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Managing Chronic Kidney Disease: Strategies and Dietary Considerations

This guide explores the Cockcroft-Gault formula for estimating creatinine clearance and offers effective strategies to slow the progression of Chronic Kidney Disease (CKD). It emphasizes the importance of strict glycemic and blood pressure control, alongside treatments such as ACE inhibitors and dietary modifications. It addresses calcium-phosphate balance disturbances and provides dietary recommendations tailored to different stages of CKD, including protein intake guidelines and supplementation. Ultimately, effective management can mitigate cardiovascular risks and improve patient outcomes.

tobias-hatfield
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Managing Chronic Kidney Disease: Strategies and Dietary Considerations

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  1. CKD Creatinine clearance - Cockroft- Gault formula (140-age) x body mass (kg) Serum creatinine concentration x 72 Female x coefficient 0.85

  2. How to slow down the progress of CKD • Documented efficacy • Strict control of glicaemia (DM) • Strict control of blood pressure • ACE-I, Xartan • Non-documented efficacy • Reduction of protein in diet • Dyslipidaemia treatment • Partial correction of anaemia

  3. HA in CKD • Target values in treatment of HA in patients with CKD: • proteinuria < 1g/d - <130/80mmHg • proteinuria > 1g/d - <125/75mmHg

  4. Disturbances in Ca-P balance

  5. Disturbances in Ca-P balance • Reduction of P intake in diet • Medicines binding P in digestive tract: • Calcium carbonicum • Aluminium hydroxide (Alusal) • Lantan salts • Sewelamer (Renagel) • Calcimimetics: cinecalcet (selectively stimulates calcium receptor in parathyroid glands)

  6. CKD- diet Products rich in P: • offal • fish • yolk • milk and diary products, cheese; • sausages, ham; • soups (instant) • coca cola • turkey, duck, meat pastry • bean • cacao, nuts, chocolade, almonds • mushrooms

  7. Disturbances in Ca-P balance Ca X P product > 55 mg/dl (>4.4 mmol/l) Risk factor of: Death because of cardiovascular events Calcifications in soft tissues Recommendations: Reduction of calcium carb. dose Sewelamer Reduction of vit.D dose

  8. CKD - diet 2. Stable period of time (1-3 stage of CKD) • Protein restriction 0.8g/kg/day • P 800-1000 mg/day • Salt intake reduction in case of HA • Energy 30-35 kcal/kg/d, from carbohydrates and lipids

  9. CKD - diet 3. Non-stable period of time PROTEIN • Reduction of intake in order to diminish of urea production; • One should reduce it gradually, max to 0.4 g/kg/d; • 4 i 5 stage of CKD ( GFR<25 ml/min) 0.6 g/kg/d • strict monitoring of nutrition every 1-3 months

  10. CKD - diet • Protein must contain essential amino acids • Supplementation of keto-analogs of exogenous amino acids (Ketosteril)

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