1,721,263 research outputs found
[Definition of the nutritional therapy in the conservative treatment of chronic kidney disease].
No full textNutritional therapy has a leading role in the conservative treatment of chronic kidney disease (CKD). In the context of CKD, nutritional therapy means designing diets to reduce the patient's intake of proteins, phosphorus and sodium, while preserving adequate energy intake. Nutritional therapy may require also supplementation with calcium carbonate, iron, or essential amino acids and keto acids. Different nutritional strategies can be devised according to the protein needs of CKD patients: diets with controlled protein intake (protein RDA: 0.8 g/kg/day); low-protein and low-phosphorus diets (protein: 0.6 g/kg/day, phosphorus: 500-700 mg/day); very low-protein and low-phosphorus diets (protein: 0.3 g/kg/day, phosphorus: 300-400 mg/day). Much of the protein intake should be of high biological value (e.g., 0.4 g/kg/day of 0.6 g/kg/day or supplementation with essential amino acids and keto acids is needed). The sodium chloride content of low-protein and very low-protein diets should be kept between 2 and 5 g/day according to individual needs, and the energy intake should be kept at 30 to 35 kcal/kg/day
Update on nephrolithiasis: beyond symptomatic urinary tract obstruction
No full textNephrolithiasis research and care have been focused on biochemical changes in urinary solute excretion leading to stone formation, but abnormalities in urine chemistry alone do not explain many aspects of the condition of patients with kidney stone disease. Evidence exists of an association with metabolic syndrome, obesity, diabetes and hypertension, and of enhanced risk of chronic kidney disease and metabolic bone disease. Very recently also a higher risk of cardiovascular events and damage has been reported in kidney stone formers when compared with non-stone formers. It is time to view nephrolithiasis as a condition predictive of chronic kidney disease and cardiovascular damage, which deserves full metabolic evaluation together with an early prevention care strategy, mainly consisting of dietary and lifestyle changes, in a multidisciplinary approach. Kidney stone disease should be considered as a systemic disorder with clinical relevance beyond symptomatic urinary tract obstructio
The role of dietary phosphorus restriction in the conservative management of chronic renal disease
No full textEvidence exists that phosphate retention plays a major role in causing secondary hyperparathyroidism, cardiovascular morbidity, and loss of residual renal function in chronic renal disease patients, and that a subtle elevation in serum phosphate occurs at early stages in the course of renal insufficiency. The implementation of a low-phosphorus, low-protein dietary regimen plays a special role in the conservative management of chronic renal disease patients, for the prevention and correction of secondary hyperparathyroidism and for the renal and cardiovascular protection. However, the success and safety of dietary phosphate restriction largely depends on good compliance with dietary recommendations, which must represent a major goal to be regularly pursued in the clinical practice. To this aim, it is crucial that dietitians expert in renal nutrition give education and personalized dietary advice, with the aim of enhancing the patient's adherence to nutritional prescriptions
Keto-analogues and essential aminoacids and other supplements in the conservative management of chronic kidney disease
No full textThe manipulation of dietary protein intake is the mainstay of nutritional treatment of patients affected by chronic renal insufficiency, with the aim to reduce the burden of uremic toxins in order to decrease uremic toxicity and delay the need for dialysis. Consensus exists regarding the benefit of progressive protein restriction towards delaying the progression of renal failure and the need for dialysis, provided adequate energy supply. Although pivotal, protein restriction is only one aspect of the dietary management of chronic kidney disease (CKD) patients. Additional features, though strictly related to proteins, include modifications in sodium, phosphorus and energy intake, as well as in the source (animal or plant derived) of protein and lipids. In addition, supplements play an important role as a means to obtain both beneficial effects and nutritional safety in the renal patient. Essential amino acid and ketoacid mixtures are the most utilized types of supplementation in CKD patients on restricted protein regimens. The essential amino acids plus ketoacid supplementation is mandatory in conjunction with a very low-protein diet in order to assure an adequate essential amino acid supply. It is needed to safely implement a very low protein (and phosphorus) intake, so as to obtain the beneficial effect of a severe protein restriction while preventing malnutrition. Protein-free products and energy supplements are also crucial for the prevention of protein-energy wasting in CKD patients. Calcium, iron, native vitamin Dand omega-3 PUFAs are other types of supplementation of potential benefits in the CKD patients on conservative management
The impact of known and unknown dietary components to phosphorus intake
No full textThe pathogenesis of CKD-MBD is multifactorial but the tendency towards phosphorus retention due to an excessive dietary intake for the residual renal function plays a central role. The dietary phosphorus is absorbed in the intestine as inorganic free phosphorus. The share of intestinal absorption (about 60% on average) is negligible for plant phosphorus (in the form of phytate), while it is maximal for phosphate or polyphosphates contained in food additives. The latter represent a dangerous extra load of phosphorus because they are poorly recognized by patients and widely used in modern nutrition, in particular in low-cost food. In a free mixed diet, the phosphorus content is directly related to that of proteins. It follows that protein-rich foods are the main source of phosphorus. This is a favorable condition for CKD patients in conservative therapy when a low-protein diet is implemented, while it represents a huge problem for dialysis patients, who need a high-protein diet. A simple and effective approach to reduce the load of dietary phosphorus without reducing protein intake is to educate patients to avoid foods high in phosphorus (cheese, egg yolk, nuts, etc.), and particularly those containing phosphorus additives. In addition, they should prefer boiling (resulting also in a decrease in sodium and potassium) to other methods of cooking. Counseling by a dietician is important for successful patient care. The dietician provides nutritional education, can help the patient with the choice of food, and may favor the adherence to dietary prescriptions, which is a crucial aspect in an integrated approach to CKD-MBD
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