CKD
Description of patient and diagnosis:
Client: 50 year old white female, Juanita Robertson, has suffered a 20 year battle with kidney
disease and was recently progressed to stage 3 chronic kidney disease (CKD). She is a manager of a
restaurant who is 5’4’’ tall and weighs 133lbs. She has been placed on a renal diet but she will not be
receiving dialysis. Her doctor has given her a through description of her condition and she has come to
consult a new meal plan/diet instruction.
Etiology:
Chronic kidney disease is the kidneys decreased ability to filter the blood. If the kidneys decrease
the efficiency of filtering the blood then high levels of waste from the blood begins to accumulate. As a
result high blood pressure can occur, one can develop anemia, electrolyte imbalances and uremic
syndrome. After time, the kidney function continues to decrease while brain function and heart
problems can occur.
The two main causes of chronic kidney disease are diabetes mellitus and high blood pressure.
Diabetes occurs when serum glucose levels is too high, causing damage to many organs in your body,
including the kidneys and heart, as well as blood vessels, nerves and eyes. High blood pressure, or
hypertension, occurs when the pressure of blood against the walls of the blood vessels increases. If
uncontrolled, high blood pressure can be a leading cause of heart attacks, strokes and chronic kidney
disease.
Diagnostic Measures:
In determining if one is at risk for having chronic kidney disease (CKD) test include measuring of
blood pressure, testing serum creatinine to estimate GFR, estimate albumin-to-creatinine ratio after a
fasting state and to examine the urine sediment for red and white blood cells. kidney function is
normally expressed as the glomerular filtration rate (GFR). Normal GFR is 90-130 mL/minute. A normal
blood urea nitrogen (BUN) level is 5-25 mL/dL. Urea is a waste product from the metabolism of
proteins. When the kidneys begin to fail to eliminate urea in the urine, urea will build up in the blood.
The 5 stages of kidney disease are:
▪ Stage 1—GFR is more than 90 mL/minute, with persistent protein in the urine
▪ Stage 2—GFR is 60-89 mL/minute, with persistent protein in the urine (mild disease)
▪ Stage 3—GFR is 30-59 mL/minute (moderate disease)
▪ Stage 4—GFR is 15-29 (severe disease)
▪ Stage 5—GFR is less than 15 or individual is on dialysis (kidney failure)
Other diagnostic tests include blood electrolyte tests, a kidney biopsy, testing BUN and creatinine levels
and a hemoglobin A1C test.
Discussion of the disease:
Treatment:
There is no cure for CKD, only maintenance of the remaining kidney function. Diet modification
is among the most important maintenance measures. Other medications that are recommended for
chronic kidney disease patients include iron supplements, calcium tablets, phosphorus binders, blood
pressure medications and corticosteroids. The dietary supplements such as the calcium tablets, iron
supplements and phosphate binders are all important because these important nutrients can become
deficient with the dietary restrictions that come with a renal diet. Important medication to avoid
include milk of magnesia, aspirin, laxatives vitamin or food supplements and alka seltzer. These are
important to avoid because these medications have an effect of the buildup of specific nutrients in the
body that affect kidney function.
If the disease does progress to total renal failure, the patient will have to undergo dialysis treatment
and/or receive a kidney transplant.
Proper diet instruction about the renal diet is necessary for all CKD patients to obtain. This can be given
through a registered dietitian or licensed diabetes educator.
Medical Nutrition Therapy
Estimated Caloric Needs:
655 + (9.56 ˣ 60) + (1.85 ˣ 162.5)-(4.68 ˣ 50) = 1,295
1,295 ˣ 1.2= 1,554 calories/day
Mrs. Robertson needs approximately 1,500 calories/day.
PRO Needs:
.5 g/kg ˣ 60kg = 30 grams of protein a day
30g ÷ 7g/oz= 4.2 oz /day.
CHO Needs:
1,500 ˣ .55= 825g/day
FAT Needs:
1,500 ˣ .3= 450 g/day
Limiting Protein:
Important dietary restrictions of protein are critical for patients with CKD. Protein restriction
isn’t necessary until stage 3 and later on in the disease. A normal person should consume approximately
.8-1.2 g/kg of ideal body weight per day. A person on a renal diet who is not going through dialysis
should consume .4-.6 g/kg of ideal body weight per day. Limiting protein can help reduce the waste
products of metabolism and therefore reduce the workload of the kidneys.
Calorie Intake:
Those who are overweight/obese should create a healthy diet plan that will encourage weight
loss while still maintaining the renal diet restrictions.
Limit Sodium Intake:
Increased sodium levels can lead to increased blood pressure, thirst and swelling. This can have an
overall negative effect of overall kidney function. It is recommended that CKD patients on the renal diet
consume no more than 2,400 mg of sodium per day. Those with CKD should avoid cooking with salt,
snacking on salty foods such as chips, pretzels or salted nuts. It is also recommended to avoid canned
foods and other processed foods in order to reduce sodium consumption.
Phosphorus Intake:
If the kidneys have decreased function then phosphorus levels can build up in the blood and
lead to bone disease. When there is too much phosphorus in the body calcium is pulled from the bones
therefore causing osteoporosis. By taking a phosphate binder when food is consumed the medication
will bind to the excess phosphorus in the body and eliminate it through stool. Those with CKD should
consume approximately 800-1,000 mg of phosphorus a day.
Potassium:
When kidney function is reduced, potassium can build in the blood and lead to fatal heart
arrhythmias. It is recommended that those on the renal diet shouldn’t consume more than 2,000mg of
potassium a day.
Fluid Restriction:
As kidney function worsens it is important to control the amount of fluid that the body intakes
in order to control swelling. It’s important to consider how much urine is produced when calculating
how much fluid a CKD patient is allowed to receive. Generally only 4 cups of fluid is allowed per day. It
is important not to forget the amount of liquids that could be hidden in food i.e- watermelon or
cucumbers.
Vitamins and Minerals:
As mentioned earlier with the limited amount of intake that comes with a renal diet it is
important to incorporate vitamin and mineral supplementation. Multivitamins should be avoided
because it would increase the amount of phosphorus and potassium in the patient. Instead, water
soluble vitamins such as C and B should be supplemented to ensure they are adequately utilized in the
body. Likewise iron and zinc supplements should be taken in order to prevent deficiency due to the low
protein diet. Calcium supplementation is suggested because of the limit in fluid restriction that the
patient is allowed to have.
Prognosis:
There is no cure for chronic kidney disease. The maintenance of the remaining kidney function is key to
prolonging further kidney dysfunction. If the disease does progress, total kidney failure will occur and
the patient will need to begin dialysis treatment or undergo a renal transplant.
Work Cited
About chrinic kidney disease. (2010, November 20). Retrieved from
http://www.kidney.org/kidneydisease/aboutckd.cfm
Addison, G. (2011, September 17). Chronic kidney disease. Retrieved from
http://www.webmd.com/a-to-z-guides/chronic-kidney-disease-what-happens
Chronic kidney disease. (2011, September 9). Retrieved from
http://www.nlm.nih.gov/medlineplus/ency/article/000471.htm
Ckd guidelines. (2011, March 12). Retrieved from
http://www.kidney.org/professionals/kdoqi/guidelines_ckd/p9_approach.htm
Guidelines for a low sodium diet. (2006, March). Retrieved from
http://www.ucsfhealth.org/education/guidelines_for_a_low_sodium_diet/index.html
How much is one ounce. (2007, November). Retrieved from
http://nutrition.cedwvu.org/howmuchmeat.php
Nutrition and chronic kidney disease. (2010, December 15). Retrieved from
http://www.kidney.org/atoz/pdf/nutri_chronic.pdf
Taylor, B. (2012, January 31). Chronic kidney disease stages. Retrieved from
http://effectivehealthcare.ahrq.gov/index.cfm/search-for-guides-reviews-andreports/?pageaction=displayproduct&productid=936
Thompson, W. (2011, April 2). A parent's guide to chronic kidney disease. Retrieved from
http://www.unckidneycenter.org/kidneyhealthlibrary/CKD/CKD Education Book.pdf
Spencer, F. (2009, October 11). The renal diet. Retrieved from
http://www.vcuhealth.org/upload/docs/Transplant/renal_diet.pdf