correct answers
Functions of normal kidney ✔✔o Filter waste products
o Maintain fluid balance
o Regulate electrolyte status
o Role in blood pressure regulation
o Stimulation of red blood cell production
o Maintain bone health, regulation of calcium and phosphorus metabolism by activation
of Vitamin D and excretion of excess phosphorus
Characterized by decrease in removal of waste products. As disease progresses, rises
in urea blood level can cause nausea, fatigue, loss of appetite. Urine output may begin
to decline. ✔✔Renal Insufficiency or CKD Stages 1-4
Deterioration of renal function to a level at which uremia can cause death unless
treatment is initiated to replace renal function. ✔✔End Stage Renal Disease or CKD
Stage 5
at risk of CKD ✔✔DM, HTN, family hx, age, ethnicity
GFR: >90
stage 1 ✔✔Kidney damage (protein in urine)
GFR >90
stage 2 ✔✔Kidney damage + decrease in GFR
GFR 60-89
stage 3 ✔✔Moderate decrease in GFR
GFR 30-59
stage 4 ✔✔Severe decrease in GFR
GFR 15-29
stage 5 ✔✔Kidney failure (dialysis or tx needed)
GFR <15
, Medical Nutrition Therapy Goals in Kidney Disease ✔✔• Prevention/treatment of
malnutrition, weight maintenance, decreased morbidity and mortality
• Control and correct an overload of products of protein metabolism
• Maintain resistance to infection, control tissue catabolism
• Maintain electrolyte balance
• Maintain fluid balance
• Prevent/control renal bone disease by maintaining calcium and phosphorus balance.
Despite advances in dialysis techniques, the mortality rate for those on maintenance
dialysis remains ____ per year. ✔✔~ 20%
Epidemiological studies repeatedly and consistently show a strong association b/t what?
✔✔clinical outcome and measures of malnutrition and inflammation
Reported prevalence of PEW (protein energy wasting) varies greatly b/t _______ in
dialysis patients according to type of dialysis, nutritional assessment tools, and origin of
pt population. ✔✔45%-75%
2/3 of all maintenance dialysis pts in the US exhibit ______ ✔✔hypoaluminemia
causes of malnutrition in kidney disease ✔✔o Decreased nutrient intake
o Abnormal renal metabolism
o Abnormal mineral metabolism
o Losses of nutrients into dialysate
o Metabolic acidosis
o Hypercatabolism due to dialysis
o Frequent concurrent illnesses
The National Kidney Foundation has developed clinical guidelines ... what are those
called ✔✔NKF-KDOQI Guidelines
steps of KDOQI guidelines ✔✔1. Evaluation of protein-energy nutritional status
2. Management of protein and energy intake (very individualized)
3. Intensive nutritional counseling of individuals with CKD.
a valid and clinically useful measure of protein-energy nutritional status in maintenance
dialysis patients ✔✔-serum pre-albumin
-Serum Albumin
-serum cholesterol
-serum creatinine and the creatinine index
goal of serum pre-albumin ✔✔>30mg/dL
goal of Serum Albumin ✔✔>4.0g/dL