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614 Medical Nutrition Therapy in Chronic Kidney Disease

Advanced Nutrition and Dietetics in Diabetes,(2)

* While guidelines recommend dietary sodium re- ple providers, several strategies may be implemented
striction to less than 1.5–- 2.3g/day, excessively low that enhance its successful implementation (1).
sodium intake may be associated with hyponatremia Diabetes education should aim to be inclusive of an
as well as impaired glucose metabolism and insulin individual’s renal dietary adaptations and lifestyle re-
(1)
sensitivity
strictions and address the patient’s issues relating to
* Fluid restrictions in patients with CKD is individual- balancing both conditions. It should also focus on
ised based on excretory and obligatory losses. helping patients to recognise, understand and ad-
dress their body signals in relation to both diabetes
* When nephropathy is advanced, the diet should
reflect the need for phosphorus and potassium re- and dialysis and teach people how to convey these
striction, with the use of phosphate binders signals to the relevant healthcare professional (2).
(5).
Chronic, low-grade inflammation is implicated in the
* Potassium levels should be monitored while admin- pathogenesis of diabetes. Inflammation, confounded
istering ARBs .
(3)
by protein energy malnutrition (PEM) is common in
* Potassium restriction based on Serum Potassium the dialysis population and is consistently linked to
values. In case of hyperkalaemia, hyperphosphate- increased morbidity and mortality. Interrelated and
mia to follow a potassium, phosphorous restricted concurrent conditions associated with both inflam-
diet if required leaching of vegetables, rice may be mation and PEM, such as poor appetite, hyper ca-
required. tabolism, nutrient losses via dialysis, oxidative stress,
hyperphosphatemia, uraemia and fluid overload have
* Look for hyperuricemia in CKD and add on a further
restriction of purine restricted diet. led to the term ‘malnutrition-inflammation complex
syndrome’ (MICS) (2)
* Non-Nutritive Sweeteners (U.S Department of
Health and Human Services, 2015) Food fortification methods and nutritional supple-
ments should be considered to help combat malnu-
* Sucralose 5 mg/kg body weight/day (Acceptable trition and meet nutritional requirements. In dialysis
Daily Intake) Acesulfame K Contraindicated in Hyper- patients, intra-dialytic parenteral nutrition can be con-
kalaemia Adherence to nutritional guidelines may be sidered if food fortification and other nutrition sup-
challenging among DKD patients who bear multiple port routes are unsuccessful (2)
concurrent comorbidities resulting in complex med-
ication regimens and recommendations from multi-

GCDC 2017