectives
More informationSUBJECT INDEX. Tvedegaard, E., 20. Ulerich, L., E1 (July) Wapensky, T., 45 Warner, J., 116 Warsaba, D., 52
268 Supasyndh, O., 134 Suraci, C., 208 Tatangelo, P., 208 Tavares, I., 157 Tozzo, C., 208 Tvedegaard, E., 20 Ulerich, L., E1 (July) Wapensky, T., 45 Warner, J., 116 Warsaba, D., 52 Wells, L.M., 26 Winkler,
More informationLLL Session - Nutritional support in renal disease
ESPEN Congress Leipzig 2013 LLL Session - Nutritional support in renal disease Peritoneal dialysis D. Teta (CH) Nutrition Support in Patients undergoing Peritoneal Dialysis (PD) Congress ESPEN, Leipzig
More informationNutritional Cases with CKD HEMODIALYSIS
Nutritional Cases with CKD HEMODIALYSIS S. Muge DEGER, MD, FISN Yuksek Ihtisas University Faculty of Medicine, Koru Hospital Department of Nephrology Ankara, TURKEY CASE-1 BC, is a 60- year- old Caucasian
More informationAdvances in Practice. Effect of Peridialytic Protein Bar Supplementation Among Malnourished Hemodialysis Patients
Advances in Practice Effect of Peridialytic Protein Bar Supplementation Among Malnourished Hemodialysis Patients Corresponding Author: Vasudevan Preethi MSc Clinical Nutrition Student, Department of Clinical
More informationEpidemiology, Diagnostic and treatment for Protein Energy Wasting in Dialysis
Epidemiology, Diagnostic and treatment for Protein Energy Wasting in Dialysis Pr Denis FOUQUE Department of Nephrology Centre de Recherche en Nutrition Humaine University Claude Bernard Lyon - France ESRD
More informationDOWNLOAD OR READ : NUTRITION DURING DIALYSIS TREATMENT PDF EBOOK EPUB MOBI
DOWNLOAD OR READ : NUTRITION DURING DIALYSIS TREATMENT PDF EBOOK EPUB MOBI Page 1 Page 2 nutrition during dialysis treatment nutrition during dialysis treatment pdf nutrition during dialysis treatment
More informationPr Denis FOUQUE. Department of Nephrology Centre de Recherche en Nutrition Humaine University Claude Bernard Lyon - France
Pr Denis FOUQUE Department of Nephrology Centre de Recherche en Nutrition Humaine University Claude Bernard Lyon - France Observatoire Phosphocalcique, January 2011 1200 36.1 ± 5.0 g/l 1050 900 PEW
More informationTABLE OF CONTENTS T-1. A-1 Acronyms and Abbreviations. S-1 Stages of Chronic Kidney Disease (CKD)
A-1 Acronyms and Abbreviations TABLE OF CONTENTS S-1 Stages of Chronic Kidney Disease (CKD) Chapter 1: Nutrition Assessment Charts, Tables and Formulas 1-2 Practical Steps to Nutrition Assessment Adult
More informationin CKD Patients Associate Professorr of Medicine Iran University of Medical Sciences
Management of Nutrition in CKD Patients Shokoufeh Sa avaj MD Associate Professorr of Medicine Iran University of Medical Sciences Introduction Dietary factors may have an effect on the progression of kidney
More informationNutrition Assessment in CKD
Nutrition Assessment in CKD Shiaw-Wen Chien, MD, EMBA Division of Nephrology, Department of Medicine, Tungs Taichung MetroHarbor Hospital Taichung, Taiwan September 10, 2017 Outline Introduction Composite
More informationIntradialytic Parenteral Nutrition
Intradialytic Parenteral Nutrition Policy Number: 8.01.44 Last Review: 8/2014 Origination: 8/2014 Next Review: 8/2015 Policy Blue Cross and Blue Shield of Kansas City (Blue KC) will provide coverage for
More information17 th Annual Meeting of JSHDF, Sept 3-4, 2011
17 th Annual Meeting of JSHDF, Sept 3-4, 2011 Sug Kyun Shin 1, JY Moon 2, SW Han 3, DH Yang 4, SH Lee 2, HC Park 5, JK Kim 6 and YI Jo 7 1 Nephrology, NHIC Ilsan Hospital, 2 Kyunghee University Hospital
More informationIntradialytic Parenteral Nutrition. Description
Subject: Intradialytic Parenteral Nutrition Page: 1 of 9 Last Review Status/Date: September 2015 Intradialytic Parenteral Nutrition Description Intradialytic parenteral nutrition (IDPN) is the infusion
More informationDiseases of the Renal System
Diseases of the Renal System Chapter 20 1 2 Kidneys - Anatomy Regulatory and metabolic functions Nephron - functional unit; approx. 1.2 million in each kidney Glomerulus within Bowman s capsule Afferent
More informationGuidelines for the Management of Nutrition
S 42 Indian Journal of Nephrology Introduction Protein-energy malnutrition (PEM) is very common among patients with advanced chronic kidney disease (CKD). In the Indian scenario, where malnutrition is
More informationAccelerated lean body mass loss in incident chronic dialysis patients with diabetes mellitus
Kidney International, Vol. 68 (2005), pp. 2368 2374 Accelerated lean body mass loss in incident chronic dialysis patients with diabetes mellitus LARA B. PUPIM, OLOF HEIMBÜRGER, ABDUL RASHID QURESHI, T.
More informationAssessment and monitoring of CKD stages 1-3
Assessment and monitoring of CKD stages 1-3 Annual Paediatric Nephrouroradiology and Network Symposium 2014 Pearl Pugh Paediatric Renal Dietitian Nottingham Children s Hospital Goals of Dietetic Management
More informationObesity in the pathogenesis of chronic disease
Portoroz October 16th 2013 Obesity in the pathogenesis of chronic disease Rocco Barazzoni University of Trieste Department of Medical, Surgical and Health Sciences Obesity Trends* Among U.S. Adults BRFSS,
More informationHEMODIAFILTRATION PRINCIPLES AND ADVANTAGES OVER CONVENTIONAL HD PRESENTATION BY DR.ALI TAYEBI
HEMODIAFILTRATION PRINCIPLES AND ADVANTAGES OVER CONVENTIONAL HD PRESENTATION BY DR.ALI TAYEBI high-flux Hemodiafiltration (HDF) Combination of two dialysis techniques, hemodialysis and hemofiltration:
More informationESPEN Congress Copenhagen 2016
ESPEN Congress Copenhagen 2016 THE DIVERSITY OF OBESITY MALNUTRITION IN THE OBESE R. Barazzoni (IT) Malnutrition in the obese patient Rocco Barazzoni Dept of Medical, Surgical and Health Sciences University
More informationClinical Nutrition 28 (2009) Contents lists available at ScienceDirect. Clinical Nutrition
Clinical Nutrition 28 (2009) 401 414 Contents lists available at ScienceDirect Clinical Nutrition journal homepage: http://www.elsevier.com/locate/clnu ESPEN Guidelines on Parenteral Nutrition: Adult Renal
More informationAssessment and Monitoring of Nutritional Status in Chronic Kidney Disease Patients
Divisions of Baxter Novum and Renal Medicine, Department of Clinical Science, Intervention and Technology, Karolinska Institutet Assessment and Monitoring of Nutritional Status in Chronic Kidney Disease
More informationNutritional considerations in the dialysis population: from malnutrition to obesity
Nutritional considerations in the dialysis population: from malnutrition to obesity Jessica Stevenson Senior Renal Dietitian, St George Hospital PhD Candidate, The University of Sydney Presentation outline:
More informationIntradialytic Parenteral Nutrition
Intradialytic Parenteral Nutrition Policy Number: 8.01.44 Last Review: 8/2017 Origination: 8/2014 Next Review: 8/2018 Policy Blue Cross and Blue Shield of Kansas City (Blue KC) will provide coverage for
More informationBy; Ashraf El Houfi MD MS (pulmonology) MRCP (UK) FRCP (London) EDIC Consultant ICU Dubai Hospital
By; Ashraf El Houfi MD MS (pulmonology) MRCP (UK) FRCP (London) EDIC Consultant ICU Dubai Hospital Introduction The significance of nutrition in hospital setting (especially the ICU) cannot be overstated.
More informationIpovitaminosi D e metabolismo calcio-fosforo in dialisi peritoneale. Maurizio Gallieni Università degli Studi di Milano
Ipovitaminosi D e metabolismo calcio-fosforo in dialisi peritoneale Maurizio Gallieni Università degli Studi di Milano G Ital Nefrol 2018 - ISSN 1724-5990 Nutrients 2017, 9, 328 Vitamin D deficiency (
More informationreview & 2013 International Society of Nephrology
review http://www.kidney-international.org & 2013 International Society of Nephrology Prevention and treatment of protein energy wasting in chronic kidney disease patients: a consensus statement by the
More informationNUTRITION CONSIDERATIONS FOR PATIENTS WITH DIABETIC NEPHROPATHY
NUTRITION CONSIDERATIONS FOR PATIENTS WITH DIABETIC NEPHROPATHY Becca Wallschlaeger, MS RDN CD Transplant Nutritionist University of Wisconsin Transplant Program Fall 2017 OBJECTIVES Recognize kidney disease
More informationNutrition in Liver Disease An overview of the EASL Clinical Practice Guidelines
Nutrition in Liver Disease An overview of the EASL Clinical Practice Guidelines Marike Bauermeister Registered Dietitian Wits Donald Gordon Medical Centre Malnutrition Malnutrition is a complication in
More informationSurgical Nutrition for the Cardiothoracic Patient. Stephanie Kunioki RD, CNSC, LD Memorial Hermann TMC
Surgical Nutrition for the Cardiothoracic Patient Stephanie Kunioki RD, CNSC, LD Memorial Hermann TMC Financial Disclosures NONE Declared PROPER NUTRITION Surgical Effects on Nutrition Intake & Status
More informationGuidelines elderly population with CKD 3-5: Nutrition
Guidelines elderly population with CKD 3-5: Nutrition Dr.P.Bernaert, nefrologie, AZ Maria Middelares Gent AZ MM - SJ Belgium Notion:Nutritional status is a strong predictor of survival in patients starting
More informationNutrition in end-stage renal disease
Kidney International, Vol. 50 (1996), pp. 343 357 PERSPECTIVES IN CLINICAL NEPHROLOGY Nutrition in end-stage renal disease Despite substantial improvements in the science and technology of renal replacement
More informationCardiovascular Mortality: General Population vs ESRD Dialysis Patients
Cardiovascular Mortality: General Population vs ESRD Dialysis Patients Annual CVD Mortality (%) 100 10 1 0.1 0.01 0.001 25-34 35-44 45-54 55-64 66-74 75-84 >85 Age (years) GP Male GP Female GP Black GP
More informationLa relation dialyse et nutrition
Nutrition en dialyse : controverses La relation dialyse et nutrition Charles Chazot, MD NephroCare Tassin-Charcot Sainte Foy Les Lyon, France HEMO study lessons (1) Dose Body weight flux Rocco, Kidney
More informationTOTAL PARENTERAL NUTRITION
TOTAL PARENTERAL NUTRITION Indication See algorithm. Timing Start TPN as indicated on algorithm 1. There is no need to build up TPN volume. The volume of TPN (including lipids) should equate to the total
More informationNutritional Demands of Disease and Trauma
al Demands of Disease and Trauma Lecture 89 Medical School al Requirements Based on needs to support optimal physiological function Are changed by disease or injury metabolism is altered to prevent further
More informationNutrition in Acute Kidney Injury Enrico Fiaccadori
Nutrition in Acute Kidney Injury Enrico Fiaccadori Nephrology Dept. Parma University Medical School Parma, Italy Diagnosis, epidemiology and prognostic impact of proteinenergy wasting (PEW) in AKI Pathogenetic
More informationNutritional concerns of overweight / obese older persons. Gordon L Jensen, MD, PhD Dept Nutritional Sciences Penn State University
Nutritional concerns of overweight / obese older persons Gordon L Jensen, MD, PhD Dept Nutritional Sciences Penn State University Prevalence of obesity among older adults: NHANES 1999-2004 Sex Age (years)
More informationCase Study: Renal Disease
Case Study: Renal Disease Laboratory Values: Lab Units Patient Normal Source Interpretation GFR ml/min 46 above 90 Renal Lecture 2 BUN mg/dl 40 10-20 NTP A-90 Serum creatinine mg/dl 2.5 0.6-1.2 NTP A-90
More informationFinal Case Study: Renal Disease Due 3/19/14 60 points
NUT 116BL Name: CHRISTINE WOO Winter 2014 Section: 1 Final Case Study: Renal Disease Due 3/19/14 60 points Part I: Initial Presentation Present Illness: Jenny is a 19 yo F student referred to the renal
More information2017 KDIGO Guidelines Update
2017 KDIGO Guidelines Update Clinic for Hemodialysis Clinical Center University of Sarajevo 13 th Congress of the Balkan cities Association of Nephrology, Dialysis, and Artificial Organs Transplantation
More informationDr. Liliana Garneata Assistant Professor of Nephrology Dr Carol Davila Teaching Hospital of Nephrology, Bucharest, Romania
Dr. Liliana Garneata Assistant Professor of Nephrology Dr Carol Davila Teaching Hospital of Nephrology, Bucharest, Romania Nutritional management of CKD: Key-role of ketoanalogues with low protein diets
More informationNutrition care plan. Components and development
Nutrition care plan Components and development Objectives To define the nutrition care plan To present the components of the nutrition care plan To discuss the different approaches in determining the contents
More informationCase Study: Chronic Kidney Disease
Taylor Zwimpfer Joan Rupp Nutrition 409 23 September 2014 Case Study: Chronic Kidney Disease 1. Kidneys act to maintain the balance of fluids, electrolytes and organic solutes in the body through filtration
More informationModule 1 An Overview of Nutrition. Module 2. Basics of Nutrition. Main Topics
Module 1 An Overview of Nutrition Module 2 What is Nutrition? What Are Nutrients? Units of Energy Why we need energy? Maintaining energy balance Daily energy requirements Calorie Requirements for Different
More informationApplying clinical guidelines treating and managing CKD
Applying clinical guidelines treating and managing CKD Develop patient treatment plan according to level of severity. Source: Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO 2012
More informationIntradialytic Parenteral Nutrition
Applies to all products administered or underwritten by Blue Cross and Blue Shield of Louisiana and its subsidiary, HMO Louisiana, Inc.(collectively referred to as the Company ), unless otherwise provided
More informationNutritional Demands of Disease and Trauma
Nutritional Demands of Disease and Trauma Lecture 89 2000 Northwestern University Medical School Nutritional Requirements Based on needs to support optimal physiological function Are changed by disease
More informationCan Oral Supplementation with a Collagen-Casein-Based Liquid Protein Improve Serum Albumin Levels in Hemodialysis Patients?
Can Oral Supplementation with a Collagen-Casein-Based Liquid Protein Improve Serum Albumin Levels in Hemodialysis? Ann Pittaoulis, RD, LDN; Evelyn Phillips, MS, RD, LDN A. Pittaoulis is with Belmont Court
More informationProduct Segments. Medical Nutrition. General Nutrition. Wellness Nutrition. Sports Nutrition. And Many More..
Product Segments Medical Nutrition General Nutrition Diabetic Nutrition, Renal Nutrition, Cancer Nutrition, Critical Care Nutrition, Hepatic Nutrition, Bone Health Nutrition, MCT & Fibers Balanced Nutrition,
More informationNutrition JMRSO 2017 FOOD SCIENCE
Nutrition JMRSO 2017 FOOD SCIENCE What is nutrition? Nutrition is the science that interprets the interaction of nutrients and other substances in food in relation to maintenance, growth, reproduction,
More informationNutrition. Chapter 45. Reada Almashagba
Nutrition Chapter 45 1 Nutrition: - Nutrient are organic substances found in food and are required for body function - No one food provide all essential nutrient Major function of nutrition: providing
More informationSection Questions Answers
Section Questions Answers Guide to CKD Screening and Evaluation -Alec Otteman, MD Delaying Progression - Paul Drawz, MD, MHS, MS 1. Modifiable risk factors for CKD include: a. Diabetes b. Hypertension
More informationPatient Description and Diagnosis: Sarah Jones is a 50-year-old female, 5 4, 131
Julia Kaesberg Counseling Session KNH 413 February 27 th, 2014 Patient Description and Diagnosis: Sarah Jones is a 50-year-old female, 5 4, 131 pounds and her usual body weight is 125 pounds. Her %UBW
More information6 ESSENTIAL NUTRIENTS PART II VITAMINS MINERALS WATER
6 ESSENTIAL NUTRIENTS PART II VITAMINS MINERALS WATER VITAMINS What Are They? Tasteless organic compounds that you need in small amounts for growth, reproduction, and overall good health. The DO NOT provide
More informationNew aspects of acid-base disorders
New aspects of acid-base disorders I. David Weiner, M.D. C. Craig and Audrae Tisher Chair in Nephrology Division of Nephrology, Hypertension and Transplantation University of Florida College of Medicine
More information9/26/2016. The Impact of Dietary Protein on the Musculoskeletal System. Research in dietary protein, musculoskeletal health and calcium economy
The Impact of Dietary Protein on the Musculoskeletal System Outline A. The musculoskeletal system and associated disorders Jessica D Bihuniak, PhD, RD Assistant Professor of Clinical Nutrition Department
More informationVascular calcification in stage 5 Chronic Kidney Disease patients on dialysis
Vascular calcification in stage 5 Chronic Kidney Disease patients on dialysis Seoung Woo Lee Div. Of Nephrology and Hypertension, Dept. of Internal Medicine, Inha Unv. College of Medicine, Inchon, Korea
More informationImportant aspects of acid-base disorders
Important aspects of acid-base disorders I. David Weiner, M.D. Co-holder, C. Craig and Audrae Tisher Chair in Nephrology Division of Nephrology, Hypertension and Transplantation University of Florida College
More informationInflammation and wasting in chronic kidney disease: Partners in crime
http://www.kidney-international.org & 2006 International Society of Nephrology Inflammation and wasting in chronic kidney disease: Partners in crime CM Avesani 1, JJ Carrero 1, J Axelsson 1, AR Qureshi
More informationPotential Impact of Nutritional Intervention on End-Stage Renal Disease Hospitalization, Death, and Treatment Costs
ORIGINAL RESEARCH Potential Impact of Nutritional Intervention on End-Stage Renal Disease Hospitalization, Death, and Treatment Costs Eduardo Lacson, Jr., MD,* T. Alp Ikizler, MD, J. Michael Lazarus, MD,*
More informationInnovations in Nutritional Therapy for Cats with CKD Rebecca Mullis, DVM, DACVN
Innovations in Nutritional Therapy for Cats with CKD Rebecca Mullis, DVM, DACVN Content presented at the 2017 Hill s Global Symposium in Washington D.C., May 5-6, 2017. Chronic kidney disease (CKD) is
More informationTaking Care of Your Kidneys
Taking Care of Your Kidneys Part A Roseville & Sacramento Medical Centers Health Promotion Department Nutritional Services Agenda Slide How your kidneys work Explaining chronic kidney disease Protecting
More informationChapter 16 Nutrition, Fluids and Electrolytes, and Acid-Base Balance Nutrition Nutrients Water o Functions Promotes metabolic processes Transporter
Chapter 16 Nutrition, Fluids and Electrolytes, and Acid-Base Balance Nutrition Nutrients Water o Functions Promotes metabolic processes Transporter for nutrients and wastes Lubricant Insulator and shock
More information1. Reggie J. Divina, M.D. (1) 2. Fe S. Felicilda, M.D., DPBCN (1,2) 3. Rufino E. Chan, M.D. (1) 4. Luisito O. Llido, M.D.
82 TITLE: Nutritional status of hemodialysis patients in the Philippines: a cross sectional survey in four out- patient dialysis centers Submitted: January 10, 2010 Posted: August 30, 2010 AUTHOR(S) 1.
More informationAssessment of Malnutrition of Dialysis Patients and Comparison of Nutritional Parameters of CAPD and Hemodialysis Patients
Biomedical Science Letters 2017, 23(3): 185~193 https://doi.org/10.15616/bsl.2017.23.3.185 eissn : 2288-7415 Original Article Assessment of Malnutrition of Dialysis Patients and Comparison of Nutritional
More informationNUTRITION & IMMUNITY IN OLDER AGE
NUTRITION & IMMUNITY IN OLDER AGE Parveen Yaqoob Professor of Nutritional Physiology Head of School, Chemistry, Food & Pharmacy Copyright University of Reading SCOPE OF LECTURE Impact of ageing on the
More informationNutritional Support in Renal Failure Topic 15
Nutritional Support in Renal Failure Topic 15 Module 15.3 Nutrition Support in End-stage Renal Disease Patients on Haemodialysis (ESRD-HD) Learning Objectives Alice Sabatino RD, MSc Acute and Chronic Renal
More informationThe Diabetes Kidney Disease Connection Missouri Foundation for Health February 26, 2009
The Diabetes Kidney Disease Connection Missouri Foundation for Health February 26, 2009 Teresa Northcutt, RN BSN Primaris Program Manager, Prevention - CKD MO-09-01-CKD This material was prepared by Primaris,
More informationSarcopenia. Juan Jesús Carrero. Dept Medical Epidemiology and Biosta9s9cs Karolinska Ins9tutet, Sweden.
Sarcopenia Juan Jesús Carrero Dept Medical Epidemiology and Biosta9s9cs Karolinska Ins9tutet, Sweden. 1 Revisi&ng the concept of sarcopenia in geriatric diseases Nephrol Dial Transplant. 2017 Jul 1;32(7):1127-1136.
More informationPARENTERAL NUTRITION
PARENTERAL NUTRITION DEFINITION Parenteral nutrition [(PN) or total parenteral nutrition (TPN)] is the intravenous infusion of some or all nutrients for tissue maintenance, metabolic requirements and growth
More informationPROTEIN-ENERGY STATUS IN PATIENTS RECEIVING DIALYSIS
Original scientific paper UDC 616.61-008.64-78-083.2 PROTEIN-ENERGY STATUS IN PATIENTS RECEIVING DIALYSIS Natalija Uršulin-Trstenjak 1*, Brankica Vitez 2, Davor Levanić 1, Melita Sajko 1, Marijana Neuberg
More informationEffects of Diabetes Mellitus, Age, and Duration of Dialysis on Parathormone in Chronic Hemodialysis Patients. Hamid Nasri 1, Soleiman Kheiri 2
Saudi J Kidney Dis Transplant 2008;19(4):608-613 2008 Saudi Center for Organ Transplantation Saudi Journal of Kidney Diseases and Transplantation Original Article Effects of Diabetes Mellitus, Age, and
More informationESPEN Congress Vienna Nutritional implications of renal replacement therapy in ICU Nutritional consequences of RRT. E. Fiaccadori (Italy)
ESPEN Congress Vienna 2009 Nutritional implications of renal replacement therapy in ICU Nutritional consequences of RRT E. Fiaccadori (Italy) Nutritional consequences of RRT Enrico Fiaccadori Internal
More informationCENTRAL OFFICE. Scheduled Menu Analysis TMS Menu: Serving Size
40030 Period: 900191 Grape Juice 1 4 Ounce 81640 MeatballPennePastasScBrocItalVeg FRZ000657 1 Meal Table: % Energy kcal 685.0000 674.1027 98.4092 Protein g 19.0000 37.3486 22.1620 196.5716 Sodium, Na mg
More informationHEALTHYSTART TRAINING MANUAL. Living well with Kidney Disease
HEALTHYSTART TRAINING MANUAL Living well with Kidney Disease KIDNEY DISEASE CAN AFFECT ANYONE! 1 HEALTHYSTART PROGRAMME HEALTHYSTART is a lifestyle management programme to assist you to remain healthy
More informationCPT David J. Licciardello, DVM Veterinary Advisor
CPT David J. Licciardello, DVM Veterinary Advisor Carbohydrates Fats (Fatty Acids) Minerals Proteins (Amino Acids) Vitamins Water Referred to as Fiber Made up of the forage portion of a diet In a complete
More informationFat soluble vitamins- special care needed - most likely avoid
A balanced diet is the best way to get the recommended amount of vitamins and minerals. However when you have kidney disease sometimes it is difficult to get enough. This might be because: - you have dietary
More informationChronic Kidney Disease
Chronic Kidney Disease Chronic Kidney Disease (CKD) Guideline (2010) Chronic Kidney Disease CKD: Executive Summary of Recommendations (2010) Executive Summary of Recommendations Below are the major recommendations
More informationAging and nutrition 03/11/2012. Why do people age? Oxidative stress and damage
Aging and nutrition % of elderly people in Canadian population is increasing more than for other age groups within the elderly age group there is great variability in terms health, metabolism, physical
More informationEnd-Stage Renal Disease. Anna Vinnikova, M.D. Associate Professor of Medicine Division of Nephrology
End-Stage Renal Disease Anna Vinnikova, M.D. Associate Professor of Medicine Division of Nephrology ESRD : Life with renal replacement therapy CASE: 18 month old male with HUS develops ESRD PD complicated
More informationThe CARI Guidelines Caring for Australians with Renal Impairment. Other criteria for starting dialysis GUIDELINES
Date written: September 2004 Final submission: February 2005 Other criteria for starting dialysis GUIDELINES No recommendations possible based on Level I or II evidence SUGGESTIONS FOR CLINICAL CARE (Suggestions
More information--> Buy True-PDF --> Auto-delivered in 0~10 minutes. GB Table of contents 1 Scope... 3
Translated English of Chinese Standard: GB28050-2011 www.chinesestandard.net Sales@ChineseStandard.net NATIONAL STANDARD GB OF THE PEOPLE S REPUBLIC OF CHINA National Standard on Food Safety National label
More informationDietary intake patterns in older adults. Katherine L Tucker Northeastern University
Dietary intake patterns in older adults Katherine L Tucker Northeastern University Changes in dietary needs with aging Lower energy requirement Less efficient absorption and utilization of many nutrients
More informationIngvar Bosaeus, MD, Sahlgrenska University Hospital, Goteborg, Sweden
Cachexia in Cancer Ingvar Bosaeus, MD, Sahlgrenska University Hospital, Goteborg, Sweden Severe, progressive malnutrition and wasting often is seen in advanced cancer, with weight loss long associated
More information