Diet and CKD

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Diet and CKD

• Angela Haslam
• Specialist Renal Dietitian

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What is the Dietitians role?

• To educate and advise people on diet
• To provide support through treatment
• To work as part of the MDT
• To provide support for non-renal staff

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Aims of Diet therapy

• Maintain normal biochemistry levels
• Minimise symptoms
• Prevent malnutrition and unintentional weight
  loss

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Factors that influence dietary advice

• Stage of CKD
• Biochemistry levels (trends)
• Medications
• Treatments e.g. Conservative, Dialysis
• Other medical conditions e.g. Diabetes
• Lifestyle (social, psychological aspects)

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Dietary advice

• Energy
• Protein
• Salt
• Potassium
• Phosphate
• Fluid

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Case study Mr A

• Age 45, Caucasian male
• Wt 103kg, Ht 1.64m, BMI 38 kgm2
• Stage I CKD, (eGFR 90ml/min)
• PMHx Type II DM, Obesity, Hypertension,
  Hypercholesterolaemia, Proteinurea.
• Medications Simvastatin 20mg OD, Lisinopril 20mg
  OD, Metformin 500mg BD
• Social History wife recently left him, lives
  alone, works at supermarket 5/7

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Dietary advice

• Weight Management - activity/lifestyle, current
  intake, food preferences, cooking methods, food
  labelling, alcohol.
• DM Control - meds, regular meals starchy CHOs,
  low sugar, fruit veg.
• Lipid Control ?saturated fats, ?mono fats, oily
  fish, fruit veg.
• Salt Intake - at table, in cooking, convenience
  foods.

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Case study Mrs P

• Age 25, South-East Asian female.
• Wt 55 Kg, Ht 1.6 m, BMI 17.5 kgm2
• Stage IV CKD (eGFR 19ml/min), symptomatic with
  nausea vomiting.
• PMHx Glomerulonephritis, Nephrotic Syndrome,
  recent Pre-eclampsia (lost baby).
• Medications Darbepoetin, Labetalol, Ferrous
  Sulphate.
• Social History lives with husband 4 yr old
  child, housewife.
• Current Biochemistry
• Na 135, K 6.0,
  Creat 279
• Ur 21.2, P04 1.42

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Dietary advice

• Low Appetite, Depressed Symptomatic small
  often intake, energy dense and mod protein foods.
• High Potassium Level cooking methods, food
  choices frequencies of high K foods.
• Hypertension salt intake
• Phosphate Level OK. Not on binder medication.
  Issue not addressed in detail at 1st appt, but to
  be discussed at review.
• Factors Considered by Dietitian
• Family situation recent loss of child
• Culture Asian diet cooking methods
• Future life changing treatments Haemodialysis

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Our contact details

• If you have any questions, please do not hesitate
  to contact the renal dietitians
• Department of Nutrition and Dietetics
• St Lukes Hospital
• Little Horton Lane
• Bradford
• BD5 0NA
• Tel [phone]
• www.bradford-dietetics.org

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An Overview of Psychological Factors in Renal
Disease

• Dr Kate Ryder and Dr Helen Toone
• Clinical Psychologists
• Renal Team, St Lukes Hospital

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Contact Details

• Dr Helen Toone, Clinical Health Psychologist
  (helen.toone_at_bradfordhospitals.nhs.uk)
• Dr Kate Ryder, Clinical Health Psychologist
  kate.ryder_at_bradfordhospitals.nhs.uk)
• St. Lukes Hospital. 01274 365176