Efficacy of Dietary Intervention in END STAGE RENAL DISEASE
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Transcript of Efficacy of Dietary Intervention in END STAGE RENAL DISEASE
Efficacy of Dietary Intervention in ESRD
PatientsDr. Ch. M. Junaid Nazar
Senior Medical Officer/Research AssociateMBBS, MPH, M.Sc. Nephrology, MD Internal Medicine, FRSPH
Nephrology Department,Pakistan Kidney Institute,
Shifa International Hospital,Pakistan
Content• Introduction• Prevalence• Pathophysiology• Risk Factor• Association of Nutrition and outcome of Kidney Disease • Extent of malnutrition in ESRD patients • Methodology• Discussion• Conclusion
Introduction Chronic Kidney is a internationally recognized epidemic. The Third National Health and Nutrition Examination
Survey has noted that more than 20 million American have chronic renal kidney disease
One study suggests that 40 to 70 % of patients with end-stage renal disease are malnourished
It is very common and latest data suggest that it affects about 8 % of the UK adult population. The incidence of end stage renal disease (ESRD) patients joining renal replacement therapy (RRT) program in the UK is about 125/million each year
Prevalence The incidence of end stage renal disease
(ESRD) patients joining renal replacement therapy (RRT) program in the UK is about 125/million each year
The figure is almost 300/million in parts of the USA (because of racial factors and increased population prevalence of diabetes and hypertension
In United Kingdom, the number of patients on RRT is around 600/million.
Pathophysiologykeys1.Adaptive changes to nephron injury promote various effects the ultimately contributes to progression of CKD.
2.Hypertension, hyperfilteration, hyperglycemia, high grade proteinuria, and over activation of RAAS cause renal injury and progression of kidney to ESRD 3.CKD patients with high levels of proteinuria are at highest risk to progress to ESRD.
4.Therapies that reduce blood pressure to appropriate goals, reduce proreinuria, and inhibit the RAAS provide the most benefit to slow loss of renal function in diabetic and non- diabetic patients with proteinuria kidney disease.
5.ACE inhibitors and ARBs provides renoprotection in CKD patients: combination therapy with these drugs and aldosterone antagonist may provide further kidney protection but needs further validation.
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Risk FactorsDecreased protein and caloric intake Anorexia, Frequent Hospitalization, Inadequate
dialysis dose
Comorbidities hypertension, Diabetes mellitus, gastrointestinal
diseases, on-going inflammatory response autoimmune disorders
Increased protein and energy requirement Losses of nutrients Increased resting energy expenditure Older age Family history of chronic kidney disease
Association of Nutrition and outcome of Kidney Disease
• A number of studies have evaluated the nutritional status of advance CKD stage (3-5) has reported some degree of poor nutritional status. The prevalence of abnormalities has been estimated to range from approximately 20 % to 60 % using various nutritional parameters.
• Similarly in stage 4-5, mild to severe malnutrition by subjective global assessment is reported in 44 % of patients and for patients on HD it was 30 % and for PD patients it was 40 patients
Indices of Nutritional Status
The parameters which have been proposed to assess the nutritional status are albumin, cholesterol and creatinine as well more complex and not yet readily available parameters such as plasma and muscle amino acid profiles, pre albumin and insulin growth factor (IGF)
Analysis of body composition there will be different body techniques such as anthropometric, bioelectrical impedance.
Serum albumin is most extensively used method to measure malnutrition in CKD patients
Extent of malnutrition in ESRD patients
Pre -dialysis patients Dialysis dependent patients Transplant patient
Dialysis
• Hemodialysis• Peritoneal dialysis
Predialysis• Malnutrition is not specific to any stage of end
stage renal disease but it is evident that it is present even before the starting RRT.
• Report which is published by MDRD study indicated that early signs of malnutrition such as reduction in body mass index (BMI), weight, anthropometric measurements and notable decline in urinary biochemistry parameters including urinary creatinine excretion were observed in the chronic renal failure were noted.
Transplant The extent of malnutrition in transplant is
still under process and little is known about its effects
However, the treatment and prevention of malnutrition has not been discussed in these patients.
Malnutrition in pre-dialysis, dialysis, and post dialysis stage is related to multiple factors.
Methodology
Outcomes Related with Diet
• Hypertension• Diabetes Mellitus• Cardiovascular Diseases• Obesity• Protein• Protein Calorie malnutrition (PCM)• Potassium• Vitamins
Different risk factor effecting Nutrition in ESRD
• Education and Understanding • Late Referrals• Mistakes in Prescription• Low immune status and Lack of
donors• Poor Diagnostic Methods
FindingsEnvironmental Physiological
Anorexia related to uremia, fever, or treatmentsMalabsorption and diarrhea, Nausea and vomiting related to chemotherapy, gastritis, esophagitis, reduced peristalsis, Low calorie or palatable diet, altered mental status related to dementia etc
DepressionDesire for deathFood aversions related to alteration in taste, texture, and smellAltered perception of food value: fat diet, junk food, mega dosing nutrition’s, using special food.
Target for Future Research
The development of new practice guidelines,
particularly for fluid management, Special attention needs to be focused on the
additional impact of immunosuppressive medications
Clinical research efforts using interventional dietary trials for multiple post transplant complications
Conclusion
• Life style, particularly diet is a critical component of treatment for these conditions.
• Registered dietitians paly a key role in bridging the gap between the science of nutrition and the empowerment of individuals to alter their lifestyles in a healthy manner
• Diet intervention in relation with end stage renal disease is really complicated topic
References
• Available on Request
ContactPlease send me email in order you got any questions Email Address: [email protected] Mobile Number:0092_3331491063Edited by: Waqar Art Studios Mobile Number: 0092_3315173837 Email: [email protected]