1 / 22

Feast or Famine: Survival and Chronic Kidney Disease

Feast or Famine: Survival and Chronic Kidney Disease. Kerin Worley and Deb Gipson UNC Chapel Hill April, 2004. 1. Select the patient for whom a UNC standard renal diet is appropriate. Answer yes or no to each option:

inigo
Download Presentation

Feast or Famine: Survival and Chronic Kidney Disease

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Feast or Famine: Survival and Chronic Kidney Disease Kerin Worley and Deb Gipson UNC Chapel Hill April, 2004

  2. 1. Select the patient for whom a UNC standard renal diet is appropriate Answer yes or no to each option: A. 6 month old with posterior urethral valves and chronic renal insufficiency (eGFR 35) B. 15 year old with nephrotic syndrome (Urinary protein excretion 5 gm/day) and normal serum creatinine (0.7) C. 8 year old dependent on peritoneal dialysis D. 5 year old dependent on hemodialysis E. 11 year old with a functioning kidney transplant

  3. 1. Select the patient for whom a UNC standard renal diet is appropriate Answer yes or no to each option: A. 6 month old with posterior urethral valves and chronic renal insufficiency (eGFR 35) No B. 15 year old with nephrotic syndrome (Urinary protein excretion 5 gm/day) and normal serum creatinine (0.7) No C. 8 year old dependent on peritoneal dialysis No D. 5 year old dependent on hemodialysis No E. 11 year old with a functioning kidney transplant No

  4. 2. What are the restricted ingredients of a standard UNC Hospitals renal diet? Answer yes or no to each option: A. water B. sodium C. potassium D. phosphorus E. flavor

  5. 2. What are the restricted ingredients of a standard UNC Hospitals renal diet? Answer yes or no to each option: A. water No B. sodium Yes C. potassium Yes D. phosphorus No E. flavor :)

  6. 3. What is the proper diet for a child with dialysis dependence? Write the order please: Diet: ____________________________

  7. 4. What is the most appropriate diet for an infant with posterior urethral valves and chronic renal insufficiency (eGFR 30)? Write the order please: Diet: ____________________________

  8. Somatic Growth in Children with CKD Impairment related to • Diminished caloric intake • Increased risk of calorie loss: GERD • Acidosis • Polyuria w/ early satiety • IGF/Growth Hormone Axis disturbance • Age of onset of CKD • Severity of renal failure • co-morbidities/syndromes

  9. How do our children grow?NAPRTCS 2003 ADR: CRI Registry Ht SDS Entry 12 24 36 Time (months)

  10. Weight and CRINAPRTCS 2003 ADR: CRI Registry Weight SDS entry 12m 24 m 36 m

  11. Growth and Dialysis in ChildrenNAPRTCS 2003 ADR: Dialysis Registry Entry Month 12 Month 24 Weight SDS Age 0-1 -2.36 -1.83 -1.30 2-5 -1.28 -1.32 -1.21 6-12 -1.26 -1.24 -1.42 >12 -1.00 -1.02 -1.28 Height SDS Age 0-1 -2.52 -2.31 -2.12 2-5 -1.99 -2.24 -2.03 6-12 -1.75 -1.89 -2.17 >12 -1.33 -1.45 -1.59

  12. Nutritional Focus: 1985 and beyondUSRDS, 2001 ADR Death rates on dialysis for children age 0-19 Hemodialysis Year 1: 29/1000 patient years Year 2: 32/ 1000 patient years Peritoneal Dialysis Year 1: 60 / 1000 patient years Year 2: 34 / 1000 patient years

  13. Hypoalbuminemia and Survival in ESRDC. Wong, Kidney Int. 61, 2002 • Incident dialysis patients 1995 - 1998 • N=1723 • Age 0-18 years • Outcome: mortality • 93 deaths over 2953 patient-years observed Mortality rate of 31.5 / 1000 pt years

  14. Hypoalbuminemia and Survival in ESRDC. Wong, Kidney Int. 61, 2002 Mortality Risk Albumin < 3.5 g/dL RR 1.90 (1.16, 3.10) Adjusted for gender, age, race, modality, etiology of esrd, height sds and wt sds Insert fig 1 c. wong 2002 ki

  15. Prevalence of Protein MalnutritionA. Brem, P. Nephrol, 2002 • Given hypoalbuminemia is a surrogate for mortality risk • Question the prevalence of serum albumin<2.9 in • children PD • children HD • adults PD • Assess nutritional protein intake

  16. Prevalence of Protein MalnutritionA. Brem, P. Nephrol, 2002 Dietary protein intake is assessed as Protein Catabolic Rate (PCR). National dialysis guidelines recommend PCR of 1g/kg/day (KDOQI)

  17. Correlates of Protein Malnutrition in ChildrenA. Brem, P. Nephrol, 2002 S Alb at dialysis initiation correlates with future hypoalbuminemia risk Relationship between Inflammation and S Alb

  18. CKD Severity and NutritionL Norman, P Nephrol. 15, 2000 GFR N Age RD consult Cal Intake(% Goal) > 75 35 8.2 3% 103 50-75 23 8.2 13% 99 25-49 19 8.5 37% 92 <25 61 10.2 61% 85 Insert figure 1 Comparison of anthros and CKD severity

  19. CKD and BMI: The big UC. Wong, AJKD 36, 2000 N=1949 Prevalent ESRD All Modes ‘89-’91 aRR for Death BMI Standard Deviation Score P=0.001

  20. Dietary protein and progressive CKD • Adults (Klahr, NEJM, 1994) • Modification of Diet in Renal Disease Study (MDRD) • RCT of protein restriction • Inclusion GFR 25 - 55ml/min • Usual diet (P 1.3 g/d) vs Low diet (P 0.58 g/d) • 2-3 years follow up • GFR decline ~ 5 ml/min/yr in both • Pediatrics • Dietary protein intake to RDA / optimize nutritional status • No association between protein restriction and CKD progression in small studies

  21. Kerin Worley, RD

  22. Distribution of height SDS of 1949 patients compared with children in US general population Wong CS et al. Am J Kidney Dis 2000; 36(4):811-819

More Related