This document summarizes medical nutrition therapy for chronic kidney disease and end-stage renal disease. It discusses the pathophysiology and stages of chronic kidney disease, complications that can arise at different levels of kidney function, and nutritional management strategies and guidelines for protein, fluid, electrolyte, and energy intake at various stages of kidney disease and on different types of dialysis.

1. Medical Nutrition Therapy in CRF Dr. B. K. Iyer

2. Terms to know CRD CRI CRF ESRD Chronic renal disease is a patho-physiologic process with multiple causes, resulting in the inevitable decrease of nephron number and function. Chronic renal insufficiency (CRI) is the term for patients with mild-to-moderate renal impairment, those whose GFR falls at 30-70 cc/min. Chronic renal failure Is characterized by progressive destruction of renal mass with irreversible loss of nephrons over a period of at least months to many years. End-stage renal disease is a stage of total or nearly total and permanent kidney failure to render patient permanently dependent upon RRT

4. Pathophysiology

7. History of diabetic nephropathy

12. Renal stages

17. Uremic syndrome

21. Clinical abnormalities

34. Physical Examination

36. Treatment MNT

38. Treating pathologic manifestations of CRF with oral alkali supplementation Metabolic acidosis with loop diuretics or ultrafiltration Fluid overload with calcitriol or vitamin D analogs. Hyper-parathyroidism with calcium supplements +/- calcitriol Hypo- calcemia with dietary phosphate binders and dietary phosphate restriction Hyper-phosphatemia with erythropoietin Anemia

47. Haemodialysis

48. Haemodialysis

49. Haemodialysis

50. Haemodialysis

55. MNT In ESRD

57. Therapy concerns

58. MNT concerns Individualized [~1000 mg/day] Individualized [~1000 mg/day] Individualized [based on serum level] Calcium (mg/d) Individualized 500-750 + urine output (1000 if anuric) Unrestricted Fluid (ml/d) Individualized ~ 40 Individualized Potassium (mg/kg IBW) 2000-4000 2000-3000 1000-3000 Sodium (mg/d) <17 indiv <17 indiv 8-12 indiv Phosphorus 30-35 30-35 30-35 Energy (kcal/kg IBW) 1.2-1.5 1.1-1.4 0.6-1.0 Protein [g/kg/day] CAPD or CCPD Haemo dialysis CKD Nutrients

65. Treatment In HD MNT

69. Treatment In PD MNT

73. Background basics MNT