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612 Medical Nutrition Therapy in Chronic Kidney Disease

Medical Nutrition Therapy in

Chronic Kidney Disease

DR.MEENAKSHI BAJAJ

PG.DND., M.Sc., C.D.E., R.D., CCN (U.S.A).,(PhD).,
DIETICIAN , Tamil Nadu Govt. Multi Super Specialty Hospital,Chennai

Introduction :
Chronic kidney disease (CKD) is one of the most ican Diabetes Association’s (ADA’s) Standards of
prevalent complications of diabetes, and patients Medical Care in Diabetes, 2011
with diabetic kidney disease(DKD) have a substan- As there is not an ideal percentage of calories from
tially higher risk of cardiovascular disease and death carbohydrate, protein, and fat for all people with
compared to their non-diabetic CKD counterparts. In diabetes (B); therefore, macronutrient distribution
addition to pharmacologic management strategies, should be based on Individualized assessment of
nutritional and dietary interventions in DKD are an current eating patterns, preferences, while keeping
essential aspect of management with the potential total calorie and metabolic goals in mind Since CKD
(4)
for ameliorating kidney function decline and prevent- is a hypercatabolic phase in order to preserve lean
ing the development of other end-organ complica- muscle mass the calorie requirements are increased
tions (1).
from the baseline.
Diabetes-related diet and lifestyle modification is of Carbohydrates from sugars should be limited to less
benefit across the Chronic Kidney Disease (CKD) than 10% of energy intake, and it is also suggest-
spectrum. Dietary modification contributes to CKD ed that higher polyunsaturated and monounsaturat-
prevention; minimising disease progression in early ed fat consumption inlieu of saturated fatty acids,
CKD; blood glucose management and malnutrition trans-fat, and cholesterol are associated with more
prevention in dialysis (CKD 5) and risk factor man- favorable outcomes (1).
agement for optimal graft survival in transplant re-
cipients (2). As patients with advanced DKD progressing to end-
stage renal disease may be prone to the “burnt-out
Accordingly, the 2012 KDIGO guidelines recommend diabetes” phenomenon (i.e.,spontaneous resolution
the following lifestyle changes to lower BP and im- of hypoglycemia and frequent hypoglycemic epi-
prove long-term cardiovascular and other outcomes sodes),further studies in this population are particu-
in non-dialysis– dependent CKD patients (3):
larly needed to determine the safety and efficacy of
• Achieve or maintain a healthy weight with a body dietary restrictions in this population.
mass index in the range of 20–25 kg/m.2
Hypoglycemia
• Lower salt intake to <90 mmol (<2 g) per day of so-
dium, which corresponds to 5 g of sodium chloride, Glucose is the preferred treatment for hypoglyce-
unless contraindicated. mia, ingestion of 15–20 g of glucose is an effective
treatment.
• Follow an exercise program
On the contrary in patients on Peritoneal Dialysis de-
Optimal Mix of Macronutrients pending on the dialysate glucose concentration and
ADA does not endorse any single meal plan volume, energy from glucose can provide 120–1200
kcal per day. Absorption of PD dialysate glucose may
or specified percentages of macronutrients, and the increase the requirement of hypoglycaemic agents
term “ADA diet” should no longer be used (3). Amer-
. If weight maintenance is the desired therapeutic

GCDC 2017