Nutrition in Renal Failure
Nutrition in Renal Failure
Nutritional Guidelines for Chronic Renal Failure
| |Infant (108 |102 |4-6yr: 90 |♀11-14yr: 47 |
|(kcal/kg/d) |6-12mo: >98 | |7-10yr: 70 |♀ 15-18yr: 40 |
| | | | |♂11-14yr: 55 |
| | | | |♂ 15-18yr: 45 |
|Protein |0-6mo: 2.2 |1.2 g/kg |4-6: 1.2 g/kg |11-14: 1g/kg |
|(g/kg/d) |6-12mo: 1.6 | |7-10: 1g/kg |15-18:0.9 g/kg |
Nutritional Guidelines for Hemodialysis
| |Infant (108 |102 |4-6yr: 90 |♀11-14yr: 47 |
|(kcal/kg/d) |6-12mo: >98 | |7-10yr: 70 |♀ 15-18yr: 40 |
| | | | |♂11-14yr: 55 |
| | | | |♂ 15-18yr: 45 |
|Protein |0-6mo: 2.6 |1.6 g/kg |4-6: 1.6 g/kg |11-14: 1.4 g/kg |
|(g/kg/d) |6-12mo: 2.0 | |7-10: 1.25 g/kg |15-18: ♂ 1.3 |
| | | | |♀ 1.2 |
Nutritional Guidelines for Peritoneal Dialysis
| |Infant (108 |102 |4-6yr: 90 |♀11-14yr: 47 |
|(kcal/kg/d) |6-12mo: >98 | |7-10yr: 70 |♀ 15-18yr: 40 |
| | | | |♂11-14yr: 55 |
| | | | |♂ 15-18yr: 45 |
|Protein |0-6mo: 2.9-3.0 |1.9-2.0 g/kg | | |
|(g/kg/d) |6-12mo: 2.3-2.4 | |4-6: 1.9-2.0 g/kg |11-14: 1.7-1.8 g/kg |
| | | |7-10: 1.7-1.8 g/kg |15-18: 1.4-1.5 g/kg |
Nutrition on Peritoneal Dialysis
▪ Nutritional benefits:
▪ Liberalization of dietary restrictions
▪ Calories from dialysate dextrose (9-18 kcal/kg/day; 7-15% of total daily caloric intake)
▪ Nutritional cons:
▪ Losses of proteins (Ig, albumin, transferrin), amino acids, vitamins, trace elements
▪ Intra-abdominal pressure ( anorexia, reflux
▪ Hyperglycemia
▪ Protein losses: between 100-300 mg/kg/day (10% of total daily intake)
▪ Increased losses during peritonitis
CRRT
▪ Common modality in acutely ill patients
▪ Allows for unrestricted fluid intake
▪ Hypercatabolism, hypermetabolism
▪ High protein requirements
▪ Amino acid losses
▪ Losses of vitamins and trace elements (Selenium, Copper, Thiamine, Phosphorus)
Caloric requirements during acute illness
▪ Average Hospital Requirements:
▪ 0-10 kg: 100 kcal/kg/day
▪ 10-20 kg: 1000 + 50 kcal/kg
▪ 20-30 kg: 1500 + 20 kcal/kg
▪ Increased energy requirements:
▪ Fever: ↑12% per degree celsius >37
▪ Heart Failure: ↑15-25%
▪ Surgery: ↑20-30%
▪ Severe Sepsis: ↑40-50%
Basal Metabolic Rate
|Males |Females |
|0-3: 60.9 x wt - 54 |0-3: 61.0 x wt - 51 |
|3-10: 22.7 x wt + 495 |3-10: 22.5 x wt + 499 |
|10-18:17.5 x wt + 651 |10-18: 12.2 x wt + 746 |
|Energy Requirement= BMR x activity factor |Activity Factor |
| |Confined to bed: 1.2 |
| |Sedentary: 1.5 |
| |Normal: 1.7 |
| |Athlete: 2.0 |
Calcium Recommendations (provided patient does not have hypercalcemia)
• Infants: 600mg/day
• Toddlers: 800mg/day
• Children: 800mg/day
• Adolescents 1200mg/day
Vitamins/Minerals
▪ Water soluble vitamin supplementation
▪ B vitamins
▪ Avoid high doses of vitamin C and B6: Hyperoxalemia and peripheral neuropathy
▪ Avoid fat soluble vitamins- risk of toxicity
▪ Vitamin A levels often increased due to increased retinol binding protein
▪ Accumulation/deficiency of trace elements
▪ Zinc deficiency
▪ Selenium deficiency
▪ Accumulation of aluminum
Nutritional Supplements
▪ DPI = RDA + losses
▪ Use of amino acid-based dialysis solutions
▪ Risks: increased BUN, metabolic acidosis, anorexia, nausea, expensive
▪ Water soluble vitamins-goal RDA
Dyslipidemia
▪ Affects up to 70% of patients with CKD
▪ Type IV hyperlipoproteinemic pattern (Hi triglycerides, Hi VLDL, Low HDL, Low/low-nl LDL)
▪ Do not be misled by a low Total Cholesterol– a common sign of malnutrition!
Food: Renal Diets
▪ Restrictions may include: Sodium, Potassium, Phosphorus, Fluid
▪ Renal Diet Orders – Do’s & Don’ts
▪ Do specify each restriction quantitatively ie. 2 gm K+ (not ‘Low sodium’)
▪ Don’t write for mMoles phos – write it as mg Phos
Renal Formulas
▪ Similac PM 60/40
▪ Calories: 0.67 cal/mL
▪ Protein:16g/L (whey/casein)
▪ Fat 38 g/L
▪ K: 15 meq/L
▪ Ca/P: 380/190 (mg/L)
▪ Amin-aid
▪ Calories: 2 kcal/mL
▪ Protein: 19 g/L (free AA)
▪ Fat: 46 g/L
▪ K: ................
................
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