This document provides an overview of chronic kidney disease and diabetes, current guidelines for treatment, and the role of registered dietitian nutritionists. It discusses that chronic kidney disease is commonly caused by diabetes and that tight glycemic control and low-protein diets can help slow disease progression. Registered dietitian nutritionists play an important role in educating patients on nutrition therapy, such as carbohydrate counting and limiting sodium, to manage both their diabetes and kidney disease.
chronic kidney failure definition and stages of "CKD" SOAP (subjective,objective,assessment and planing ) example format to easy understand about CKD patients.
COMPLICATIONS OF DIABETES BY DR BASHIR AHMED DAR ASSOCIATE PROFESSOR MEDICINE...Prof Dr Bashir Ahmed Dar
The complications of diabetes mellitus are far less common and less severe in people who have well-controlled blood sugar levels.Wider health problems accelerate the deleterious effects of diabetes. These include smoking, elevated cholesterol levels, obesity, high blood pressure, and lack of regular exercise.
Efficacy of Dietary Intervention in END STAGE RENAL DISEASEJunaid Nazar
Chronic kidney disease (CKD), a major global public health problem, has been recognized as one of the eleven important causes of death (WHO, 2009). This review explores wide range of barriers related to patients and health systems involved in controlling the prevalence of CKD at the primary health care level.
Evolving diets in GI Disease 2019 Raymond/GallagherPatricia Raymond
As presented 09/2019 at RMSGNA: In the 50's , doctors recommended smoking for your health. More recently gastroenterologists told patients with ulcers to drink milk and eat bread to heal.
Are you using new science based dietary information for your patients? It's time to update your timeworn dietary strategies and handouts. Join us and review the science on recent advances in dietary management for gastrointestinal disorders: Fatty liver, IBS, IBD, Gastroparesis, Post gastric bypass, Diverticulosis, Cirrhosis, and more!
Examine historical misinformation in dietary management of gastrointestinal disorders
Describe the emerging evidence supporting the primary role of dietary therapies in digestive disease including Irritable Bowel Syndrome, Inflammatory Bowel Disease, Small Intestinal Bacterial Overgrowth, Non-Alcoholic Fatty Liver Disease, Gastroparesis, Pancreatitis, Post-Gastric Bypass, and Diverticulitis.
Identify the role of the Registered Dietitian and the importance of a multi-disciplinary approach to the management of digestives diseases
chronic kidney failure definition and stages of "CKD" SOAP (subjective,objective,assessment and planing ) example format to easy understand about CKD patients.
COMPLICATIONS OF DIABETES BY DR BASHIR AHMED DAR ASSOCIATE PROFESSOR MEDICINE...Prof Dr Bashir Ahmed Dar
The complications of diabetes mellitus are far less common and less severe in people who have well-controlled blood sugar levels.Wider health problems accelerate the deleterious effects of diabetes. These include smoking, elevated cholesterol levels, obesity, high blood pressure, and lack of regular exercise.
Efficacy of Dietary Intervention in END STAGE RENAL DISEASEJunaid Nazar
Chronic kidney disease (CKD), a major global public health problem, has been recognized as one of the eleven important causes of death (WHO, 2009). This review explores wide range of barriers related to patients and health systems involved in controlling the prevalence of CKD at the primary health care level.
Evolving diets in GI Disease 2019 Raymond/GallagherPatricia Raymond
As presented 09/2019 at RMSGNA: In the 50's , doctors recommended smoking for your health. More recently gastroenterologists told patients with ulcers to drink milk and eat bread to heal.
Are you using new science based dietary information for your patients? It's time to update your timeworn dietary strategies and handouts. Join us and review the science on recent advances in dietary management for gastrointestinal disorders: Fatty liver, IBS, IBD, Gastroparesis, Post gastric bypass, Diverticulosis, Cirrhosis, and more!
Examine historical misinformation in dietary management of gastrointestinal disorders
Describe the emerging evidence supporting the primary role of dietary therapies in digestive disease including Irritable Bowel Syndrome, Inflammatory Bowel Disease, Small Intestinal Bacterial Overgrowth, Non-Alcoholic Fatty Liver Disease, Gastroparesis, Pancreatitis, Post-Gastric Bypass, and Diverticulitis.
Identify the role of the Registered Dietitian and the importance of a multi-disciplinary approach to the management of digestives diseases
Materi Workshop Diabetes Melitus untuk Dokter Umum - Practical Management of ...Dayu Agung Dewi Sawitri
Materi Workshop Diabetes Melitus untuk Dokter Umum - Practical Management of Diabetes and Its Complication for General Practitioner.
Diselenggarakan oleh Perkeni, Kementerian Kesehatan RI dan STENO Diabetes Center
What Spine Surgeons Need to Know About Dietary Strategies for Heart Disease a...James McCarter
Presentation to the North American Spine Society Annual Meeting. Interdisciplinary Spine Forum: Obesity and Diabetes: Impact on the Spine and Evidence-Based Management Strategies. Organized by Dr. Carrie Diulus
Diabetes and obesity have reached epidemic proportion. It is imperative that spine providers take these factors into consideration. We also have the opportunity to be powerful motivators to our patients with some straight forward evidence-based strategies.
Upon completion of this session, participants should gain strategies to:
Understand impact of metabolic syndrome on spine conditions/degeneration and treatment outcomes
Learn dietary strategies to have a positive impact on these conditions and the most current science behind these recommendations
Understanding the impact of strategies on heart disease and lipids
How to implement recommendations in a busy clinical setting
Review on developing nutritional intervention approaches as therapy for diabe...ManojKumbhare2
Review on developing nutritional intervention approaches as therapy for diabetes mellitus
1. Introduction 2. Literature review3. Metabolic vulnerabilities of diabetes4. General pathways nutrient metabolism5. Tissue specific metabolism6. Systemic effects of dietary therapies7. Other dietary intervention
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.
Comparison of Popular diets for the Management of Type 2 DiabetesKimmer Collison-Ris
“Diabetes, a disorder of carbohydrate metabolism, is characterized by high blood glucose level and glycosuria resulting from dysfunction of pancreatic beta cells and insulin resistance; in advance stages of diabetes, metabolism of protein and lipids are altered. When patients are able to keep blood glucose levels closer to normal, fewer complications occur. Over 90% of known diabetic patients are Type 2 (Marieb, 2010) and diet plays a key role in the treatment. Nutrients needed for health, divide into carbohydrates, lipids, proteins, vitamins, minerals, and water. Most foods offer a combination of nutrients but some categories and larger quantities elevate glucose levels. This paper serves to compare the ADA low fat, low carbohydrate diet to the Paleo, the Atkins, the Alkaline Acid diets, and food combining; offering possible alternatives for the diabetic patient.
Diabetes and Gut interplay
By Dr. Usama Ragab Youssif
In Gastro Canal Association Annual Conference
Agenda
Diabetes as the main player
Gut as the main player
Diabetes and gut in a separate game
Gut as game changer
Tips and tricks: diabetes drugs
Slowing Progression of Chronic Kidney Disease Through Value-Based Carei3 Health
i3 Health is pleased to make this infographic from this activity available for use as a non-accredited self-study or teaching resource.
This two module CPE activity brings two leading pharmacists together to discuss the slowing progression of Chronic Kidney disease through value-based care.
In Module 1 of this activity, Jeff Sperry, PharmD, BCPS, Clinical Pharmacist at UCHealth Memorial Hospital, will explore risk factors contributing to CKD, efficacy and safety of novel therapies for slowing kidney function decline, and evidence-based strategies for management of CKD complications.
In Module 2 Justin J. Bioc, PharmD, BCPS, BCGP, RPh, Head of Clinical Pharmacy at Devoted Health, will explore the cost-effectiveness of novel therapies indicated to slow kidney function decline and strategies that maximize collaboration between payers and providers to optimize the care of patients with CKD.
2. Outline
• Chronic Kidney Disease and Diabetes
• Recommendations & guidelines: Glycemic Control and Protein
• For the practicing RDN
• Patient education and counseling
3. Chronic Kidney Disease (CKD)
• CKD definition: Abnormalities of kidney structure or function, present for
> 3 months, with implications for health
• The most common cause of kidney failure ???
• Latter stages of Chronic Kidney Disease (CKD)
• 35%- Adults with Diabetes
8. Glycemic Control
• Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation
(ADVANCE)
• Subjects (randomized)
• Tight glycemic control (Hgb A1c <6.5%)
• Standard control
• 10% risk reduction in macro/microvascular events
• 21% reduction in nephropathy
• Meta-analysis published in 2012
• Tight glycemic control reduces overall albuminuria
• Target goal A1c <7%
9. Low Protein Diet
• Low-Protein and Diabetic
Nephropathy: Meta-analyses
• LPD – 0.6-0.8 g/kg/day
• Control – 1-1.6g/kg/day
• Actual Protein Intake Ratio (APIR)
• Protein intake
• Diet compliance
• Protective effects
• Improved eGFR & proteinuria
• No negative impact on glycemic
control
• Sustainable intervention is key!
10. CKD: Protein Intake for Diabetic
Nephropathy:
Academy Supported Evidence
• WHAT ARE THE PROTEIN REQUIREMENTS TO MINIMIZE DISEASE
PROGRESSION WHILE MAINTAINING ADEQUATE NUTRITION
STATUS IN ADULT NON-DIALYZED PATIENTS WITH DIABETIC
NEPHROPATHY?
• CKD: Protein Intake for Diabetic Nephropathy
• For adults with diabetic nephropathy, the RD should recommend or prescribe a protein-
controlled diet providing 0.8g to 0.9g of protein per kg of body weight per day. Providing
dietary protein at a level of 0.7g per kg of body weight per day may result in
hypoalbuminemia and potential risk of malnutrition. Research reports that protein-restricted
diets improved microalbuminuria.
• American Diabetes Association: 0.8g/kg
12. RDN Skill Level
• Competent, proficient and expert
• Certificate of Training Program in CKD Nutrition Management
• CDR’s Board Certification in Renal Nutrition
14. Patient Education and Counseling
• Obesity
• Increased risk for DN
• Hyperlipidemia
• Coronary disease – lipid management
• Vitamin D therapy
• RAAS and albuminuria
• Antioxidants
• Not recommended as a treatment
15. Patient Education and Counseling
• Carbohydrate Counting
• Keep cholesterol level under control
• Limit protein to a healthy level based on individualized recommendations
(CAUTION)
• Limit sodium intake, <2 grams
17. References
• Academy of Nutrition and Dietetics Evidence Analysis Library. (n.d.). CKD: protein intake for diabetic nephropathy. Retrieved December 7, 2014, from andeal.org:
http://www.andeal.org/template.cfm?template=guide_summary&key=2409
• American Diabetes Association. (2014). Nephropathy in diabetics (Position statement). Diabetes Care, 37(12).
• Franz, M. J., Powers, M. A., Leontos, C., Holzmeister, Kulkarni, K., Monk, A., . . . Gradwell, E. (2010, December). The evidence for medical nutrition therapy for type 1 and type 2
diabetes in adults. Journal of the American Dietetic Association, 110(12), 1852-1889. doi: http://dx.doi.org/10.1016/j.jada.2010.09.014
• Kent, P. S., McCarthy, M. P., Burrowes, McCann, L., Pavlinac, J., Goeddeke-Merickel, C. M., . . . Benner, D. (2014). Academy of Nutrition and Dietetics and National Kidney
Foundation: Revised 2014 standards of practice and standards of professional performance for Registered Dietitian Nutritionists (competent, proficient and expert) in nephrology
nutrition. Journal of the Academy of Nutrition and Dietetics, 1448-1503.
• Kowalski, A., Krikorian, A., & Lerma, E. V. (2014). Diabetic nephropathy for the primary care provider: new understandings on early detection and treatment. The Ochsner Journal,
14(3), 369-379.
• Lowth, M. (2013). Chronic kidney disease - an update. Practice Nurse, 43(1), 34-39.
• Mahan, K. E.-S. (2012). Krause's food and the nutrition care process. St. Louis, MO: Elsevier.
• Nezu, U., Kamiyama, H., Kondo, Y., Sakuma, M., Morimoto, T., & Ueda, S. (2013, April 25). Effect of low-protein diet on kidney function in diabetic nephropathy: meta-analysis of
randomised controlled trials. BMJ Open. doi:10.1136/bmjopen-2013-002934
• Steves, P. (2013). Evaluation and managment of chronic kidney disease: synopsis of the kidney disease: improving global outcomes 2012 clinical practice guideline. Annals of Internal
Medicine, 825-830.
• Supplement: summary of recommendation statements. (2013). Kidney International, 3, 5-14. doi:10.1038/kisup.2012.77