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CKD

CKD. Creatinine clearance - Cockroft- Gault formula (140-age) x body mass (kg) Serum creatinine concentration x 72 Female x coefficient 0.85. How to slow down the progress of CKD. Documented efficacy Strict control of glicaemia (DM) Strict control of blood pressure ACE-I, Xartan

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CKD

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  1. CKD Creatinine clearance - Cockroft- Gault formula (140-age) x body mass (kg) Serum creatinine concentration x 72 Female x coefficient 0.85

  2. How to slow down the progress of CKD • Documented efficacy • Strict control of glicaemia (DM) • Strict control of blood pressure • ACE-I, Xartan • Non-documented efficacy • Reduction of protein in diet • Dyslipidaemia treatment • Partial correction of anaemia

  3. HA in CKD • Target values in treatment of HA in patients with CKD: • proteinuria < 1g/d - <130/80mmHg • proteinuria > 1g/d - <125/75mmHg

  4. Disturbances in Ca-P balance

  5. Disturbances in Ca-P balance • Reduction of P intake in diet • Medicines binding P in digestive tract: • Calcium carbonicum • Aluminium hydroxide (Alusal) • Lantan salts • Sewelamer (Renagel) • Calcimimetics: cinecalcet (selectively stimulates calcium receptor in parathyroid glands)

  6. CKD- diet Products rich in P: • offal • fish • yolk • milk and diary products, cheese; • sausages, ham; • soups (instant) • coca cola • turkey, duck, meat pastry • bean • cacao, nuts, chocolade, almonds • mushrooms

  7. Disturbances in Ca-P balance Ca X P product > 55 mg/dl (>4.4 mmol/l) Risk factor of: Death because of cardiovascular events Calcifications in soft tissues Recommendations: Reduction of calcium carb. dose Sewelamer Reduction of vit.D dose

  8. CKD - diet 2. Stable period of time (1-3 stage of CKD) • Protein restriction 0.8g/kg/day • P 800-1000 mg/day • Salt intake reduction in case of HA • Energy 30-35 kcal/kg/d, from carbohydrates and lipids

  9. CKD - diet 3. Non-stable period of time PROTEIN • Reduction of intake in order to diminish of urea production; • One should reduce it gradually, max to 0.4 g/kg/d; • 4 i 5 stage of CKD ( GFR<25 ml/min) 0.6 g/kg/d • strict monitoring of nutrition every 1-3 months

  10. CKD - diet • Protein must contain essential amino acids • Supplementation of keto-analogs of exogenous amino acids (Ketosteril)

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