Question

Why is knowing about protein consumption important for chronic kidney disease? What are the steps in maintaining nutrition recommendations for such patients?

Provide your answer in 300-word summary with one research article to support your answer.

Answer 1

Chronic renal failure or ESRD ,is a progressive ,irreversible deterioration in renal function in which the bodys ability to maintain metabolic and fluid and electrolyte balance fails ,resulting in uremia or azotemia.THe pathophysiology is as renal function declines ,the endproducts of protein metabolism accumulate in the blood.Uremia develops and adversely affects every system in the body.The greater the buildup of waste products ,the more severe the symptoms.The rate of decline in renal function and progression of chronic renal failure is related to the underlying disorder,the urinary excretion of protein and the presence of hypertension.The disease tends to progress more rapidly in patients who excrete significant amounts of protein or have elevated bloodpressure than in those without these conditions.

When damaged kidneys are unable to excrete endproducts of metabolism ,these substances accumulate in the serum as toxins.the resulting symptoms are called uremic syndrome. The main goals of nutrition therapy are to minimize uremic symptoms and fluid electrolyte imbalances,to maintain good nutritional status through adequate protein ,calorie ,vitamin and mineral intake and to enable the patient to eat a palatable and enjoyable diet .Protein intake is restrcted to about 1.2 to 1.3g/kg/day idel body weight per day.therefore the protein must be of of high biologic quality and consist of the essential aminoacids to prevent poor protein use and to maintain a positive nitrogen balance.Dietary intervention is necessary with deterioration of renal function and includes careful regulation of protein intake ,fluidintake to balance fluid losess and some restriction of potassium.At the sametime ,adequate calorie intake and vitamin supplementation must be ensured.Protein is restricted because urea,uric acid and and organic acids -the breakdown products of dietary and tissue proteins -accumulate rapidly in the blood when there is impaired renal clearance.The allowed protein must be of high biologic value such as diary products ,eggs and meat..High biologic value proteins are those that are complete proteins and supply the essential aminoacids necessary for growth and cellrepair.

Usually the fluid allowance per day is 500ml to 600ml more than the previous day 24 hour urine output.Calories are supplied by carbohydrates and fat to prevent wasting .Vitamin supplementation is necessary because a protein restricted diet does not provide the necessary complement of vitamins.Additionaly ,the patient on dialysis may lose water-soluble vitamins during the dialysis treatment.

Hyperkalemia is prevented by ensuring adequate dialysis treatments with potassium removal and careful monitoring of diet ,medications and fluids for their potassium content.Dietary restriction is an unwelcome change in the lifestyle for many patients with chronic renal failure.Patients often feel stigmatized in social situations because there maybe few food choices available for the diet .if the restrictions are ignored life threatening complications such as hyperkalemia and pulmonary edema may result.Thus the patient may feel punished for responding to basic human rights to eat and drink.

References-Fox,C.S.,Larson ,M.G.,Leip,E.P.,et al.(2004).Predictors of new-onset kidney disease in a community -based population.Journal of American Medical Association,291(7),844-850.