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 Patients 1-3 Nutrition Care Process (NCP) Model 1-4 NCP Overview 1-7 NCP Applications in CKD 1-8 Nutrition Care Process: Nutrition Diagnostic Statements PES 1-9 KDOQI Assessment and Monitoring Recommendations 1-10 Tips for Effective Assessment, Interviewing and Teaching 1-11 Height Estimation From Knee Height 1-12 Height Estimation From Arm Span/Demi-Span 1-13 Height Estimation From Forearm 1-14 Determination of Frame Size by Elbow Breadth 1-15 Determination of Frame Size by Wrist Circumference 1-16 Patient-Determined Frame Size 1-17 Methods to Determine Body Weights for Nutrient Calculations 1-18 Standard Body Weight 1-19 Metropolitan Life Height and Weight Tables for Adults Males 1-20 Metropolitan Life Height and Weight Tables for Adults Females T-1
1-21 Weight for Height Tables for Filipinos 1-22 Desirable Body Weight Based on BMI 1-23 Adjusted Body Weight for the Obese or Underweight Patient 1-25 Estimating Dry Weight 1-26 Clinical Signs of Fluid Status in Dialysis Patients 1-26 Usual Fluid Intake and Output in Adults Without Kidney Disease 1-27 Weight Comparison Formulas 1-28 Weight Estimation in Amputees 1-29 Body Mass Index (BMI) 1-30 Body Mass Index Classifications 1-31 Creatinine Index (Estimates Edema-Free Lean Body Mass) 1-32 Sample Calculation of Edema-Free Lean Body Mass (LBM) 1-33 Body Surface Area (BSA) Formulas 1-34 Body Surface Area Nomogram 1-35 Total Body Water Formulas 1-36 Arm Anthropometrics 1-37 Reference Values for the Triceps Skinfold Thickness Male 1-38 Reference Values for the Triceps Skinfold Thickness Female 1-39 Reference Values for Mid-Arm Muscle Circumference 1-40 Reference Values for Mid-Upper Arm Muscle Area Male 1-41 Reference Values for Mid-Upper Arm Muscle Area Female 1-42 Other Measures of Body Composition 1-43 Subjective Global Assessment (SGA) 1-44 Editor s Note on SGA T-2
1-45 SGA Weight/Medical/Nutrition History 1-46 Schematic of Muscle to Guide Assessment of Wasting 1-47 SGA Part I 1-48 SGA Part II 1-50 Criteria for Estimation of Performance or Functional Status 1-51 Medical Nutrition Therapy (MNT) 1-53 Common Physical Signs of Malnutrition 1-55 Centers for Medicare and Medicaid Services (CMS) Conditions for Coverage (CfC) Chapter 2: Laboratory Values 2-2 General Information 2-3 Conversion Formulas 2-5 Laboratory Tests 2-20 Possible Non-Dietary Causes of Hyperkalemia in Kidney Disease 2-21 Potential Signs and Symptoms of Abnormal Serum Potassium 2-22 Acidosis/Acidemia 2-23 Acidosis/Alkalosis 2-24 Na + /K + Content of Salt and Salt Substitutes Chapter 3: Medications 3-2 Medications in CKD 3-3 Antihypertensives 3-6 Antidepressants 3-8 Antilipemics/Antihyperlipidemics T-3
3-10 Anticonvulsants 3-11 Gout Treatments 3-12 Gout Medications 3-13 Nonsteroidal Anti-Inflammatory Drugs 3-14 Potential Nutrition Effects of Common Immunosuppressant Drugs 3-15 Drug-Nutrient Interactions 3-16 Drugs That May Impair Absorption or Utilization of Nutrients 3-17 Drug Actions on Nutrition 3-18 Herbal Supplements 3-19 Potentially Detrimental Herbal Supplements in CKD 3-21 Potentially Beneficial Herbal Supplements in CKD Chapter 4: Nutrient Prescription 4-2 General lnformation 4-3 Daily Nutrient Recommendations for CKD 4-5 L-Carnitine Supplementation in Hemodialysis Patients 4-6 Nutritional Effects of HIV/AIDS 4-7 Nutrient Recommendations for AIDS and Dialysis 4-8 Harris-Benedict Formulas for Resting Energy Expenditure (REE) 4-9 Suggested Adjustment Factors for Energy Needs During Acute Illness 4-10 Estimated Energy Needs in Spinal Cord Injury Patients 4-11 Estimates of Calories Absorbed Per Liter From Peritoneal Dialysate 4-13 National Renal Diet Food Choice Lists (CKD Not on Dialysis) 4-14 National Renal Diet Food Choice Lists (CKD on Dialysis) T-4
4-15 Vitamins Formulated for CKD Patients 4-16 Considerations for a Kosher Diet 4-17 Composition of Common High-Fiber Cereals 4-18 Composition of Milk and Substitutes Chapter 5: Diabetes Mellitus 5-2 Definitions of Diabetes 5-2 Typical Blood Glucose Values 5-3 Common Symptoms and Treatment of Diabetes 5-4 Glycated Hemoglobin (HbA 1c ) 5-5 Correlation Between HbA 1c Level and Mean Plasma Glucose 5-6 Stages of Diabetic Nephropathy 5-8 Screening for Kidney Disease 5-8 Definitions of Albumin Excretion Abnormalities 5-8 Factors That Potentially Influence Microalbuminuria Results 5-9 Recommended Daily Dietary Modification in Diabetic Nephropathy 5-10 Oral Hypoglycemic Agents 5-12 Insulin 5-13 Hypoglycemia in CKD 5-14 Food Glucose Equivalent to 15 gm Carbohydrate 5-15 Modifications for Acute Illness in Insulin-Dependent DM 5-16 Diabetes Management With Intercurrent Issues 5-17 Other Nutrition Issues for Diabetics 5-18 Sugar Alcohol and Non-Nutritive Sweeteners T-5
5-19 Diabetic Gastroparesis 5-20 Pancreas Transplant Chapter 6: Malnutrition 6-2 Descriptive Terms Relating to Abnormal Nutrition 6-4 Protein-Energy Wasting (PEW) in Kidney Disease 6-5 PEW 6-6 ISRNM Indicators for PEW 6-7 Diagnosis of PEW 6-7 ISRNM PEW Evaluation of Weight Loss 6-8 Negative Acute-Phase Reactants 6-9 Positive Acute-Phase Reactants 6-10 Indications and Steps for Implementation of Nutrition Support 6-11 Supplemental Enteral Feeding 6-12 Enteral Nutrition Formulas 6-13 Enteral Nutrition Supplements 6-14 Specialty Nutrition Bars/Cookies 6-15 Specialty Nutrition Products 6-16 Modular Products 6-17 Oral Amino Acid Therapy 6-18 Tube Feedings in CKD 6-20 Common Tube Feeding Sites 6-21 Tube Feeding Formulas 6-22 Common Tube Feeding Products T-6
6-23 Gastrointestinal Motility Studies 6-24 Intradialytic Parenteral Nutrition (IDPN) 6-25 IDPN Nutrients/Formulas 6-26 Other Considerations for IDPN 6-27 Intraperitoneal Nutrition (IPN)/Intraperitoneal Amino Acids (IPAA) 6-28 Determining the Appropriate IPN Solutions 6-29 Parenteral Nutrition Solution for Acute Kidney Injury (AKI) 6-31 Nutrition Support Monitoring Guidelines in the Stable Dialysis Patient 6-32 Nitrogen Balance Chapter 7: Dyslipidemia, Hypertension and Cardiovascular Disease 7-2 Introduction 7-4 ATP III Guideline Definitions of Dyslipidemia 7-5 National Cholesterol Education Program (NCEP), 2001 7-6 General Patterns of Dyslipidemia in CKD 7-6 Calculation of LDL Cholesterol (Friedewald Formula) 7-7 Treatment Recommendations for Correction of Dyslipidemias in CKD Stage 5 7-8 Therapeutic Lifestyle Changes (TLC) 7-9 Common Food Sources of Fat 7-10 Approximate Cholesterol Content of Common Foods 7-11 Hypertension 7-12 Recommendations for Antihypertensive Therapy in CKD 7-13 Risk Factors for Developing Cardiovascular Complications 7-14 Evaluation and Interventions for CVD T-7
Chapter 8: CKD Mineral and Bone Disorder 8-2 Bone and Mineral Metabolism Abnormalities in CKD 8-3 KDIGO Definitions of Mineral and Bone Abnormalities in CKD 8-4 Manifestations of Abnormal Mineral and Bone Metabolism 8-5 Abnormal Mineral and Bone States in CKD 8-6 Suggested Target Ranges for Biochemical Markers of CKD-MBD 8-7 Other CKD-MBD Recommendations 8-8 Phosphorus in CKD Stage 5D 8-9 Phosphorus Density of Common Foods 8-11 Phosphorus Food Additives 8-13 Phosphate Binding and Calcium Supplementation 8-14 Calcium Compounds 8-15 Available Phosphate Binder Compounds 8-17 Vitamin D 8-18 25(OH)D Levels and Recommendations in CKD Stages 3-4 8-19 Defining 25(OH)D Insufficiency/Deficiency (Non CKD) 8-20 General Recommendations for Adequate Intake (AI) of Vitamin D 8-21 Food Sources of Vitamin D 8-22 Calcitriol and Analogs of Calcitriol (U.S.) 8-23 Actions of Pharmacologic Agents Used to Treat SHPT 8-24 Protocols for Management of CKD-MBD 8-25 Initial Dosing for Vitamin D Sterols Per HD Treatment 8-26 Cinacalcet (Sensipar) T-8
8-27 Formulas for Adjusted Calcium 8-28 Symptoms of Abnormal Serum Calcium Levels 8-28 Etiology of Hypercalcemia 8-29 Soft Tissue/Vascular Calcification in CKD 8-31 Potential Indications for Parathyroidectomy 8-32 Common Clinical Course After Parathyroidectomy 8-33 Urolithiasis (Nephrolithiasis/Kidney Stones) 8-34 Nutrition Interventions for Kidney Stones 8-36 Oxalate Content of Common Foods Chapter 9: Anemia 9-2 Anemia 9-3 Terminology Used to Describe Cell Alterations in Anemia 9-4 Morphologic Types and Characteristics of Anemia 9-5 Laboratory Values Used to Evaluate Anemia in CKD 9-7 Interpretation of Iron Status Parameters 9-8 Diagnosis of Anemia Requiring Further Evaluation 9-8 Anemia in Transplant CKD 9-9 Therapeutic CKD Anemia Targets for Those on ESA 9-10 Iron Supplementation in CKD Patients 9-11 Iron Supplements (Oral) 9-12 Iron Supplements (IV) 9-13 Factors Most Commonly Associated With Hyporesponse to ESA Therapy T-9
Chapter 10: Adequacy of Dialysis 10-2 Kinetic Modeling Glossary 10-7 Methods of Measuring Hemodialysis Adequacy 10-9 Hemodialysis Adequacy Targets 10-10 Other Clinical Practice Recommendations for HD Adequacy 10-11 Types of Hemodialysis 10-12 Components of Kt/V 10-12 Parameters That Affect HD Adequacy 10-13 Total Body Water (Volume) 10-14 Volume From Surface Area (VSA) Formulas 10-16 Differences Between Single Pool and Double Pool Kinetics 10-17 Estimates of Protein Intake From Urea Kinetics 10-18 Estimates of PCRn (npcr) Using Formulas That Employ Kt/V 10-19 Other Adequacy Parameters 10-20 Common Causes of Delivered Kt/V Unequal to Prescribed Kt/V 10-21 HelpfuI Information for Analysis of UKM Results 10-22 Steps to Error Analysis of Formal HD UKM 10-23 Error Analysis for Formal UKM 10-26 Formulas for Other Measures of HD Adequacy 10-27 Formulas to Estimate Equilibrated Kt/V (ekt/v) 10-28 Daily Hemodialysis 10-29 Dialysis Dose With NxStage Technology 10-30 Peritoneal Dialysis T-10
10-31 Peritoneal Dialysis Adequacy Targets 10-32 Aspects of Peritoneal Dialysis Adequacy 10-33 Achieving Peritoneal Dialysis Adequacy Targets 10-34 PD Adequacy Calculations Kt/V 10-35 PD Adequacy Calculations PNA 10-36 Summary of KDOQI PD Adequacy Guidelines 10-37 Urea Kinetics for CKD Not on Dialysis 10-38 Nutrition Intervention Based on npna 10-39 Glomerular Filtration Rate (GFR) Calculations Chapter 11: Special Populations With CKD (Pediatrics, Pregnancy, Older Adults, Transplant) 11-2 Evaluation of Nutritional Status in Pediatric CKD Patients 11-3 Reference Table Resources 11-4 Indications for Nutrition Intervention 11-5 Energy Needs for Children With CKD Stages 2-5 and 5D 11-6 Macronutrient Ranges for Children With CKD Stages 2-5 and 5D 11-7 Protein Recommendations for Children With CKD Stages 3-5 and 5D 11-8 Vitamins and Trace Elements for Children With CKD Stages 2-5 and 5D 11-8 Elemental Calcium Recommendations for Children With CKD 11-9 Phosphorus Recommendations for Children With CKD Stages 3-5 and 5D 11-9 Higher Than Normal Values for Serum P Based on Age 11-10 Correcting Growth and Metabolic Deficits in Children With CKD Stages 2-5 and 5D 11-11 Calculation of npcr in Adolescents With CKD Stage 5HD 11-12 Recommendations for the Pregnant Patient With CKD T-11
11-14 Other Recommendations for the Pregnant HD Patient 11-16 Special Issues for the Older Adult CKD Patient 11-18 Potential Influences on Nutritional Status in the Older Adult 11-19 Dialysis in the Older Adult 11-20 Limitations of Common Nutrition Assessment Parameters in Older Adult CKD Patients 11-21 Education Considerations for Older Adults 11-22 Special Issues for the Kidney Transplant Patient 11-23 Nutrient Recommendations for the Kidney Transplant Patient N-1 Notes T-12