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7 Renal Disease
Pages 132-151

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From page 132... ... in 1960 and subsequent developments such as peritoneal dialysis, home hemodialysis, and renal transplantation, the survival period for persons with severe renal disease has markedly increased. While the prognosis for persons with ESRD has improved, the number of patients continues to grow. Read the entire page →
From page 133... ... For the purpose of this report, three stages of chronic renal disease are considered: chronic renal insufficiency, ESRD, and post-renal transplantation. Chronic renal insufficiency (CRI) Read the entire page →
From page 134... ... Although many transplant recipients also have CRI, since the level of renal function usually remains subnormal after transplantation, for the purpose of this report, these patients are considered separately from those who have CRI, without a history of renal transplantation. As described below, three key findings suggest that nutrition therapy may substantially lessen or delay the burden of chronic renal disease. Read the entire page →
From page 135... ... It included two studies related to nutrition and the progression of renal disease: � Study A assessed low protein diets (0.58 g/kg body weight per day) combined with low phosphorus intakes (5 to 10 mg/kg body weight per day) Read the entire page →
From page 136... ... A second limitation of the Study was its short duration, with an average intervention time of only 2.2 years. Many have interpreted the failure of the MDRD Study to demonstrate a beneficial effect of protein restriction over a 2- to 3-year period as proving that low protein diets do not slow renal disease. Read the entire page →
From page 137... ... , which included the MDRD Study A, reported a beneficial effect of a low protein diet on the incidence of renal failure or death (relative risk [RR] = 0.67, 95 percent confidence interval [CI] Read the entire page →
From page 138... ... Based on secondary analyses of the MDRD study results in conjunction with data from other randomized trials, it has been recommended that a protein intake of 0.6 g/kg/day for patients with chronic renal disease should be recommended (Levey et al., 1999~. Because older individuals make up a large fraction of those with renal insufficiency and because there is motivation to follow this rather restricted diet because of the negative quality of life associated with dialysis treatment, older adults with renal insufficiency should be included in dietary treatment recommendations. Read the entire page →
From page 139... ... Nutritional Status during Chronic Renal Insufficiency 139 As will be discussed later, protein-energy undernutrition is a welldescribed important risk factor for morbidity and mortality in patients maintained on dialysis. Many studies have demonstrated a high prevalence of protein-energy undernutrition in patients beginning dialysis, suggesting that this disorder begins during the stage of CRI. Read the entire page →
From page 140... ... Treatment recommendations based on cardiovascular disease risk stratification should consider the "highest risk status" of patients with chronic renal disease. Risk Factors The excess risk for cardiovascular disease in chronic renal disease is caused, in part, by a higher prevalence of conditions that are recognized as risk factors for cardiovascular disease in the general population, such as older age, hypertension, hyperlipidemia, diabetes, and physical inactivity. Read the entire page →
From page 141... ... Preliminary data from the Framingham Study (a community-based observational study of factors associated with cardiovascular disease) also document an increased risk of fatal and nonfatal cardiovascular disease events in participants with elevated serum creatinine concentration, although the relationship was strongly related to age and coexisting cardiovascular disease risk factors (Culleton et al., 1999~. Read the entire page →
From page 142... ... Finally, nutrition therapy is necessary to address risk factors for cardiovascular disease which are highly prevalent in patients with CRI and ESRD. Summary of Evidence Nutrition Therapy for Chronic Renal Insufficiency (Pre-End Stage Disease) Read the entire page →
From page 143... ... Undernutrition is common among patients with renal disease, especially those who are dependent on dialysis (Schoenfeld et al., 1983; Young et al., 1991~. Several possible etiologies of undernutrition in renal failure have been explored, including the low protein diet restrictions (MDRD Study Group, 1994) Read the entire page →
From page 144... ... Further studies are needed to identify the most appropriate diet for patients with ESRD, and to determine the frequency, type, and duration of nutrition therapy. Until further data are available, it is recommended that nutrition services be continued at their present level and that surveillance efforts continue to ensure that there are adequate numbers of trained renal nutrition specialists available to meet the needs of ESRD patients. Read the entire page →
From page 145... ... has been subject to preliminary study for use with ESRD patients receiving hemodialysis. A concentrated solution containing modest amounts of amino acids, dextrose, fat, electrolytes, vitamins, and minerals is typically administered several times weekly by infusion during hemodialysis treatments. Read the entire page →
From page 146... ... Medicare considers the provision of nutritional services to ESRD patients a "minimal services requirement," which is a condition for coverage as part of comprehensive interdisciplinary care. End-Stage Renal Disease: Summary and Recommendations It is recommended that nutrition therapy for dialysis patients be continued at the present level and that surveillance continue to document that ESRD patients receive adequate nutrition therapy provided by a trained renal nutrition specialist. Read the entire page →
From page 147... ... Given the complexity of combined dietary modifications, nutrition therapy should be provided by a trained renal nutrition specialist. Insufficient data are available at this time to determine the appropriate type and frequency of nutritional intervention to maximize the nutritional status in these patients. Read the entire page →
From page 148... ... 1992. Controlled low protein diets in chronic renal insufficiency: Meta-analysis. Read the entire page →
From page 149... ... Man NK.1997. Incidence and risk factors of atherosclerotic cardiovascular accidents in predialysis chronic renal failure patients: A prospective study. Read the entire page →
From page 150... ... 1999. Dietary protein restriction and the progression of chronic renal disease: What have all the results of the MDRD study shown? Read the entire page →
From page 151... ... 1988. Use of water soluble vitamins in patients with chronic renal failure. Read the entire page →

From page 132...

... in 1960 and subsequent developments such as peritoneal dialysis, home hemodialysis, and renal transplantation, the survival period for persons with severe renal disease has markedly increased. While the prognosis for persons with ESRD has improved, the number of patients continues to grow.

7 Renal Disease Pages 132-151

7 Renal Disease
Pages 132-151