1. Dialysis is a treatment for kidney failure that filters waste and excess fluid from the blood. It significantly extends life but does not cure kidney disease, so dietary restrictions and medication are also needed.
2. Patients on dialysis must follow a renal diet low in potassium, phosphorus, sodium, and fluid to manage levels between treatments. This diet is difficult and can lead to malnutrition if not properly supplemented.
3. Drug dosing for patients on dialysis requires consideration of renal clearance and therapeutic index, as kidney failure reduces clearance for some drugs, potentially requiring lower doses or less frequent administration. Consulting dosing guides is essential for safety.
This document provides information on nutrition in renal disorders. It discusses the functions of the kidney and how renal damage can affect metabolism, nutritional requirements, and status. Common renal disorders like acute renal failure, chronic renal failure, end stage renal disease, and nephrotic syndrome are examined in terms of their consequences, treatment, and medical nutrition therapy. Specific dietary recommendations are provided around protein, sodium, potassium, phosphorus, calcium, and fluid intake for different kidney conditions. Sample menus are also included.
Diet treatment in liver cirrhosis - di Vincenzo Ostilio PalmieriMedOliveOil
Dieta nella cirrosi epatica - di Vincenzo Ostilio Palmieri. 21 giugno 2012. Corso di formazione "valore nutrizionale e salutistico di prodotti agroalimentari” - Università degli studi di Bari.
This document discusses nutrition for disorders of the liver, gallbladder, and pancreas. It covers diseases like hepatitis, fatty liver, cirrhosis, and hepatic encephalopathy. It discusses protein requirements and sources, as well as medical nutrition therapy for various conditions which includes restricting sodium for ascites, limiting protein for hepatic encephalopathy, and restricting fat and fiber for gallbladder disorders. Overall it provides an overview of the nutritional considerations and diet modifications for diseases affecting the liver, gallbladder, and pancreas.
The renal diet is important for kidney health as it helps the kidneys remove waste, filter blood, regulate fluid balance, and maintain electrolyte levels. The renal diet is low in sodium, protein, and phosphorus, limits certain fluid intake, and stresses including high quality protein. Following the renal diet helps maintain optimal nutrition status, prevents complications related to conditions like diabetes and hypertension, and minimizes waste buildup between treatments. The renal diet food list outlines which foods to emphasize or avoid to support kidney function.
This patient has stage 5 chronic kidney disease with several complications including anemia, hyperkalemia, metabolic acidosis, and upper gastrointestinal bleeding. He is a 46-year-old male with a history of hypertension for over 20 years who now requires hemodialysis. A nutritional assessment found him to be mildly overweight with biochemical indicators consistent with renal failure and anemia. A diet was prescribed providing 1900 calories, 70g protein, 55g fat, and 245g carbohydrates to meet his nutritional needs while undergoing hemodialysis treatment.
Nutritional management of renal diseasesWajid Rather
The document discusses the major roles of the kidney in metabolic regulation including water-electrolyte homeostasis, calcium-phosphate balance, waste product removal, acid-base balance, erythropoietin production, and blood pressure regulation. It then summarizes the goals of nutritional therapy in renal failure and discusses nutritional problems patients with renal failure often experience like anorexia and metabolic abnormalities. Guidelines for protein intake, energy intake, fluid intake, sodium intake, and potassium intake are provided for non-dialysis patients, patients undergoing hemodialysis, and patients undergoing peritoneal dialysis.
The document discusses chronic kidney failure and dietary options for patients with kidney disease. It explains how the kidneys normally function to filter waste and regulate chemicals and hormones. Kidney failure means the kidneys can no longer effectively perform these functions, leading to a buildup of waste and imbalances. The diet for someone with kidney disease must be carefully controlled and individualized to limit proteins, potassium, sodium, phosphorus, and fluids based on what their body can handle. Following the prescribed diet and monitoring indicators like weight, blood pressure, and lab tests is important for slowing the progression of kidney disease.
This document provides information on nutrition in renal disorders. It discusses the functions of the kidney and how renal damage can affect metabolism, nutritional requirements, and status. Common renal disorders like acute renal failure, chronic renal failure, end stage renal disease, and nephrotic syndrome are examined in terms of their consequences, treatment, and medical nutrition therapy. Specific dietary recommendations are provided around protein, sodium, potassium, phosphorus, calcium, and fluid intake for different kidney conditions. Sample menus are also included.
Diet treatment in liver cirrhosis - di Vincenzo Ostilio PalmieriMedOliveOil
Dieta nella cirrosi epatica - di Vincenzo Ostilio Palmieri. 21 giugno 2012. Corso di formazione "valore nutrizionale e salutistico di prodotti agroalimentari” - Università degli studi di Bari.
This document discusses nutrition for disorders of the liver, gallbladder, and pancreas. It covers diseases like hepatitis, fatty liver, cirrhosis, and hepatic encephalopathy. It discusses protein requirements and sources, as well as medical nutrition therapy for various conditions which includes restricting sodium for ascites, limiting protein for hepatic encephalopathy, and restricting fat and fiber for gallbladder disorders. Overall it provides an overview of the nutritional considerations and diet modifications for diseases affecting the liver, gallbladder, and pancreas.
The renal diet is important for kidney health as it helps the kidneys remove waste, filter blood, regulate fluid balance, and maintain electrolyte levels. The renal diet is low in sodium, protein, and phosphorus, limits certain fluid intake, and stresses including high quality protein. Following the renal diet helps maintain optimal nutrition status, prevents complications related to conditions like diabetes and hypertension, and minimizes waste buildup between treatments. The renal diet food list outlines which foods to emphasize or avoid to support kidney function.
This patient has stage 5 chronic kidney disease with several complications including anemia, hyperkalemia, metabolic acidosis, and upper gastrointestinal bleeding. He is a 46-year-old male with a history of hypertension for over 20 years who now requires hemodialysis. A nutritional assessment found him to be mildly overweight with biochemical indicators consistent with renal failure and anemia. A diet was prescribed providing 1900 calories, 70g protein, 55g fat, and 245g carbohydrates to meet his nutritional needs while undergoing hemodialysis treatment.
Nutritional management of renal diseasesWajid Rather
The document discusses the major roles of the kidney in metabolic regulation including water-electrolyte homeostasis, calcium-phosphate balance, waste product removal, acid-base balance, erythropoietin production, and blood pressure regulation. It then summarizes the goals of nutritional therapy in renal failure and discusses nutritional problems patients with renal failure often experience like anorexia and metabolic abnormalities. Guidelines for protein intake, energy intake, fluid intake, sodium intake, and potassium intake are provided for non-dialysis patients, patients undergoing hemodialysis, and patients undergoing peritoneal dialysis.
The document discusses chronic kidney failure and dietary options for patients with kidney disease. It explains how the kidneys normally function to filter waste and regulate chemicals and hormones. Kidney failure means the kidneys can no longer effectively perform these functions, leading to a buildup of waste and imbalances. The diet for someone with kidney disease must be carefully controlled and individualized to limit proteins, potassium, sodium, phosphorus, and fluids based on what their body can handle. Following the prescribed diet and monitoring indicators like weight, blood pressure, and lab tests is important for slowing the progression of kidney disease.
Nutrition of patients undergoing dialysisManiz Joshi
This document discusses nutritional assessment and dietary recommendations for dialysis patients. It outlines several methods for assessing nutritional status, including physical exams, body composition measurements, functional tests, and biochemical markers like serum albumin and prealbumin. Optimal intake levels are provided for proteins, sodium, fluids, potassium, phosphorus, and various vitamins. Maintaining adequate nutrition through diet and supplements is important for dialysis patients given losses during treatment and high risk of malnutrition.
After this presentation, you should be able to:
Critically evaluate the scientific rationale regarding dietary Na+, P, K+, and fluid restrictions in HD patients, and why these restrictions may be misguided.
Better communicate with HD patients and clinic staff the nuances of these dietary restrictions.
Promote efficacious physical activity programs for hemodialysis patients.
Nutrition and liver diseases by Dr.P.Nazninazni peerkhan
This document discusses nutrition and liver diseases. It begins by providing an overview of liver anatomy and functions. The liver plays a key role in metabolizing nutrients, storing vitamins and minerals, filtering blood, and converting ammonia to urea. Chronic liver diseases can develop from viral infections, alcohol use, toxins, and autoimmune conditions. Cirrhosis is a common end-stage result, severely damaging liver structure and function. Malnutrition is common in cirrhosis patients due to reduced food intake and absorption. Treatment focuses on meeting calorie, protein, sodium, fluid and vitamin needs. Jaundice and hepatitis are also discussed, including causes, symptoms and dietary recommendations like hydration and avoiding alcohol.
This document provides information on dietary considerations for individuals with renal disease. It begins by defining renal failure and discussing the types and causes of both acute and chronic renal failure. Key principles of diet modification for renal disease include restricting fluids, sodium, potassium, and protein based on the individual's condition and lab values. Micronutrients may need to be supplemented depending on the stage of renal disease. The document provides dietary recommendations and strategies for managing conditions like renal calculi. Overall, the document outlines the essentials of medical nutrition therapy for supporting individuals with acute or chronic kidney injury or disease.
This document provides an overview of renal nutrition for non-renal dietitians. It discusses the basics of kidney function including measurement of glomerular filtration rate and stages of chronic kidney disease. Prevalence of CKD and end stage renal disease are noted. The roles and responsibilities of renal dietitians are outlined. Guidelines for protein and fluid intake at different stages of CKD are presented. Management of complications like potassium levels, edema and malnutrition are covered. A case study is provided to demonstrate application of renal nutrition principles.
This document discusses nutritional management of chronic renal disease. It covers several key topics:
- Protein restriction is important to reduce workload on kidneys and lower blood pressure. High-quality proteins like egg are recommended.
- Phosphorus intake should be restricted to reduce calcium-phosphorus crystallization in kidneys. The calcium to phosphorus ratio should be over 1.
- Sodium intake must be restricted to control hypertension, with a goal of 15-50 mg/kg daily for dogs and 0.24% salt for cats. Several renal-friendly diet formulations are provided for dogs and cats.
It include the definition , signs and symptoms, types, diagnosis, medical management, Nursing management, preventive measures, complication, Post exposure prophylaxis of Hepatitis.
The document discusses nutrition care for patients with chronic kidney disease (CKD) and those undergoing hemodialysis (HD). It outlines the stages of CKD based on glomerular filtration rate. The nutrition care process involves assessment, diagnosis, intervention, and monitoring. Key dietary recommendations for CKD and HD patients include restricting protein, sodium, and phosphorus while maintaining adequate energy, carbohydrates, and fat intake. Regular nutrition counseling and monitoring of nutritional status indicators are important for managing the disease and preventing complications.
Kidneys are the vital organs in the human body. Its main function is to remove the waste products from our body. At the stages of kidney disease it can’t completely remove toxins, excess salt, water, etc. So these waste products build up in the body and create problems. At the stages of kidney disease we have to follow a healthy renal diet without overloading kidneys. Here we are providing a general diet for kidney disease patients also who are prone to kidney disease. By making simple changes in lifestyle & diet we can improve renal health. Here also provided three simple tests to check for kidney diseases.
This document discusses dietary guidelines for kidney health. It notes that kidneys play a key role in nutrient homeostasis and that loss of kidney function disrupts this. For chronic kidney disease (CKD) patients, guidelines recommend a daily protein intake of 0.6-0.8g/kg, limiting fat intake to 30% of calories, and restricting sodium and phosphorus intake. While protein restriction may slow CKD progression, large trials like MDRD found little overall benefit. A plant-based, low-protein diet that is low in phosphorus and sodium may be most suitable for CKD patients. Focusing on overall dietary patterns like the DASH diet may be more practical than individual nutrient restrictions.
Management of nutrition in patients with renal failure is challenging as malnutrition occurs in up to 40% of such patients and is associated with increased morbidity and mortality. Malnutrition has multiple contributing factors, including decreased food intake due to gastrointestinal symptoms. Providing appropriate calorie and protein intake tailored to the patient's stage of kidney disease is important to permit adequate nutrition without unnecessary restrictions. Nutritional assessment, monitoring guidelines for calories, proteins and minerals, and specialized nutrition support are crucial for managing the nutrition of renal failure patients.
Dr. Waleed El-Refaey is a lecturer of internal medicine and nephrology. He discusses the benefits of physical activity for patients with chronic kidney disease (CKD). Regular exercise can improve cardiovascular health, reduce risk factors like blood pressure, and help prevent muscle wasting which is common in CKD patients. Exercise is also associated with reduced inflammation, improved exercise capacity and quality of life, and psychological benefits. The document emphasizes that physical activity has important protective effects across all stages of CKD.
This document discusses nutrition support for hospitalized patients. It notes that malnutrition is common in hospitals and associated with poor outcomes. Medical nutrition therapy includes oral supplements, enteral nutrition via tubes, and parenteral nutrition. Enteral nutrition is preferred over parenteral when possible due to gut health benefits. Early initiation of oral or enteral feeding after surgery improves outcomes. Monitoring for complications like diarrhea or aspiration is important when using nutrition support.
Applied nutrition 3 rd presentation - diseases of liver, gall bladder, and ...MD Specialclass
The document provides detailed information about diseases of the liver, gallbladder, and pancreas. It discusses the anatomy and functions of the liver, signs and symptoms of various hepatitis types, cirrhosis, and hepatic coma. It also covers cholecystitis, including causes, clinical manifestations, and dietary management for related conditions.
This document provides information on medical nutrition therapy for a patient with end-stage renal disease undergoing hemodialysis. The patient has a GFR of 12 mL/min and receives hemodialysis twice a week. The goals of medical nutrition therapy are to prevent deficiencies, control fluid balance and electrolytes, and prevent complications related to calcium and phosphorus levels. The dietitian provides calculations to determine the patient's energy, protein, fluid and electrolyte needs and prescribes an appropriate diet.
The document discusses guidelines for determining insurance coverage of home parenteral nutrition (PN). Coverage requires a permanent condition preventing sufficient oral nutrient absorption. Specific criteria include short bowel syndrome, malabsorption, or motility disorders unresponsive to other interventions. Initiation of PN requires documentation of the condition and failed enteral nutrition trials. Ongoing coverage requires monitoring that the criteria supporting medical necessity are still met.
Chapter 22 Nutrition and Renal Diseases KellyGCDET
The document discusses various kidney diseases and conditions. It begins by describing the anatomy and functions of the kidney, including filtering waste from the blood and regulating fluid, electrolytes, and acid-base balance. It then covers specific conditions like nephrotic syndrome, acute kidney injury, chronic kidney disease, and kidney stones. For each, it discusses causes, consequences, diagnostic assessments, and treatment approaches including nutrition therapy. Nutrition interventions aim to address issues like fluid balance, electrolyte levels, protein-energy status, and dietary modifications for related diseases.
This document discusses nutrition and liver diseases. It covers fatty liver and hepatitis, their causes and symptoms. Cirrhosis is discussed as the late stage of liver disease, with alcohol and hepatitis C being the chief causes in the US. Complications of cirrhosis include metabolic disturbances, fluid accumulation, portal hypertension, and hepatic encephalopathy. Nutrition therapy aims to correct underlying causes, prevent complications, and support nutrition needs through diet and supplementation. Liver transplantation is mentioned as a treatment for end-stage liver disease.
The document discusses the gut microbiota and its relationship to chronic kidney disease (CKD). It notes that CKD is associated with gut dysbiosis and an imbalance in the microbiota. Dysbiosis can promote chronic diseases through pathogenic bacteria and harmful substances. The gut-kidney axis involves changes in the gut barrier and microbiota that influence CKD progression. Probiotics, prebiotics, and synbiotics show promise in restoring the gut environment and may delay CKD progression by reducing inflammation and improving metabolism and lipid profiles. A meta-analysis found that supplementation decreased inflammatory markers and improved oxidative stress and lipids in CKD patients. The mechanisms of action and influence of the microbiota on CKD development and progression
Nutrition of patients undergoing dialysisManiz Joshi
This document discusses nutritional assessment and dietary recommendations for dialysis patients. It outlines several methods for assessing nutritional status, including physical exams, body composition measurements, functional tests, and biochemical markers like serum albumin and prealbumin. Optimal intake levels are provided for proteins, sodium, fluids, potassium, phosphorus, and various vitamins. Maintaining adequate nutrition through diet and supplements is important for dialysis patients given losses during treatment and high risk of malnutrition.
After this presentation, you should be able to:
Critically evaluate the scientific rationale regarding dietary Na+, P, K+, and fluid restrictions in HD patients, and why these restrictions may be misguided.
Better communicate with HD patients and clinic staff the nuances of these dietary restrictions.
Promote efficacious physical activity programs for hemodialysis patients.
Nutrition and liver diseases by Dr.P.Nazninazni peerkhan
This document discusses nutrition and liver diseases. It begins by providing an overview of liver anatomy and functions. The liver plays a key role in metabolizing nutrients, storing vitamins and minerals, filtering blood, and converting ammonia to urea. Chronic liver diseases can develop from viral infections, alcohol use, toxins, and autoimmune conditions. Cirrhosis is a common end-stage result, severely damaging liver structure and function. Malnutrition is common in cirrhosis patients due to reduced food intake and absorption. Treatment focuses on meeting calorie, protein, sodium, fluid and vitamin needs. Jaundice and hepatitis are also discussed, including causes, symptoms and dietary recommendations like hydration and avoiding alcohol.
This document provides information on dietary considerations for individuals with renal disease. It begins by defining renal failure and discussing the types and causes of both acute and chronic renal failure. Key principles of diet modification for renal disease include restricting fluids, sodium, potassium, and protein based on the individual's condition and lab values. Micronutrients may need to be supplemented depending on the stage of renal disease. The document provides dietary recommendations and strategies for managing conditions like renal calculi. Overall, the document outlines the essentials of medical nutrition therapy for supporting individuals with acute or chronic kidney injury or disease.
This document provides an overview of renal nutrition for non-renal dietitians. It discusses the basics of kidney function including measurement of glomerular filtration rate and stages of chronic kidney disease. Prevalence of CKD and end stage renal disease are noted. The roles and responsibilities of renal dietitians are outlined. Guidelines for protein and fluid intake at different stages of CKD are presented. Management of complications like potassium levels, edema and malnutrition are covered. A case study is provided to demonstrate application of renal nutrition principles.
This document discusses nutritional management of chronic renal disease. It covers several key topics:
- Protein restriction is important to reduce workload on kidneys and lower blood pressure. High-quality proteins like egg are recommended.
- Phosphorus intake should be restricted to reduce calcium-phosphorus crystallization in kidneys. The calcium to phosphorus ratio should be over 1.
- Sodium intake must be restricted to control hypertension, with a goal of 15-50 mg/kg daily for dogs and 0.24% salt for cats. Several renal-friendly diet formulations are provided for dogs and cats.
It include the definition , signs and symptoms, types, diagnosis, medical management, Nursing management, preventive measures, complication, Post exposure prophylaxis of Hepatitis.
The document discusses nutrition care for patients with chronic kidney disease (CKD) and those undergoing hemodialysis (HD). It outlines the stages of CKD based on glomerular filtration rate. The nutrition care process involves assessment, diagnosis, intervention, and monitoring. Key dietary recommendations for CKD and HD patients include restricting protein, sodium, and phosphorus while maintaining adequate energy, carbohydrates, and fat intake. Regular nutrition counseling and monitoring of nutritional status indicators are important for managing the disease and preventing complications.
Kidneys are the vital organs in the human body. Its main function is to remove the waste products from our body. At the stages of kidney disease it can’t completely remove toxins, excess salt, water, etc. So these waste products build up in the body and create problems. At the stages of kidney disease we have to follow a healthy renal diet without overloading kidneys. Here we are providing a general diet for kidney disease patients also who are prone to kidney disease. By making simple changes in lifestyle & diet we can improve renal health. Here also provided three simple tests to check for kidney diseases.
This document discusses dietary guidelines for kidney health. It notes that kidneys play a key role in nutrient homeostasis and that loss of kidney function disrupts this. For chronic kidney disease (CKD) patients, guidelines recommend a daily protein intake of 0.6-0.8g/kg, limiting fat intake to 30% of calories, and restricting sodium and phosphorus intake. While protein restriction may slow CKD progression, large trials like MDRD found little overall benefit. A plant-based, low-protein diet that is low in phosphorus and sodium may be most suitable for CKD patients. Focusing on overall dietary patterns like the DASH diet may be more practical than individual nutrient restrictions.
Management of nutrition in patients with renal failure is challenging as malnutrition occurs in up to 40% of such patients and is associated with increased morbidity and mortality. Malnutrition has multiple contributing factors, including decreased food intake due to gastrointestinal symptoms. Providing appropriate calorie and protein intake tailored to the patient's stage of kidney disease is important to permit adequate nutrition without unnecessary restrictions. Nutritional assessment, monitoring guidelines for calories, proteins and minerals, and specialized nutrition support are crucial for managing the nutrition of renal failure patients.
Dr. Waleed El-Refaey is a lecturer of internal medicine and nephrology. He discusses the benefits of physical activity for patients with chronic kidney disease (CKD). Regular exercise can improve cardiovascular health, reduce risk factors like blood pressure, and help prevent muscle wasting which is common in CKD patients. Exercise is also associated with reduced inflammation, improved exercise capacity and quality of life, and psychological benefits. The document emphasizes that physical activity has important protective effects across all stages of CKD.
This document discusses nutrition support for hospitalized patients. It notes that malnutrition is common in hospitals and associated with poor outcomes. Medical nutrition therapy includes oral supplements, enteral nutrition via tubes, and parenteral nutrition. Enteral nutrition is preferred over parenteral when possible due to gut health benefits. Early initiation of oral or enteral feeding after surgery improves outcomes. Monitoring for complications like diarrhea or aspiration is important when using nutrition support.
Applied nutrition 3 rd presentation - diseases of liver, gall bladder, and ...MD Specialclass
The document provides detailed information about diseases of the liver, gallbladder, and pancreas. It discusses the anatomy and functions of the liver, signs and symptoms of various hepatitis types, cirrhosis, and hepatic coma. It also covers cholecystitis, including causes, clinical manifestations, and dietary management for related conditions.
This document provides information on medical nutrition therapy for a patient with end-stage renal disease undergoing hemodialysis. The patient has a GFR of 12 mL/min and receives hemodialysis twice a week. The goals of medical nutrition therapy are to prevent deficiencies, control fluid balance and electrolytes, and prevent complications related to calcium and phosphorus levels. The dietitian provides calculations to determine the patient's energy, protein, fluid and electrolyte needs and prescribes an appropriate diet.
The document discusses guidelines for determining insurance coverage of home parenteral nutrition (PN). Coverage requires a permanent condition preventing sufficient oral nutrient absorption. Specific criteria include short bowel syndrome, malabsorption, or motility disorders unresponsive to other interventions. Initiation of PN requires documentation of the condition and failed enteral nutrition trials. Ongoing coverage requires monitoring that the criteria supporting medical necessity are still met.
Chapter 22 Nutrition and Renal Diseases KellyGCDET
The document discusses various kidney diseases and conditions. It begins by describing the anatomy and functions of the kidney, including filtering waste from the blood and regulating fluid, electrolytes, and acid-base balance. It then covers specific conditions like nephrotic syndrome, acute kidney injury, chronic kidney disease, and kidney stones. For each, it discusses causes, consequences, diagnostic assessments, and treatment approaches including nutrition therapy. Nutrition interventions aim to address issues like fluid balance, electrolyte levels, protein-energy status, and dietary modifications for related diseases.
This document discusses nutrition and liver diseases. It covers fatty liver and hepatitis, their causes and symptoms. Cirrhosis is discussed as the late stage of liver disease, with alcohol and hepatitis C being the chief causes in the US. Complications of cirrhosis include metabolic disturbances, fluid accumulation, portal hypertension, and hepatic encephalopathy. Nutrition therapy aims to correct underlying causes, prevent complications, and support nutrition needs through diet and supplementation. Liver transplantation is mentioned as a treatment for end-stage liver disease.
The document discusses the gut microbiota and its relationship to chronic kidney disease (CKD). It notes that CKD is associated with gut dysbiosis and an imbalance in the microbiota. Dysbiosis can promote chronic diseases through pathogenic bacteria and harmful substances. The gut-kidney axis involves changes in the gut barrier and microbiota that influence CKD progression. Probiotics, prebiotics, and synbiotics show promise in restoring the gut environment and may delay CKD progression by reducing inflammation and improving metabolism and lipid profiles. A meta-analysis found that supplementation decreased inflammatory markers and improved oxidative stress and lipids in CKD patients. The mechanisms of action and influence of the microbiota on CKD development and progression
RENAL NUTRITION AND DIALYSIS.pptx nutrional biochemistryabubakerjalal2020
1) The document discusses renal nutrition and dialysis, outlining what kidneys do, types of kidney disorders including acute kidney injury and chronic kidney disease, and medical and nutritional management of kidney disease including dialysis.
2) It describes acute kidney injury as a sudden reduction in kidney function over 2 days or less and chronic kidney disease as a slow, progressive decline in kidney function.
3) Nutritional management of kidney disease focuses on restricting protein, sodium, potassium, phosphorus and fluid based on kidney function and dialysis status while ensuring adequate calorie and nutrient intake.
This document discusses nutrition and fasting in chronic liver disease. It outlines several metabolic changes that occur in chronic liver disease, including decreased glycogen stores and glucose intolerance. It provides general nutrition guidelines for patients with liver disease, recommending adequate calories, proteins, vitamins and minerals. It discusses the benefits of fasting, including detoxification, reduced inflammation, blood sugar and weight loss. However, it notes fasting can worsen conditions in some patients and is not advised for all cases of liver disease.
This document discusses chronic kidney disease (CKD) in children. It notes that CKD prevalence in children is approximately 15-74.7 per 1 million. In children under 5 years old, CKD is commonly caused by congenital abnormalities of the kidney, while in older children it is often due to glomerulopathies. CKD progresses as nephrons are lost due to hyperfiltration injury in the remaining nephrons. Management of CKD focuses on slowing progression by controlling risk factors like hypertension, nutrition management to prevent renal osteodystrophy, and treating anemia and mineral bone disorders.
This case study describes a 31-year-old male with a history of Alport syndrome and kidney transplant who presented with acute renal failure secondary to transplant rejection. Key points include: the patient's medical history of ESRD due to Alport syndrome requiring dialysis and kidney transplant; presentation with elevated creatinine and signs of antibody-mediated transplant rejection; treatment involving immunosuppression medication and potential need for dialysis; and nutrition interventions focusing on meeting protein and calorie needs through a renal diet.
CN is a 41-year-old female on hemodialysis for stage 5 chronic kidney disease. Her current diet provides too much phosphorus and calcium compared to recommendations. She takes several medications to manage complications of kidney disease, including hyperparathyroidism. Her lab values show abnormalities consistent with kidney failure. Her diet needs modification to meet nutrient guidelines for dialysis patients and support medication treatment of her conditions.
Lecture 5 conservative management and pre dialysis careNani Nani
The document discusses conservative management for patients with renal failure who choose not to undergo dialysis or transplantation. Conservative management aims to control symptoms, protect remaining kidney function, and maintain quality of life through medical, emotional and lifestyle interventions. Key aspects of conservative care discussed include controlling blood pressure, anemia, nutrition, fluid levels, and symptoms like pain, nausea, itching and restless legs. The goal is to prolong life and delay disease progression through non-dialysis treatments.
Hypokalemia, or low potassium, is a common electrolyte abnormality that is found in over 20% of hospitalized patients and 10-40% of patients treated with thiazide diuretics. Potassium is crucial for heart and muscle function. While usually well tolerated, even mild hypokalemia increases risks for those with cardiovascular disease. The underlying cause of hypokalemia should be identified and treated.
This document provides information on chronic kidney disease (CKD) and its treatment with dialysis. It discusses the physiological functions of the kidneys, causes of CKD including diabetes, stages of CKD and associated signs/symptoms. It also describes different treatment options for stage 5 CKD including kidney transplantation and dialysis (hemodialysis and peritoneal dialysis). The document outlines components of Mrs. Joaquin's medical nutrition therapy and assesses her weight and calculates her edema-free weight.
Cirrhosis is a late stage of scarring (fibrosis) of the liver caused by many forms of liver diseases and conditions, such as hepatitis and chronic alcoholism
Nadia. sead clinical presentation in Nutrition..pptxyusufArashid
This document discusses nutritional considerations for patients with renal disease. It notes that a high protein diet, especially one high in animal proteins, can be detrimental to kidney function through various mechanisms like increased blood pressure and accumulation of toxins. For renal patients, a low-protein diet is recommended to reduce these risks and slow disease progression. Keto-analogues of amino acids can be used with low-protein diets to provide nutrition while avoiding inadequate intake. Maintaining adequate energy intake is also important for renal patients to prevent protein-energy wasting as their disease advances. Plant-based diets may offer benefits for renal patients but more research is still needed.
The document summarizes nutritional requirements and recommendations for hemodialysis patients. It discusses that hemodialysis patients have increased risk of malnutrition due to nutrient loss during dialysis and reduced dietary intake. The document then outlines nutritional guidelines for hemodialysis patients, including recommendations for energy, protein, carbohydrate, lipid, vitamin, mineral, fluid, and fiber intake. It emphasizes the importance of dietitians in prescribing and reviewing diets for hemodialysis patients to meet their nutritional needs and prevent malnutrition. The document concludes with recommendations such as early diagnosis and nutrition education to help manage the nutritional care of hemodialysis patients.
INTRODUCTION
Cancer is a general term used to refer to a condition where the body’s cells begin to grow and reproduce in an uncontrollable way. Lung cancers are the fourth most common cancer reported in the Indian males.
DEFINITION
Lung carcinoma is a malignant lung tumor characterized by uncontrolled cell growth in tissues of the lung. If left untreated, this growth can spread beyond the lung by the process of metastasis into nearby tissue or other parts of the body.
CAUSES
The most common causes of fracture include,
I. Tobacco smoke
Tobacco use is responsible for more than one of every six deaths. The younger a person is when he or she starts smoking, the greater the risk of developing lung cancer.
II. Secondhand smoke
Passive smoking has been identified as a possible cause of lung cancer in nonsmokers. People who are involuntarily exposed to tobacco smoke in a closed environment (house, automobile, and building) have an increased risk of lung cancer when compared with unexposed nonsmokers.
III. Environmental and occupational exposure
Various carcinogens have been identified in the atmosphere, including motor vehicle emissions and pollutants fromrefineries and manufacturing plants. High levels of radon have been associated with the development of lung cancer, especially when combined with cigarette smoking. Chronic exposure to industrial carcinogens, such as arsenic, asbestos, mustard gas, chromates, coke oven fumes, nickel, oil, and radiation has been associated with the development of lung cancer.
IV. Genetics
Some familial predisposition to lung cancer seems apparent, because the incidence of lung cancer in close relatives of patients with lung cancer appears to be two to three times that in the general population regardless of smoking status.
TYPES OF LUNG CANCER:
1. Small cell lung carcinoma
• Accounts for 15%-25% of lung cancers
• It is most malignant form
• Tends to spread early via lymphatic and bloodstream
• Is frequently associated with endocrine disturbances
• Predominantly central and can cause bronchial obstruction and pneumonia.
2. Non-small cell lung carcinoma
Is further classified by cell type,
Adenocarcinoma
• Most common type
• Accounts for approximately 30%-40% of lung cancers
• More common in women
• Often gas no clinical manifestations until widespread metastasis is present
• Usually begins in mucous glandular tissue, is most commonly located in peripheral portions of lungs.
Squamous cell carcinoma
• Second most common type of lung cancer
• Accounts for 30%-35% of lung cancers
• Is more common in men
• Arises from the bronchial epithelium of the lungs or bronchus, slow-growing cancer that usually begins in the bronchial tubes.
Large cell carcinoma
• The least common form
• Accounts for 5%-15% of lung cancers
• Composed of large sized cells that are anaplastic and often arise in the bronchi, commonly causes cavitation
• Is highly metastatic via lymphatic and blood.
STAGING OF NON-SMALL CELL LUNG C
What are the health considerations for people undergoing kidney dialysis.pdfMr. Business Magazine
A kidney is the most important organ for a person to function. Kidney dialysis would be the last thing any person wants to undergo. But it comes with certain conditions.
This document provides information about chronic kidney disease (CKD). It discusses the definition and stages of CKD, causes and risk factors like diabetes and hypertension, clinical manifestations such as anemia and fluid retention, and the pathophysiology. It also covers the prevalence of CKD in India, recent research studies on genetic and cellular factors, and treatments including dietary modifications, dialysis, and kidney transplantation.
Renal failure occurs when the kidneys cannot remove waste or regulate fluids and electrolytes. There are two main types: acute renal failure, which develops rapidly over hours to days; and chronic renal failure, which is progressive and irreversible. Acute renal failure causes a sudden loss of kidney function and can result from prerenal issues, direct kidney damage, or urinary tract obstruction. Chronic renal failure is treated through diet, medication, and often dialysis to remove waste when kidney function declines. Nursing focuses on managing complications, nutrition, fluid balance, and educating patients.
Cirrhosis is a disease where healthy liver tissue is replaced with scar tissue due to conditions like alcohol abuse, hepatitis, and fatty liver disease. It prevents the liver from functioning properly. Symptoms range from fatigue to jaundice to fluid buildup in the abdomen. Treatment focuses on managing complications, stopping further damage, and transplantation in severe cases. Preventing liver damage from alcohol, medications, and infections can help avoid or delay cirrhosis progression.
This document provides an overview of a case involving a 56-year-old man diagnosed with type 2 diabetes mellitus and polyuria who was later found to have concurrent central diabetes insipidus. It describes the patient's symptoms, lab results, and MRI findings confirming a pituitary macroadenoma. The document then discusses the pathophysiology of polyuria in diabetes mellitus and central diabetes insipidus, as well as the role of desmopressin in treating polyuria.
Similar to Nutrition & drug dosing in dialysis patient (20)
This document provides information on various cardio-diabetic drugs produced by ASIAN Pharmaceuticals including Presin, LRTN, LRTN-H, R-Stat, Lipostat, Asclot, Oretic, Linaglip and Diaglim. It also includes sections on the structure and function of the heart, types of blood vessels, common heart conditions like hypertension, coronary artery disease and heart attacks. Pathophysiology of hypertension and management approaches like lifestyle modifications and pharmacological therapies using drugs like amlodipine, losartan, and hydrochlorothiazide are summarized.
Thrombosis is the formation of a blood clot inside a blood vessel or heart chamber that blocks normal blood flow. There are two main types - venous thrombosis in veins and arterial thrombosis in arteries. Thrombosis can be caused by injury, immobility, inherited disorders, cancer, and certain medications. Risk factors include older age, smoking, obesity, and family history. Symptoms depend on the location of the clot but may include pain, swelling, chest pain, or numbness. Treatment involves blood thinners and procedures to open blocked vessels to prevent complications like stroke and heart attack.
The document discusses the anatomy and physiology of the digestive system, with a focus on the stomach. It describes the structures and functions of the stomach, including details on gastric juice production and acid secretion. The mechanisms of acid regulation and some common acid peptic disorders are summarized. Information is also provided on the proton pump inhibitor pantoprazole and prokinetic drug domperidone, including their indications and rationale for combined use in treating upper gastrointestinal disorders.
HYPERURICAEMIA + all related brand training material.pptxPabitra Thapa
Uric acid is produced when the body breaks down purines. Febuxostat is a new drug for treating hyperuricemia and gout that works by selectively inhibiting the enzyme xanthine oxidase, unlike allopurinol which non-selectively inhibits several enzymes. Febuxostat has been shown to effectively lower uric acid levels at recommended doses without needing dose adjustments for mild to moderate kidney or liver dysfunction, as opposed to allopurinol which requires dosage adjustments for renal impairment. Management of gout focuses on long-term urate-lowering therapy to maintain uric acid levels below target thresholds to prevent further crystal formation and promote crystal dissolution.
1. Pharmacoeconomics evaluates the costs and outcomes of drug therapy and helps healthcare decision-makers determine which services and drugs provide the best value.
2. There are several types of pharmacoeconomic analyses including cost-minimization analysis, cost-benefit analysis, cost-effectiveness analysis, and cost-utility analysis.
3. These analyses help compare the relative costs and benefits or cost-effectiveness of different treatment options to inform decisions about allocating limited healthcare resources.
Lipids are hydrophobic substances made of carbon, hydrogen and oxygen. They are obtained through diet or synthesized in the body. Lipids are digested in the mouth, stomach and intestines with the help of enzymes. They are emulsified and absorbed in the small intestine before being transported around the body within lipoproteins such as chylomicrons, VLDL, LDL, and HDL. High LDL and triglycerides increase the risk of conditions like atherosclerosis, heart attack, and stroke by promoting plaque buildup in arteries. Fenofibrate is a drug that can help lower triglycerides and LDL cholesterol and raise HDL levels to reduce cardiovascular risks.
This document discusses various marketing concepts for pharmaceutical care services. It defines marketing and discusses key aspects like identifying customer needs and wants, market segmentation, targeting specific customer groups, developing product offerings to meet customer needs, and positioning brands. It also covers analyzing the marketing environment using tools like SWOT analysis, PEST analysis, and Porter's five forces model. The goal of marketing planning is to develop strategies and action plans to achieve organizational objectives through creating and delivering customer value.
The document discusses Ondansetron tablets and syrup, which contain the active ingredient Ondansetron used to treat nausea and vomiting. It provides details on the physiology and mechanisms of vomiting, including the role of serotonin and dopamine receptors. It describes the indications, pharmacokinetics, safety profile and dosing of Ondansetron as an antiemetic for conditions like chemotherapy-induced nausea and vomiting, postoperative nausea and vomiting, and hyperemesis gravidarum.
Allergies are an abnormal response of the immune system to usually harmless substances called allergens. During an allergic reaction, the body produces antibodies that attach to immune cells and cause the release of chemicals like histamine, resulting in symptoms. Common symptoms include sneezing, runny nose, itchy eyes, and hives. Severe allergic reactions called anaphylaxis can be life-threatening. Zellar contains the active ingredient fexofenadine hydrochloride, which is a non-sedating antihistamine used to treat symptoms of allergic rhinitis and skin conditions like hives.
Allergies are an abnormal response of the immune system to usually harmless substances called allergens. During an allergic reaction, the body produces antibodies that attach to immune cells called mast cells. When the allergen is encountered again, it causes the mast cells to release chemicals like histamine that produce symptoms. Common symptoms include sneezing, runny nose, itchy eyes, and skin rashes. Severe allergic reactions called anaphylaxis can be life-threatening and require immediate medical care. Fexofenadine is an antihistamine used to treat symptoms of allergic rhinitis and skin conditions like hives. It works by blocking histamine receptors and is generally well-tolerated with
Ondansetron is an antiemetic drug that works by blocking serotonin 5-HT3 receptors. It is used to treat nausea and vomiting caused by chemotherapy, radiation therapy, and postoperative nausea and vomiting. It comes as tablets and syrup and has few drug interactions or side effects. Ondansetron is considered safe in pregnancy, though more studies are still needed.
Carboxymethylcellulose is an eye lubricant used to provide temporary relief from dryness, burning, irritation, and discomfort. It works similarly to natural tears by maintaining proper lubrication of the eyes and protecting against further irritation. Potential side effects include irritation, redness, pain, and blurred vision. Refresh Tears Drops should be administered by placing 1-2 drops directly in the eye and closing it for 1-2 minutes while applying pressure to prevent draining.
This document discusses treatments for detrusor overactivity (OAB), including anticholinergic/antimuscarinic drugs and mirabegron. It provides statistics on the prevalence and projected increase of OAB worldwide. Anticholinergics work by blocking muscarinic receptors in the bladder to reduce contractions. Mirabegron is a beta-3 adrenergic agonist that works differently by activating beta-3 receptors to relax the detrusor muscle. The document reviews the mechanisms and side effect profiles of various anticholinergic drugs and mirabegron as alternatives or additions for treating OAB.
Overactive bladder is a condition characterized by urinary urgency and frequency. It affects approximately 17% of the US population. Symptoms include sudden urges to urinate that are difficult to control, waking multiple times at night to urinate, and leaking urine with urges. Antimuscarinic drugs are commonly used to treat overactive bladder by relaxing the bladder muscle. Mirabegron is a newer treatment that works through beta-3 adrenergic receptor agonism rather than antimuscarinic effects. It was approved in 2012 as the first oral treatment for overactive bladder that does not have antimuscarinic side effects like dry mouth.
King Jai Singh of Alwar State visited a Rolls Royce showroom in London in casual dress and was insulted by the salesmen who didn't recognize him as royalty. Later, he returned in royal attire and purchased all six cars in the showroom. Upon returning to India, he had the cars used to transport city waste, damaging Rolls Royce's reputation worldwide. Rolls Royce's sales declined rapidly until they apologized and offered the king six free cars to stop using theirs for waste transport.
The document discusses the angiotensin II receptor blocker (ARB) telmisartan. It provides a history of ARB development starting in 1986. It describes how telmisartan is a highly selective AT1 receptor antagonist with a long half-life of 24 hours, ensuring blood pressure control throughout the day. The document highlights telmisartan's advantages over other ARBs, such as its lack of metabolism by CYP enzymes, avoiding drug interactions. It also notes telmisartan's partial agonist activity at PPARγ receptors, which may provide metabolic benefits for conditions like diabetes. The document concludes with sections on targeting key physician specialties and applying a marketing mix to promote telmisartan.
The nervous system contains specialized cells called neurons that coordinate animal actions and transmit signals between body parts. It performs three basic functions: receiving sensory input, integrating the input, and responding to stimuli. The nervous system is divided into the central nervous system (CNS) and peripheral nervous system (PNS). The CNS contains the brain and spinal cord, which are protected by bone and tissue. The PNS connects the CNS to other body parts and contains nerves made of neuron bundles. Neurons transmit signals as electrochemical impulses via neurotransmitters released at synapses between neurons.
The respiratory system consists of organs and structures involved in gas exchange. Its main functions are to provide oxygen to cells and remove carbon dioxide. Key organs include the nose, mouth, pharynx, larynx, trachea, bronchi, bronchioles, alveoli, diaphragm and lungs. Gas exchange occurs in alveoli surrounded by capillaries. Chronic obstructive pulmonary disease and asthma are conditions where airflow from the lungs is obstructed, causing symptoms like breathing difficulty, coughing and wheezing.
This document provides information about depression and mood disorders. It discusses the causes of depression including genetic, environmental, personality, and biological factors such as imbalances in neurotransmitters like serotonin, norepinephrine, and dopamine. It describes symptoms of major depressive disorder and outlines different forms of depression including major depression, minor depression, dysthymia, bipolar I disorder, and bipolar II disorder. The document also discusses treatment options for mood disorders and lists some antidepressant products manufactured by Asian Pharmaceuticals including tricyclic antidepressants and selective serotonin reuptake inhibitors.
This document defines dosage forms and discusses various routes of drug administration. It provides details on:
1) The need for dosage forms such as accurate dosing, protection, taste masking, and controlled release.
2) Classification of dosage forms by route of administration (oral, topical, rectal, parenteral), physical form (solid, semisolid, liquid, gaseous) and type.
3) Advantages and disadvantages of different routes including oral, sublingual, buccal, rectal, parenteral, topical and others. Time of onset of effect for different routes is also compared.
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
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The UK is currently facing a Adhd Medication Shortage Uk, which has left many patients and their families grappling with uncertainty and frustration. ADHD, or Attention Deficit Hyperactivity Disorder, is a chronic condition that requires consistent medication to manage effectively. This shortage has highlighted the critical role these medications play in the daily lives of those affected by ADHD. Contact : +1 (747) 209 – 3649 E-mail : sales@trinexpharmacy.com
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
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8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
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Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
2. 2
Nutrition of patient undergoing dialysis.
Dialysis and CKD Overview
Dialysis is a process that uses a man-made membrane to filter out toxins, waste products, and excess fluid
from the blood when kidney function is impaired. Dialysis treatment also balances the body´s calcium,
phosphorus and potassium levels. Dialysis treatment extends life expectancy significantly, but it alone is
not enough to manage advanced CKD,so it is used in conjunction with dietary restrictions and medication
to slow down the progression of CKD. (Munuais-ja maksaliitto 2013.)
Removal of excess fluid through dialysis is also known as ultrafiltration. The level of ultrafiltration is
dependent on the patient´s fluid load. Fluid load is determined by weighing the patient before dialysis
treatment to determine a post-dialysis target weight. Ideally, the weight gain between dialysis treatments is
a maximum of 2 kilograms.
Dialysis is the most widely utilized treatment for end-stage CKD. However,it requires extensive
modifications and restrictions to a patient´s lifestyle and often interferes with daily activities. (Pessoa &
Linhares 2015.) Long-term compliance with dietary restrictions, medications and treatment schedules can
cause stress to hemodialysis patients. Further, hemodialysis is a time- and energy-consuming treatment,
which can potentially cause social isolation, dependency on others, financial stress and strained family
relationships (Seah- Tan- Srinivas- Wu - Griva 2013).
CKD is a long-term health condition brought on by damage to both kidneys, which is usually irreversible,
and which can be triggered by severalcauses. The most common causes are diabetes mellitus,
hypertension, smoking, cardiovascular disease, advanced age, chronic use of non-steroidal anti-
inflammatory drugs, and obesity.
In addition to CKD,two other reasons a patient may need dialysis are glomerulonephritis and interstitial
nephritis. The glomeruli are parts of the kidney that filter excess fluid and waste products from urine and
glomerulonephritis is an inflammation of the glomeruli that is treated with dialysis. Interstitial nephritis is
a swelling between the kidney tubules, which causes the kidneys to function less efficiently, and can be
acute or chronic. Interstitial nephritis may also be treated with dialysis. (Munuais-ja maksaliitto 2013.)
Renal Diet Overview
The main goal of the renal diet is to manage the levels of circulating waste products and minerals, between
dialysis treatments. To achieve this, patients undergoing dialysis treatment are instructed to limit their
intake of vegetables, fruits, legumes, nuts, whole grains and dairy, because these foods contain high
amounts of potassium and phosphate, which can cause excess strain to already-failing kidneys. Further,
fluid intake is generally restricted in order to control interdialytic weight gain.
However,this diet is complicated to manage and can cause various problems. Prohibition of various foods
can lead to monotony of diet and malnutrition. Moreover, loss of appetite is common in dialysis patients
and contributes to undernutrition. Furthermore, limiting consumption of many everyday foods makes it
difficult for patients to adequately satisfy their energy and protein needs.
Tracking patient´s nutritional status is necessary to identify possible problems early during hemodialysis
treatment. Regular blood tests to check on albumin, phosphorus, acidosis, and C-reactive protein are part
of a patient´s treatment plan. Patients are always weighed before each dialysis treatment to determine how
much fluid can be removed safely. BMI is calculated monthly and creatinine is checked from a blood
sample monthly as well. Patients meet with a licensed nutritionist once or twice a year.Food cravings and
thirst are a common issue for dialysis patients
3. 3
Fluid and salt
Healthy kidneys can regulate fluid balance by excreting excess water and salt from the body. But patients
with CKD are unable to adequately regulate their fluid balance, due to their kidney failure. Because any
excess fluid retention in the body causes hypertension, shortness of breath and nausea, patients on
hemodialysis are put on fluid restrictions. To determine how much fluid can be safely consumed per day, a
patient´s 5 urine output is measured. The daily fluid allowance is usually the amount of urine output per
day plus 500-750 ml of fluid depending on kidney function. As a result of their kidney disease and the
resulting fluid restriction, many patients on hemodialysis urinate very little or not at all. Sodium intake is
also restricted for patients on a renal diet. Sodium intake can increase thirst for patients on a renal diet,
because sodium affects receptors located in the brain called osmoreceptors, which regulate the feeling of
thirst. Excessive thirst makes it difficult to adhere to the fluid restrictions discussed above. Current
recommendation of salt for patients on hemodialysis is less than 5 grams a day or 2000mg of sodium.To
manage thirst, use of ice cubes,small sips and sour flavoured candy were common among dialysis
patients.
Protein
Kidney disease is associated with impaired protein metabolism. Therefore,protein consumption is often
restricted. Only 1.2g/kg/day of protein is typically recommended for dialysis patients. About 50% of the
protein should come from sources that are of high biological value such as chicken, fish, eggs .
When patients are unable to ingest sufficient protein through their regular food consumption, they may
seek to supplement their protein intake through the use of oral protein supplements. However,oral protein
supplements can be hard on dialysis patients´ digestion and can cause unwanted side effects like nausea.
For patients who wish to avoid oral protein supplements or parenteralprotein supplementation, egg whites
seem to be a good choice of protein because of their low phosphate-to-protein ratio. Further, egg whites
seem to be easily digested by patients receiving hemodialysis treatment who frequently suffer from
gastrointestinal discomfort. (Taylor et al. 2011.) Patients on dialysis should carefully monitor the amount
of protein they consume because excess intake of protein can cause strain on the kidneys. Regular blood
tests for albumin serum levels are necessary for all dialysis patients. Albumin is a protein found in animal
sources such 6 as milk, eggs and meat. Lowered serum albumin is associated with higher mortality rate
among patients receiving dialysis treatments.
Phosphorus
Patients with CKD gradually lose the ability to remove excess phosphorus from their blood. This can
result in renal osteodystrophy, which happens when impaired kidneys fail to maintain calcium and
phosphorus levels in the blood causing damage to veins, arteries, lungs and soft tissues of the body. Renal
osteodystrophy affects nearly all people receiving dialysis treatment. Phosphorous restrictions are used to
prevent and slow down the progression of renal osteodystrophy. Dialysis patients should limit their daily
phosphorus intake to 800- 1000mg. The amount is adjusted according to patient´s weight and gender.
Many foods that contain high amounts of phosphorus also contain high amounts of protein, so many
scientific societies recommend lowered protein intake in order to reduce the amount of phosphorus
consumed. One gram of protein has about 15mg of phosphorus and about 30% to 70% of it is absorbed in
the intestine. (GonzalesParra et al. 2012.)
Potassium
Healthy kidneys are able to maintain normal potassium levels by excreting excess potassium through
urine. But people with CKD have impaired kidney function, which causes accumulation of potassium in
their blood and increases the risk of hyperkalemia. Hyperkalemia causes abnormal heart rhythms which
increases the risk of sudden death.In CKD patients, hemodialysis treatment is not enough to control
4. 4
potassium levels and dietary restriction on potassium consumption is always necessary. The average daily
limit for potassium intake for a hemodialysis patient is 2000-2500mg. (Munuais-ja maksaliitto 2013.)
Prevention of Anemia
Anemia is common among dialysis patients and it appears to be more common in those who suffer from
malnutrition or protein energy wasting. Symptoms of anemia include fatigue, weakness,dizziness,
headache,low immunity, breathless or shortness of breath, chest pain, low appetite and pale.
Anemia of chronic kidney disease is one of the complications of kidney failure. The main reason
for anemia among chronic disease patients is the reduced production of erythropoietin (EPO) by the
kidneys. EPO prompts the bone marrow to make red blood cells. When the kidney’s function is
decreasing, the amount of EPO produced will be reduced. Other factors causing anemia among dialysis
patients are:
1. Reduced red blood cell lifespan due to accumulated urea toxic
2. Malnutrition
3. Lack of iron
4. Lack of folate and other vitamins
5. Blood loss during haemodialysis
Adequate intake of protein, iron, vitamin C, vitamin B 12 and folate are important in preventing and
treating anemia as these nutrients are the important elements in making new red blood cells.
Conclusion
To evaluate the amount of food intake and food preference, the patient's diet history should be
taken. The patient's age, gender, social environment, economic, psychological, and educational
status and history of the disease should be considered due to nutrition effect. Also, including
weekends, during the 3-7 days whole foods is recorded by the patient along with the amount.
Daily intake of calories and nutrients of the patients are calculated with information from those
records. In addition, laboratory values and SGA as a scoring tool are very important for preparing
a appropriate diet for HD patients.
The hemodialysis therapy should be dealt with by a multidisciplinary team, as recommended for other
high risk populations (Morais 2005). A part of medical nutrition therapy is to provide nutrition education
and periodic counseling by dietitians. For effective intervention, dietitians should present a guide for
educating HD patients about individual nutritional needs. This guide should provide information about
food sources,nutrients and usage exchange food lists. Adapting to patients requirements of intakes should
be based on their laboratory values. Patients may be predisposed to receiving lower than recommended
amounts of energy and macro-nutrients to the diet and patients who received information or counseling
about their diet must be followed up closely by renal dietitians (Mahan 2012).
If a patient has diabetes, the control of blood sugar is required with a specialized diet therapy. Due to high
serum glucose levels, osmolality increases,water and potassium are pulled out of cells. There are the
relationship between glycemic control and survival of hemodialysis patients (Mahan 2012). Poor glycemic
control causes to macrovascular complications and generation of advanced glycation end products
(AGEs)( Ricks 2012). The diet for diabetes management can be modified for a patient on dialysis.
References:
Munuais-ja maksaliitto. 2013. Munuaispotilaan opas. http://www.muma.fi/munuaispotilaan_opas/munuaispotilaan_opas.
Accessed 30.1.2017
Taylor, L., Kalantar-Zadeh, K., Markewich, T., Colman, S., Benner, D., Sim, J., Kovesdy, C. (2011). Dietaryegg whites for
phosphorus control inmaintenance hemodialysis patients. Journal ofRenalCare. 37 (1), 16-24.
Gonzalez-Parra, E., Gracia-Iguacel, C., Egido, J., Ortiz, A. (2012) Phosphorus and nu-tritioninchronic kidneydisease. International
Journal of Nephrology. 2012, 1-5
5. 5
Drug Dosing Consideration for Patients on Dialysis
The pharmacokinetics of a drug may be altered in patients with renal impairment who require dialysis.
Some drugs are contraindicated. The drug’s clearance and therapeutic index determine if a dose
adjustment is needed. A lower dose or less frequent dosing may be required.We should start at a low dose
and increase gradually. If possible give once-daily drugs after dialysis.
Renal impairment reduces the clearance of some drugs.4
When prescribing for patients on dialysis, it is
essential to consult a reference guide to determine if the drug is subject to renal clearance and requires a
dose adjustment.
Dose adjustments can be made by reducing the dose, increasing the interval between doses or a
combination of the two. The approach to take is determined by the relative importance of stable serum
drug concentrations (for instance to maintain the antimicrobial effect of penicillins), the adverse effects of
peak concentrations after intermittent doses, and patient convenience.
Suggested resources for drug dosing in dialysis
Australian Medicines Handbook (https://amhonline.amh.net.au)
Therapeutic Guidelines: Antibiotic. Version 15 (www.tg.org.au)
MIMS Australia (http://mims.com.au)
Bailie and Mason’s 2014 Dialysis ofDrugs (http://renalpharmacyconsultants.com/publications)
Oxford Handbook ofDialysis. 3rd ed. Oxford: Oxford University Press; 2009.
The Renal Drug Handbook. 4th ed. London: Radcliffe Publishing; 2014.
Pharmacokinetics
The two main considerations that determine if a particular drug requires dose reduction in dialysis patients are renal
clearance and therapeutic index. Other factors that may affect dosing include clearance by dialysis, increased
availability of highly protein-bound drugs due to hypoalbuminaemia,altered volume of distribution and the presence
of comorbid hepatic dysfunction.
Clearance
We should Consider the magnitude of the renal component of total clearance of the drug and any active metabolites.
For drugs subject to significant renal clearance, the marked decrease in glomerular filtration rate seen in patients on
dialysis results in an increase in half-life and drug accumulation with repeated dosing in the absence of dose
adjustment. These changes also apply to renally cleared drug metabolites which may be active or toxic.
The increased half-life also prolongs the time to achieve a steady-state which,in clinical practice, means a longer
period is required before judging that the maximum effect of a particular dose has been achieved. The starting dose
should be low and caution is required before increasing drug doses.Given the longer time to steady state,a loading
dose can be considered if giving a renally adjusted dose could lead to a delay in reaching a therapeutic serum
concentration (for instance, if treating a severe infection). In practice, loading doses are rarely used.
Therapeutic index
A drug with a wide therapeutic index may be safely given without a dose reduction knowing that, although the drug
concentration will be higher, this is unlikely to result in harm. However, drugs with narrow therapeutic indices may
require substantialdose reductions.
Dialysis and drug clearance
Patients on dialysis are subject to extracorporeal clearance of small molecules, including many drugs.The extent to
which dialysis removes a particular drug from plasma is dependent on its water solubility, molecular weight, protein
binding and volume of distribution.3 Many reference sources contain lists of drugs cleared by dialysis.
6. 6
Haemodialysis can pose a challenge as it is intermittent and has the potential for relatively rapid drug clearance. In
practice this is most important when prescribing once-daily drugs,especially antibiotics. It may be best to give them
after dialysis. Dose timing is typically left unchanged for drugs dosed more frequently, as complex dosing regimens
may reduce adherence to therapy. In peritoneal dialysis, timing is not important as the clearance of small molecules
is slower and more even than in haemodialysis.
Commonly prescribed drugs
Many drugs are not renally cleared. Specific examples of commonly used drugs include proton pump inhibitors,
statins,corticosteroids and calcium channel blockers. They are unlikely to need a dose adjustment in patients on
dialysis.
Analgesics
Patients on dialysis may have comorbid pain, but its treatment is often suboptimal.Paracetamol is the preferred simple analgesic.
It is safe and can be used without dose modification.
Although nephrotoxicity might be considered of little importance, non-steroidal anti-inflammatory drugs (NSAIDs) should be
avoided as they may cause sodium retention, hypertension and gastrointestinal toxicity. Due to theincreased risk of myocardial
infarction seen in the general population, cyclo-oxygenase-2 inhibitors isnot recommend in dialysis patients as they are already at
markedly higher baseline cardiovascular risk.Topical NSAIDs appear to be safe as systemicabsorption is minimal.
Many opioids, or their active metabolites, are renally cleared (Table). Codeine and morphine have active, renally excreted
metabolites so they are not recommended because of theincreased risk of toxicity. Hydromorphoneis our preferred oral opioid
for treating severe pain. It is five to seven times more potent than morphine so starting doses are correspondingly low (0.5–1 mg
orally 6-hourly).Its active metabolite hydromorphone-3-glucuronide can accumulate, but is substantially cleared by haemodialysis
and is less likely to cause adverse effects than morphine metabolites.Oxycodone may be used, although thesustained-release
formulations should be used only with caution due to the risk of accumulation and toxicity. Fentanyland buprenorphineboth
undergo hepatic clearance and can be used when theoral route is not suitable.Whichever opioid is chosen, it is important to use
small starting doses and closely monitor up-titration to avoid toxicity.
Neuropathic pain is common in patients on dialysis.Amitriptyline is hepatically metabolised and does not accumulate. However, it has
numerous adverse effects including anticholinergic effects and postural hypotension which may limit its use in patients with multiple
comorbidities. Gabapentin and pregabalin are effective andmay also treat uraemic pruritis. However, they are extensively renally cleared
and marked dose reductions are necessary to avoid sedation, ataxia and dizziness. Doses should be taken after dialysis.
7. 7
Opioid-induced constipation
In surveys,over half of the patients on dialysis report constipation.Prevention of opioid-induced constipation is
particularly important in patients on peritoneal dialysis as constipation may markedly reduce its effectiveness.
Lactulose, docusate,senna and bisacodylare all suitable treatments.
Antimicrobials
Many antibiotics require dose adjustment in patients receiving dialysis. Quinolones, sulfamethoxazole with
trimethoprim, glycopeptides and aminoglycosides all require significant dose reductions.Trimethoprim should be
avoided in patients due to the risk of hyperkalaemia and bone marrow suppression.2
Nitrofurantoin is primarily
renally excreted, and relies on urinary concentration to achieve its effect. It is rarely associated with neurotoxicity
and life-threatening pulmonary toxicity.Despite recent support for extending its use in chronic kidney disease,it
should be avoided in patients on dialysis.Cephalosporins and penicillins have wider therapeutic indices and vary in
the need for dose adjustment.Once-daily doses should be prescribed after haemodialysis.
The antiviral drug aciclovir and its prodrugs,famciclovir and valaciclovir, are extensively renally excreted. These
drugs accumulate rapidly in patients on dialysis and may cause severe neurological toxicity.They should only be
prescribed after discussion with the treating nephrologist and with appropriate dose reduction and close clinical
follow-up.
Anticoagulants
Despite controversy surrounding its use for stroke prevention in dialysis patients with atrial fibrillation, warfarin
remains the anticoagulant of choice for those with venous thromboembolism or other indications for anticoagulation.
The dose is adjusted according to the INR in the usualmanner. Close monitoring and avoidance of supratherapeutic
INRs is particularly important as patients on dialysis have increased rates of bleeding with warfarin.Low-molecular-
weight heparins are renally excreted and they are rarely used for anticoagulation as their effect is difficult to
predict.Unfractionated heparin is preferred for acute treatment of venous thromboembolism in patients on dialysis.
The newer oral anticoagulants (such as dabigatran and rivaroxaban) are contraindicated. They all undergo a degree of
renal clearance which makes them unsuitable for patients on dialysis.
Drugs for diabetes
Patients with diabetes who need dialysis have reduced insulin clearance, so they may be more liable to
hypoglycaemia with both insulin and insulin secretagogues (sulfonylureas).These patients may also be at increased
risk of hypoglycaemia unawareness due to comorbid illnesses and co-prescribed drugs.
Gliclazide and glipizide are the preferred sulfonylureas as they have short half-lives and no active metabolites. All
sulfonylureas should be started at low doses and up-titrated carefully. The dipeptidyl peptidase-4 inhibitors vary in
their suitability for use in dialysis so the product information should be reviewed before prescribing.Metformin is
contraindicated due to the risk of lactic acidosis.Although not renally excreted, thiazolidinediones are associated
with fluid retention and are not recommended.The sodium-glucose co-transporterinhibitors are contraindicated in
dialysis patients as they depend on the glomerular filtration of glucose for their effect.
Conclusion: In general, commence with a low dose,observe closely for adverse effects and increase the dose only
after a timely interval. Put simply: ‘start low and go slow’.
References:
1. ClaytonP, McDonald S, HurstK, editors.ANZDATARegistry AnnualReport2013. Adelaide: Australia and New Zealand Dialysis and Transplant
Registry; 2013.www.anzdata.org.au/anzdata/AnzdataReport/36thReport/ANZDATA_36th_Annual%20_Report.pdf [cited 2016 Jan4]
2. Manley HJ, Drayer DK, MutherRS. Medication-relatedproblemtypeand appearancerate in ambulatory hemodialysis patients. BMC
Nephrol 2003;4:10. 10.1186/1471-2369-4-10 [PMC freearticle][PubMed][Cross Ref]
3. Weir MR, Fink JC. Safety ofmedicaltherapy in patients withchronic kidney diseaseand end-stagerenal disease. CurrOpinNephrol
Hypertens 2014;23:306-13.10.1097/01.mnh.0000444912.40418.45 [PubMed][Cross Ref]
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4. Faull R, LeeL. Prescribing in renal disease. Aust Prescr 2007;30:17-20.
5. Meijers BK, Bammens B, Verbeke K, Evenepoel P.Areview ofalbumin binding in CKD. Am J Kidney Dis 2008;51:839-50.
10.1053/j.ajkd.2007.12.035 [PubMed][Cross Ref]
6. Katzung BG, Masters SB, Trevor AJ. Basic& clinical pharmacology. LANGEBasicScience. 12thed. McGraw-Hill Education; 2012