Nutritional Management of Renal Disease

Front Cover......Page 1
Nutritional Management of Renal Disease
......Page 4
Copyright......Page 5
Dedication
......Page 6
Contents......Page 8
List of Contributors......Page 12
Preface......Page 16
INTRODUCTION......Page 18
CKD INTERRUPTS THE COMPONENTS OF PROTEIN METABOLISM......Page 19
DEFINING MUSCLE WASTING......Page 20
THE
UBIQUITIN-PROTEASOME SYSTEM......Page 21
SYNERGISM OF PROTEOLYTIC PATHWAYS CAUSES MUSCLE WASTING IN CKD......Page 22
FACTORS TRIGGERING MUSCLE WASTING IN CKD AND OTHER CATABOLIC STATES......Page 23
MYOSTATIN IN MUSCLE INCREASES IN CATABOLIC CONDITIONS......Page 25
CKD CHANGES THE CONCENTRATIONS OF CERTAIN AMINO ACIDS......Page 26
LINKS BETWEEN AMINO ACID AND PROTEIN METABOLISM......Page 28
References......Page 29
INSULIN RESISTANCE......Page 34
HYPOGLYCEMIA......Page 36
CARBOHYDRATE METABOLISM IN PATIENTS WITH RENAL REPLACEMENT THERAPY......Page 37
TREATMENT OF DIABETES MELLITUS IN DIABETICS WITH CKD......Page 39
DRUG MANAGEMENT IN DIABETICS WITH CKD (FIGURE 2.1)......Page 40
References......Page 42
THE NATURE AND MECHANISMS OF CKD-INDUCED LIPID ABNORMALITIES......Page 48
THE NATURE AND MECHANISMS OF ADVERSE EFFECTS OF LIPID DISORDERS IN CKD......Page 52
TREATMENT OF CKD-ASSOCIATED DYSLIPIDEMIA......Page 54
POTENTIAL ADVERSE EFFECTS OF STATINS......Page 58
References......Page 60
UREMIC SYMPTOMS AND SIGNS......Page 66
TOXIC EFFECTS OF UREMIC PLASMA OR SERUM......Page 68
DEFINITION OF A UREMIC TOXIN......Page 69
IMPACT OF DIALYSIS TREATMENT ON UREMIC TOXICITY......Page 71
TOXICITY OF INORGANIC SUBSTANCES IN UREMIA......Page 72
FREE WATER-SOLUBLE LOW-MOLECULAR-WEIGHT SOLUTES......Page 74
PROTEIN-BOUND SOLUTES......Page 78
MIDDLE MOLECULES......Page 80
GENERAL CONCLUSIONS......Page 84
References......Page 85
MULTIFACTORIAL CAUSES OF INFLAMMATION IN CHRONIC KIDNEY DISEASE......Page 96
INFLAMMATION AS A CAUSE OF PROTEIN-ENERGY WASTING......Page 98
MONITORING INFLAMMATION......Page 101
References......Page 103
DEFINITION OF CATALYTIC (LABILE) IRON AND ITS IMPORTANCE IN TISSUE INJURY......Page 110
GENTAMICIN-INDUCED MOBILIZATION OF IRON FROM RENAL CORTICAL MITOCHONDRIA......Page 112
EVIDENCE SUGGESTING A ROLE FOR IRON IN GENTAMICIN-INDUCED ACUTE RENAL FAILURE IN RATS......Page 113
CATALYTIC IRON IN CHRONIC KIDNEY DISEASE (TABLE 6.3)......Page 114
CATALYTIC IRON IN DIABETIC NEPHROPATHY......Page 116
CATALYTIC IRON IN CHRONIC KIDNEY DISEASE......Page 117
References......Page 118
INCREASED AGE AND OTHER PROTEIN MODIFICATIONS......Page 122
CARBONYL STRESS......Page 123
CLINICAL CONSEQUENCES OF CARBONYL STRESS......Page 124
References......Page 125
ACUTE RESPONSES TO ACIDOSIS AND ALKALOSIS......Page 128
COMPARING EFFECTS OF ACIDEMIA TO THOSE OF STARVATION......Page 129
ENDOCRINE RESPONSES TO ACIDEMIA......Page 130
CALCIUM METABOLISM......Page 131
PROTEIN MALNUTRITION......Page 132
METABOLIC ACIDEMIA STIMULATES THE UBIQUITIN/PROTEASOME PROTEOLYTIC PATHWAY......Page 133
CLINICAL IMPLICATIONS OF ACIDEMIA FOR PROTEIN NUTRITION......Page 135
References......Page 136
CARDIOVASCULAR RISK FACTORS......Page 140
MANAGEMENT OF CVD......Page 146
References......Page 148
DEFINITION OF PROTEIN AND ENERGY WASTING......Page 154
ASSESSMENT OF PROTEIN MASS......Page 155
ASSESSMENT OF PROTEIN AND ENERGY HOMEOSTASIS......Page 165
SUMMARY AND RECOMMENDATIONS......Page 169
References......Page 170
CAUSES OF PEW IN CKD......Page 176
PATHOPHYSIOLOGY OF PEW IN CKD......Page 177
ENDOCRINE AND HORMONAL DISORDERS......Page 178
ALTERED PROTEIN KINETICS IN CKD......Page 181
ROLE OF METABOLIC ACIDEMIA......Page 182
OXIDATIVE STRESS: OTHER KEY PATHWAYS......Page 183
References......Page 184
INTRODUCTION......Page 188
PERTINENT OUTCOMES IN PATIENTS WITH CKD......Page 189
NUTRIENT INTAKE AND OUTCOMES......Page 192
BODY SIZE, BODY COMPOSITION AND OUTCOMES......Page 195
LABORATORY MEASURES AND OUTCOME......Page 196
NUTRITIONAL SCORING SYSTEMS AND OUTCOMES......Page 198
NUTRITIONAL INTERVENTIONS AND OUTCOMES......Page 199
References......Page 202
INTRODUCTION......Page 214
HUMORAL MEDIATORS......Page 215
LOCAL MEDIATORS......Page 216
INTRINSIC RENAL MECHANISMS......Page 217
LEVELS OF PLASMA CREATININE AND SERUM UREA NITROGEN IN PATIENTS WITH PROTEIN-ENERGY MALNUTRITION......Page 218
ACID EXCRETION AND ACID-BASE BALANCE IN PATIENTS WITH CALORIE-PROTEIN MALNUTRITION......Page 219
EFFECTS OF CHRONIC PROTEIN-ENERGY MALNUTRITION ON RENAL SODIUM EXCRETION......Page 220
References......Page 221
ASSESSING THE PROGRESSION OF CHRONIC RENAL INSUFFICIENCY......Page 226
PROTEIN INTAKE AND CHRONIC RENAL INSUFFICIENCY: EXPERIMENTAL DATA......Page 229
DIETARY PROTEIN INTAKE: CLINICAL STUDIES......Page 232
CLINICAL EVIDENCE OF THE EFFECTS OF LOW PROTEIN DIETS......Page 239
References......Page 244
METABOLISM OF INDOXYL SULFATE, A TRYPTOPHAN METABOLITE......Page 250
INDOXYL SULFATE INDUCES REACTIVE OXYGEN SPECIES (ROS) IN THE KIDNEY......Page 251
INDOXYL SULFATE REDUCES KLOTHO AND INDUCES SENESCENCE IN THE KIDNEY......Page 252
VASCULAR TOXICITY OF INDOXYL SULFATE......Page 253
CLINICAL EFFECTS OF AST-120......Page 254
References......Page 255
KIDNEY DISEASE AND DYSLIPIDEMIA......Page 258
STATINS IN EXPERIMENTAL KIDNEY DISEASE......Page 259
EFFECTS OF DYSLIPIDEMIA AND STATINS ON THE PROGRESSION OF KIDNEY DISEASE IN HUMAN SUBJECTS......Page 260
References......Page 263
ROLE OF DIETARY PHOSPHORUS INTAKE IN DISTURBANCES OF MINERAL METABOLISM IN CKD......Page 266
DISORDERS OF PHOSPHORUS HOMEOSTASIS AND KIDNEY DISEASE PROGRESSION......Page 267
DIETARY PHOSPHORUS RESTRICTION IN CKD: PRACTICAL CONSIDERATIONS MOVING FORWARD......Page 269
CONCLUSIONS......Page 270
References......Page 271
MECHANISM OF ACIDOSIS IN CKD......Page 274
ANIMAL MODELS OF TREATMENT......Page 275
OBSERVATIONAL STUDIES IN HUMANS......Page 276
References......Page 278
CALCIUM METABOLISM......Page 280
VITAMIN D......Page 281
PHOSPHATE METABOLISM......Page 282
FIBROBLAST GROWTH FACTOR 23 (FGF-23)......Page 283
ALTERATIONS IN MINERAL METABOLISM IN CKD......Page 284
PHOSPHATE AND CARDIOVASCULAR DISEASE (CVD)......Page 285
PHOSPHATE AND VASCULAR CALCIFICATIONS......Page 286
DIETARY PHOSPHORUS RESTRICTION......Page 288
INORGANIC PHOSPHORUS AND FOOD ADDITIVES......Page 289
DIETARY PHOSPHORUS, PROTEIN INTAKE AND PHOSPHORUS-PROTEIN RATIO......Page 290
PHOSPHORUS REMOVAL WITH DIALYSIS......Page 291
PHOSPHATE BINDERS......Page 292
CALCIMIMETICS......Page 294
References......Page 295
INTRODUCTION......Page 302
PHOSPHATE METABOLISM IN HEALTH......Page 303
PHOSPHATE METABOLISM ACROSS THE SPECTRUM OF CKD......Page 306
THE ROLE OF PHOSPHATE AND FGF-23 EXCESS IN THE PATHOPHYSIOLOGY OF CKD OUTCOMES......Page 309
THERAPEUTIC APPROACHES TO LOWERING PHOSPHATE AND FGF-23 EXCESS......Page 313
IMPACT OF DIETARY PHOSPHATE ON PHOSPHATE/FGF-23 EXCESS......Page 314
QUESTIONS AND CONTROVERSIES......Page 318
References......Page 319
NORMAL VITAMIN D METABOLISM......Page 326
PREVALENCE AND ETIOLOGY OF DEFICIENCY IN THE VITAMIN D AXIS IN CKD......Page 328
IMPLICATIONS......Page 330
INTERVENTIONS......Page 333
THERAPEUTIC CONSIDERATIONS......Page 335
References......Page 336
SODIUM AND CHLORIDE......Page 340
WATER......Page 346
POTASSIUM......Page 348
MAGNESIUM......Page 351
References......Page 352
ALTERATIONS IN ESSENTIAL TRACE ELEMENTS IN PATIENTS WITH KIDNEY DISEASE......Page 356
ALTERATIONS IN NONESSENTIAL TRACE ELEMENTS, METALS, AND METALLOIDS IN PATIENTS WITH KIDNEY DISEASE......Page 359
TRACE ELEMENT ABNORMALITIES IN RENAL-SPECIFIC SYNDROMES......Page 361
CONCLUSIONS......Page 362
References......Page 363
STRUCTURE AND PHYSIOLOGICAL ROLE OF VITAMINS......Page 368
VITAMIN INTAKE IN CHRONIC RENAL DISEASE......Page 376
VITAMINS STATUS IN CHRONIC RENAL DISEASE......Page 378
VITAMINS AS THERAPY FOR PEOPLE WITH KIDNEY DISEASE......Page 383
RECOMMENDATIONS FOR VITAMIN SUPPLEMENTATION AND VITAMIN THERAPY IN RENAL DISEASES......Page 388
References......Page 393
IRON......Page 400
VITAMIN D......Page 402
VITAMIN B6 (PYRIDOXINE)......Page 403
GROWTH HORMONE AND INSULIN-LIKE GROWTH FACTOR-I (IGF-I)......Page 404
References......Page 405
INTRODUCTION......Page 410
ALBUMIN HOMEOSTASIS IN THE NEPHROTIC SYNDROME......Page 411
DIETARY PROTEIN AND RENAL INJURY......Page 413
EFFECTS OF THE NEPHROTIC SYNDROME ON SOLID TISSUE PROTEINS......Page 414
DIETARY PROTEINS AS POTENTIAL ALLERGENS RESPONSIBLE FOR RENAL DISEASE......Page 415
DIETARY FAT......Page 416
THROMBOEMBOLIC COMPLICATIONS......Page 417
POLYUNSATURATED FATTY ACIDS......Page 418
DERANGEMENTS IN DIVALENT CATION METABOLISM IN THE NEPHROTIC SYNDROME......Page 419
DERANGEMENTS IN SALT AND WATER METABOLISM IN THE NEPHROTIC SYNDROME (VOLUME HOMEOSTASIS) 
......Page 420
RECOMMENDATIONS FOR NUTRITIONAL AND NON-NUTRITIONAL TREATMENT OF THE NEPHROTIC SYNDROME......Page 422
References......Page 424
OBESITY AND ENERGY INTAKE......Page 432
INDIVIDUAL NUTRIENTS, MISCELLANEOUS SUBSTANCES AND BLOOD PRESSURE......Page 437
HEALTH ENHANCING DIETS AND LIFESTYLES......Page 444
LONG-TERM ADHERENCE AND BLOOD PRESSURE RESPONSES TO HEALTH ENHANCING LIFESTYLES......Page 449
CHALLENGES TO DIET AND LIFESTYLE APPROACHES FOR PREVENTING AND TREATING HYPERTENSION......Page 450
KEY POINTS......Page 452
References......Page 453
INTRODUCTION......Page 462
DEFINITIONS OF OBESITY/METABOLIC SYNDROME......Page 463
PATHOPHYSIOLOGY OF OBESITY ON THE KIDNEY......Page 466
EFFECT OF WEIGHT LOSS INTERVENTIONS ON KIDNEY DISEASE......Page 469
References......Page 470
INTRODUCTION......Page 474
OBESITY-RELATED CHRONIC KIDNEY DISEASE (CKD)......Page 475
OBESITY-RELATED GLOMERULOPATHY......Page 476
METABOLIC SYNDROME......Page 478
TREATMENT OF OBESITY AND OBESITY-RELATED KIDNEY DISEASE......Page 479
BARIATRIC SURGERY (SEE ALSO CHAPTER 28)......Page 481
References......Page 485
CLINICAL MANIFESTATIONS......Page 490
MEDICAL THERAPY......Page 491
SURGICAL TECHNIQUES OF BARIATRIC SURGERY (See Figure 30.1) 
......Page 492
OUTCOMES OF BARIATRIC SURGERY......Page 494
PATHOGENESIS OF RENAL DISEASE IN OBESITY......Page 495
BARIATRIC SURGERY AND NEPHROLITHIASIS......Page 496
FUTURE RESEARCH......Page 497
References......Page 498
GLUCOSE/INSULIN HOMEOSTASIS......Page 502
VALUE OF GLYCEMIC CONTROL, AND ITS DETERMINATION IN CKD......Page 505
HYPOGLYCEMIA......Page 507
DIABETES/BONE AND MINERAL METABOLISM......Page 509
DIETARY PROTEIN INTAKE AND DIABETIC KIDNEY DISEASE......Page 512
SALT INTAKE AND DIABETIC KIDNEY DISEASE......Page 515
References......Page 516
INTRODUCTION......Page 520
FACTORS ALTERING NUTRIENT INTAKE IN MAINTENANCE HEMODIALYSIS PATIENTS......Page 521
LOSS OF NUTRIENTS DURING MAINTENANCE HEMODIALYSIS TREATMENT......Page 522
ASSESSMENT OF NUTRITIONAL STATUS IN MHD PATIENTS......Page 523
ACIDEMIA AND PROTEIN WASTING......Page 527
DIETARY NUTRIENT REQUIREMENTS (See Table 32.3)
......Page 528
MANAGEMENT OF PEW IN MHD PATIENTS......Page 542
DAILY OR LONG DURATION HEMODIALYSIS AND NUTRITIONAL STATUS......Page 544
References......Page 545
TYPE OF PERITONEAL DIALYSIS......Page 556
PERITONEAL DIALYSIS SOLUTIONS......Page 557
SPECIFIC EFFECTS OF PERITONEAL DIALYSIS ON NUTRITIONAL STATUS AND METABOLISM......Page 558
DIETARY RECOMMENDATIONS FOR ESRD PATIENTS UNDERGOING PERITONEAL DIALYSIS......Page 561
PROTEIN-ENERGY WASTING IN PERITONEAL DIALYSIS PATIENTS......Page 564
References......Page 570
ANEMIA......Page 580
BONE DISEASE......Page 581
DIABETES MELLITUS......Page 582
DYSLIPIDEMIA......Page 583
HYPERTENSION......Page 584
HYPOPHOSPHATEMIA......Page 585
OVERWEIGHT/OBESITY......Page 586
MALNUTRITION......Page 587
PROTEIN AND ENERGY REQUIREMENTS......Page 588
NUTRITIONAL MANAGEMENT......Page 590
PRETRANSPLANT STATUS AND POSTTRANSPLANT OUTCOME......Page 591
References......Page 593
ETIOLOGY OF PROTEIN-ENERGY WASTING......Page 598
ASSESSMENT OF NUTRITIONAL STATUS......Page 599
NUTRITIONAL REQUIREMENTS......Page 603
BONE MINERAL METABOLISM......Page 608
ACID–BASE AND ELECTROLYTES......Page 610
VITAMINS AND MICRONUTRIENTS......Page 611
NUTRITION MANAGEMENT......Page 612
References......Page 615
METABOLIC ENVIRONMENT OF THE PATIENT WITH AKI......Page 622
METABOLIC ALTERATIONS SPECIFICALLY ATTRIBUTABLE TO AKI......Page 623
METABOLIC INTERVENTIONS OF CONTROLLING CATABOLISM......Page 625
CARBOHYDRATE METABOLISM......Page 626
MICRONUTRIENTS AND THE ANTIOXIDANT SYSTEM IN AKI......Page 627
ELECTROLYTES......Page 629
METABOLIC AND NUTRITIONAL FACTORS AND THE PREVENTION AND THERAPY OF AKI......Page 630
IMPACT OF RENAL REPLACEMENT THERAPY (RRT) ON METABOLISM AND NUTRIENT BALANCES......Page 631
PRACTICE OF CLINICAL NUTRITION IN PATIENTS WITH AKI......Page 633
ORAL NUTRITION IN PATIENTS WITH AKI......Page 634
ENTERAL NUTRITION IN AKI......Page 635
PARENTERAL NUTRITION IN AKI......Page 637
MONITORING OF NUTRITION SUPPORT IN PATIENT WITH AKI......Page 640
References......Page 641
MODES OF CRRT......Page 646
GENERIC EFFECTS OF CRRT ON ENERGY METABOLISM......Page 647
SPECIFIC EFFECTS ON NUTRIENT BALANCE......Page 649
RECOMMENDATIONS ON NUTRITIONAL THERAPY......Page 655
References......Page 657
PREVALENCE OF ANOREXIA, METHODS OF ASSESSMENT AND CLINICAL IMPLICATIONS......Page 662
PATHOGENESIS OF ANOREXIA IN CKD......Page 664
TREATMENT OF ANOREXIA IN CKD......Page 670
References......Page 672
INTRODUCTION......Page 676
ORAL AND ENTERAL (TUBE FEEDING) NUTRITION IN CKD PATIENTS......Page 677
ORAL AND ENTERAL NUTRITION FOR PATIENTS WITH NEPHROTIC SYNDROME......Page 678
ORAL AND ENTERAL NUTRITION IN CHRONIC DIALYSIS PATIENTS......Page 679
ORAL AND ENTERAL NUTRITION IN ACUTE KIDNEY INJURY......Page 684
References......Page 686
INTRADIALYTIC PARENTERAL NUTRITION (IDPN)......Page 690
RANDOMIZED PROSPECTIVE CONTROLLED TRIALS OF IDPN......Page 697
INDICATIONS FOR IDPN......Page 698
NUTRITIONAL HEMODIALYSIS AND INTRAPERITONEAL NUTRITION......Page 699
References......Page 700
INTRODUCTION......Page 702
GROWTH FACTORS IN THE MANAGEMENT OF WASTING IN RENAL DISEASE......Page 703
References......Page 711
PATHOPHYSIOLOGY OF KIDNEY STONE FORMATION......Page 716
GENERAL DIETARY EFFECTS ON KIDNEY STONES......Page 717
EFFECT OF DIET BASED ON URINARY FINDINGS......Page 721
OBESITY AND KIDNEY STONES......Page 723
References......Page 724
INTRODUCTION......Page 728
CHRONIC KIDNEY DISEASE......Page 729
FIVE HERBALS WITH SOME PROVEN EFFICACY......Page 740
CLINICAL IMPLICATIONS......Page 742
References......Page 743
EFFECT OF FOOD INTAKE ON DRUG ABSORPTION......Page 746
EFFECTS OF NUTRIENTS ON DRUG METABOLISM......Page 747
INTERACTIONS OF FOOD SUPPLEMENTS WITH DRUGS......Page 749
DRUG-INDUCED NUTRITIONAL DEFICIENCIES......Page 750
NUTRIENT INTERACTIONS WITH ORAL ANTICOAGULANTS......Page 751
INTERACTIONS OF CALCINEURIN INHIBITORS WITH NUTRIENTS......Page 752
References......Page 753
CHARACTERISTICS OF ADVANCED CKD PATIENTS......Page 756
VALUE OF EXERCISE AND PHYSICAL ACTIVITY IN ADVANCED CKD......Page 758
PRINCIPLES OF EXERCISE TRAINING......Page 765
PATIENT ASSESSMENT......Page 766
COMPONENTS OF THE EXERCISE TRAINING PRESCRIPTION......Page 770
EXERCISE TRAINING PROGRAM DESIGN FOR PATIENTS WITH ADVANCED CKD......Page 774
COMPONENTS OF THE EXERCISE TRAINING SESSION......Page 778
RISKS OF EXERCISE IN THE ADVANCED CKD PATIENT......Page 782
URGENT NEED FOR DEVELOPMENT OF RENAL REHABILITATION PROGRAMS......Page 783
References......Page 784
WHAT IS MOTIVATIONAL INTERVIEWING?......Page 792
PRINCIPLES......Page 794
HANDLING RESISTANCE......Page 798
EMPIRICAL SUPPORT......Page 799
LEARNING MOTIVATIONAL INTERVIEWING......Page 800
CONCLUSIONS......Page 801
References......Page 802
Index......Page 804