Taryn Berry
Medical Nutrition Therapy Diet-Acute Renal Failure
1. Purpose
a. Nutrition Indicators-screening the individuals should be the first step of
nutrition assessment, both subjective and objective components. This includes
anthropometric measures and physical examination (height, weight, presence
of edema), biochemical data (serum, BUN, GFR, cholesterol, calcium,
phosphorus, intake/output), and nutrition (usual intake, 24 hour recall,
chewing/swallowing ability) and medical history (disease state, treatment,
nutrition implications, medication interactions).
b. Criteria to Assign the Diet-weight indicators (percent IBW, unintentional weigh
change, edema/fluid loss), alimentation indicators (decrease P.O. intake,
TPN/PPN/TF, nausea/vomiting/anorexia/ileus), biochemical indicators
(hypoalbuminemia, trend of electrolytes), clinical indicators (etiology of renal
failure, comorbid conditions, recent surgery, ventilator support, renal
replacement therapy, medication)
c. Rationale for Diet-nutrition consultation is indicated if enteral or parenteral
nutrition is prescribed. Risk factors for protein-energy malnutrition in acute
renal failure increase in certain states and should be monitored.
2. Population
a. Overview-Acute renal failure occurs in approximately 20% of the patients
admitted into the intensive care unit because of complications following sepsis,
trauma, or multiple organ failure. For acute renal failure, Continuous Renal
Replacement Therapy (CRRT) is used in some cases. This form of dialysis is
used to slowly remove fluids and solutes, as well as, correct electrolyte and
metabolic abnormalities. There are two different kinds of CRRT, arteriovenous
renal replacement therapies and venovenous renal replacement therapies based
on the patients blood pressure.
b. Disease Process- Acute renal failure, or acute renal injury, is often a response
to sepsis, trauma, or multiple organ failure. There are three stages of acute
renal failure, prerenal, intrarenal, and postrenal. The prerenal stage is when
something decreases blood flow to the kidney, decreasing the glomerular
filtration rate. The intrarenal stage is when part of the kidney is damaged. The
postrenal stage is when a crystal or other structure is obstructing urine flow.
The dialytic method depends on the situation. In any stage, the kidneys lose the
ability to create urine and filter the body’s waste. This can cause dangerous
levels of waste to accumulate and affect the chemical makeup of the blood.
c. Biochemical and Nutrient Needs-Protein intake should be adjusted according
to the following, clinical condition, degree of catabolism, extent of impairment
of renal function, and whether renal replacement has been started. Electrolytes
should be monitored to avoid refeeding syndrome and vitamin/mineral should
also be monitored to maintain within the acceptable range.
3. General Guidelines
a. Nutrition Rx
 Protein: 0.8-1.2 g/kg of bodyweight without dialysis; 1.2-1.5 g/kg
bodyweight catabolic.
 Energy: 25-35 kcal/kg of bodyweight depending on stress/status of
nutrition.
 Sodium: 2-3 g/day based on blood pressure, edema-replace in diuretic
phase.
 Potassium: 2-3 g/day- replace in diuretic phase.
 Phosphorous: 8-15mg/kg
 Calcium: maintain serum value with normal limits
 Fluid: 500 cc + urine output.
 Vitamins/Minerals: use DRIs and adjust to catabolic amounts.
b. Adequacy of Nutrition Rx- nutrition support might improve prognosis, but has
not been confirmed. Negative nitrogen balance indicates that the patient should
be provided with optimal nutrients.
c. Goals-Include eliminating the cause of kidney failure, prevent further damage,
support kidneys and other affected organs, provide adequate protein and
energy, preserve lean body mass, prevent deficiencies, maintain/improve
electrolyte and fluid imbalance, manage anemia, reassess drugs, promote
recovery.
d. Does it Meet DRI-if given the correct amount of nutrients, as stated above, the
DRI values should be met. Based on dialysis losses, inadequate intake, drugnutrient interaction, and increased needs, supplements should be given.
4. Education Material
a. Nutrition Therapy-it has not been proven that nutrition support helps in the
recovery of renal function or survival but its has supporting evidence to suggest
it is beneficial in those with acute renal failure. Preventing and minimizing
malnutrition by providing adequate amounts of protein, calories, and other
nutrients is necessary.
b. Ideas for Compliance-focusing on one nutrient at a time, providing daily meal
plans, providing lists of foods that are low or high in a specific nutrient of
interest, be positive, be accessible to patient, and explain the benefits of
following the new diet.
5. Sample Menu
a. Foods Recommended
 Low potassium: apples, blackberries, grapes, pineapple, celery, corn,
onions, pasta, bread, rice.
b. Foods to Avoid
 Limit phosphorous: phosphorous containing food include seeds, nuts,
cheese, pork, shellfish, soy foods, beans, and salmon
 Avoid added salt: tv dinners, bagged foods (ex. chips, pretzels), canned
soup, and fast food.
c. Example of a meal plan
 Breakfast-toast with butter, 1egg, apple juice.
 Snack-Mixed berry smoothie.
 Lunch-Grilled chicken sandwich, celery and peanut butter.
 Snack- Grapes.
 Dinner-Mixed green salad (lettuce, cucumber, onion, low sodium
dressing), quesadilla with peppers, eggplant, and corn.
 Snack-Dairy free ice cream
6. Websites
a. Organizations with Websites
 American Kidney Fund- http://www.kidneyfund.org/
 DaVita- http://www.davita.com/
 The National Kidney Foundation- https://www.kidney.org/
b. Government Websites
 MedlinePlushttp://www.nlm.nih.gov/medlineplus/ency/article/000501.htm
 National Kidney Disease Education Programhttp://nkdep.nih.gov/resources/eating-right-508.pdf
7. References
a. Journal articles references
Nutrition Care Manual. “Acute Renal Failure.”
https://www.nutritioncaremanual.org/topic.cfm?ncm_category_id=1&lv1=5537&lv2=25
5347&ncm_toc_id=23011&ncm_heading=Nutrition%20Care
“Acute Kidney Failure: Lifestyle and Home Remedies.” Mayo Clinic.
http://www.mayoclinic.org/diseases-conditions/kidney-failure/basics/lifestyle-homeremedies/con-20024029