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• Renal nutrition


  Nutrition for patients with kidney disease
• Ronal RA no. 0862 nutrition ½ dieteres law of 2016


  Regulation or guideline related to renal nutrition
• Steps in nutrition


  1. Assessment

  2. Diagnosis

  3. Intervention

  4. Monitoring intervention
• Nutritional therapy for CKD pts

  • Adjustment of protein phosphate
  • Meeting requirements of essential amino acids
  • High energy supply
• First objective is to prevent uremia
• Second objective is to preserve residual renal function and slow the rate of progression
• Protein energy wasting of CKD

  State of metabolic nutritional derangement
• Factors related to clinical outcomes are renal function and nutritional status
• Nutritional management


  1. Nutrition screening

  2. CKD 3-5 patients nutrition assessment at least 2 yearly

  3. CKD 5 or MHD - multifrequency BIA 730 monthly

  4. 1-50 or post kidney transplant clinically stable - measure BMI monthly

  5. HD - monthly and PD at least 3 monthly
• BMI is a predictor of mortality in CKD patients
• Higher BMI is associated with better survival in CKD patients
• Ketanalogues


  Nitrogen-free orals of essential amino acids
• "keto diet"


  • Variety of KA
  • 1½ low protein diets
• CKD 3-5 or post-transplantation


  • At risk of weight PEW
• Improve nutritional status if dietary intake is insufficient

  73 month trial
• CKD 1-5 or on dialysis

  • With PEW
• Adjunct therapies


  • Anabolic hormones
  • Appetite stimulants
  • Anti-inflammatory interventions
• CKD is progressive damage of kidney function present for 3 months
• Goal in PEW


  Preservation of muscle mass to maintain body homeostasis
• Renal nutritional management needs a holistic, integrative approach
• Hemodialysis


  • Session length 4-6h
  • Blood flow rate: 350
  • Target Kt/V->1.2
  • URR: 765%
  • Dialysate flow rate: * 2 of BFR
  • Dialyzer Kuf dialyzer urea clearance
  • Dialysis on tap 35-37
• Energy requirement for CKD 1-5 post-transplantation is 25-35 kcal/kg body weight per day