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Medical Nutrition Therapy
for Kidney Disease
N. L. Kondracki, MS, RD, LDN
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(Manual, 287 pgs) The most comprehensive CPE program we have ever published!
Discover how to apply the principles of medical nutrition therapy (MNT)
for a variety of kidney diseases consistent with current clinical practice
recommendations including how to:
- Calculate dialysis adequacy for hemodialysis and peritoneal dialysis
- Implement treatment goals for conditions associated with kidney
disease
- Assess fluid and nutrient needs for patients at each stage of kidney
disease
- Interpret laboratory tests important to the evaluation of kidney
patients’ nutrition status
- Provide appropriate nutrition education to patients with kidney
disease
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To order an additional Reporting Form click below:
| C215F |
30 CPEUs |
REPORTING FORM |
$50.00 |
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Copyright 2011 Wolf Rinke Associates. All rights reserved for
this self-directed, accredited learning program. Reproduction in whole
or part without written permission from the publisher is prohibited.
CUSTOMER COMMENTS
Barbara Vogel: "Excellent detail provided. A good reference source to keep and use. Good depth of course material."
Juel Steffen: "This course provided info that is up to date & I can use on reg. basis. Liked the calculation formulas w/ Examples."
Rita Nauer: "The course was so very complete & I liked being able to study it over time."
Leslie Merklin-Barber: "Purchased to learn as a nurse about kidney disease Mgt. & to support my RD's."
Jennifer Rosario: "The level of instruction was high and I enjoyed learning the more detailed information regarding kidney disease."
Habiba Qurashi: "This book provides a lot of information about medical nutrition therapy and kidney disease. It is easy to read and understand also."
Arlene Patricia Williamson: "This was extremely comprehensive n challenging . very well written .all i needed to know wanted to know dreamed of knowing the text is a keeper."
Barbara Dromazos: "Good overview course! The table of contents makes it easy to find specifics. I really appreciate the references, the glossary, and the resource list."
Joyce Whitford: "I love the explanations to the questions; a helpful learning tool."
Patricia Yacovoni: "It gave me indepth knowledge that I needed to better assess the resident's receiving dialysis as well as those with poor kidney function."
Sarah O'Gara: "It was very complete, I feel confident in my CKD knowledge to apply for a position in that area."
INTRODUCTION AND INSTRUCTIONS
Historically, "renal nutrition" has been one of the most challenging
areas of dietetics to master. The complexities of this area of study
relate to the significant roles that the kidneys play in the human body,
such as maintaining homeostasis and eliminating wastes, as well as the
varied and continually evolving options for treating renal failure.
Both the current best practices and indications for future practice
based on emerging research are presented here.
In an effort to be more consumer-friendly many practitioners have ceased
using the term "renal" in favor of the more straightforward
"kidney." The two terms are used interchangeably throughout
this course. The human urinary system is comprised of the kidneys, ureters,
bladder and urethra. Although there are circumstances in which the latter
three are discussed, this course will primarily focus on the functions,
physiology, and treatments related to the function and dysfunction of
the kidneys.
This self-directed learning program is a Level 2 Continuing Professional
Education (CPE) program approved for 30 Continuing Professional Education
Units (CPEUs). That means that the reader has general knowledge of the
literature and professional practice within the area covered. The focus
of the program is to enhance knowledge and application.
To get the most benefit from this program, we suggest you adhere to
the following four steps:
Step 1: Review the objectives for the learning program.
Step 2: Study each chapter. As you read, think of patients from your
own practice who fit the situation described.
Step 3: Assess what you have learned by completing the self-assessment
instrument at the end of this learning program.
Step 4: Compare your answers with the answer key that has been provided.
If you score at least 80% correct, transfer your answers to the Continuing
Professional Education Reporting Form. If you scored less than 80% correct,
re-read this learning program until you are able to score at least 80%
correct.
After you have successfully completed the program complete the CPEU
REPORTING FORM and:
Mail to: Wolf Rinke Associates, 721 Valley Forge Road #486, Valley Forge, PA 19481,
Or fax to: (410) 531-9282,
Or submit on-line at www.easyCPEcredits.com.
We will email your Certificate of Completion.
When you submit your CPEU Reporting Form to us via mail, fax or www.easyCPEcredits.com,
be sure to write your correct email address in the space provided on
the CPE Reporting Form. If writing by hand, be sure to print your email
address clearly.
To ensure that our emails are delivered to your inbox (instead of your
junk/spam folders), please add cpesupport@wolfrinke.com to your Address
Book or Safe List of allowed email senders. Also, be sure to allow attachments
from this email address.?
GOAL
To provide current, accurate and practical information and resources
that will assist you in applying the principles of medical nutrition
therapy for a variety of kidney diseases in a manner consistent with
current clinical practice guidelines and recommendations.
OBJECTIVES
As a result of studying and applying the concepts presented in this
accredited, self-directed leaning program, you will be better able to:
- Recognize the functions and physiology of the human kidneys.
- Assess the common diseases associated with kidney dysfunction.
- Identify populations that present special challenges for renal dietitians
and explain the challenges for each.
- Assess different types of dialysis and recognize the advantages
and disadvantages of each.
- Calculate dialysis adequacy for hemodialysis and peritoneal dialysis.
- Recommend basic medical nutrition therapy goals and treatments for
a variety of kidney diseases and their manifestations.
- Implement treatment goals and options for conditions that occur
as complications of kidney disease.
- Assess fluid and nutrient needs for patients at each stage of kidney
disease.
- Interpret laboratory tests important to the evaluation of kidney
patients' nutrition status.
- Provide appropriate nutrition education to patients with kidney
diseases.
TABLE OF CONTENTS
Chapter 1: Kidney Disease Today 1
THE BURDEN OF KIDNEY DISEASE 1
ETHNIC DISPARITIES 4
CURRENT RENAL NUTRITION PRACTICE 5
MEDICAL NUTRITION THERAPY REIMBURSEMENT 6
Chapter 2: Kidney Anatomy, Physiology, and Function 8
THE URINARY TRACT SYSTEM 8
KIDNEY ANATOMY, PHYSIOLOGY, AND BLOOD FLOW 9
HOMEOSTATIC FUNCTIONS 14
Regulation of Fluid Balance 14
Regulation of Acid/Base Balance 22
Red Blood Cell Production 27
Vitamin D Activation 27
Blood Pressure Control 27
Chapter 3: The Spectrum of Kidney Diseases 30
ACUTE KIDNEY INJURY 30
CHRONIC KIDNEY DISEASE 30
END-STAGE RENAL DISEASE 36
GLOMERULAR DISEASES 38
Nephritic Syndrome 38
Nephrotic Syndrome 38
Pyelonephritis 40
Membranous Nephropathy 41
IgA Nephropathy 42
Glomerulosclerosis 42
POLYCYSTIC KIDNEY DISEASE 43
KIDNEY STONES/NEPHROLITHIASIS 44
Oxalosis 49
RENAL CANCER 50
URINARY TRACT INFECTIONS 52
Dietary Supplements 54
HEMOLYTIC UREMIC SYNDROME 55
DIABETES INSIPIDUS 56
Chapter 4: Treatment Modalities 59
TYPES OF DIALYSIS 59
Conventional 61
Peitoneal Dialysis 61
Hemofiltration 68
ASSESSING DIALYSIS ADEQUACY 69
The Kidney Disease Clinical Studies Initiative Hemodialysis Study 69
Urea Kinetic Modeling 70
Total Body Water Volume Calculations 72
BUN Measurements 73
Alternative Methods to Formal Kinetic Modeling 73
Expression of Treatment Frequency 74
Criteria for Minimal Adequate Hemodialysis Dose 75
The Evolution of Efforts to Improve Adequacy 78
Peritoneal Dialysis 80
Error Analysis 84
TYPES OF VASCULAR ACCESS 88
Quality Programs 89
KIDNEY TRANSPLANT 90
Diabetes, Lipids, and The Metabolic Syndrome 92
Short- Vs. Long-Term Concerns 93
Drug Side Effects 95
Parathyroidectomy 97
Chapter 5: Populations Presenting Special Challenges 99
DIABETES 99
Treatment Options 99
CARDIOVASCULAR DISEASE 104
Lipid Management 105
Blood Pressure Management 106
CHILDREN AND ADOLESCENTS 107
OLDER ADULTS 114
PREGNANCY AND OTHER WOMEN'S ISSUES 117
HIV-ASSOCIATED NEPHROPATHY 119
HEPATITIS C INFECTION 120
VEGETARIAN DIET 121
CELIAC DISEASE/GLUTEN-FREE DIET 121
Chapter 6: Complications of CKD 123
MINERAL BONE DISORDERS 123
Phosphorus Management 125
Hypophosphatemia 131
Osteomalacia 132
Osteosclerosis 133
Challenges Associated With the Management of Mineral Bone Disorders
134
ANEMIA 135
UREMIA 139
UNDERNUTRITION 140
NEPHROGENIC FIBROSIS 142
Chapter 7: Assessment of Nutrition Status in Renal Patients 144
CLINICAL GUIDELINES 144
ASSESSMENT OF NUTRIENT NEEDS 145
Nutrient Intake Assessment 145
Subjective Global Assessment 147
Assessment of Anthropometric Measures and Weight 148
Assessment of Calorie and Protein Needs 149
Laboratory and Medical Tests 150
Assessment of Fluid Needs 150
Care Planning 151
MEASUREMENTS/CALCULATIONS 153
Body Water Calculations 153
Body Surface Area (BSA) Formulas 153
Body Weight Determinations 153
Height Estimates 155
Arm Anthropometrics 156
Frame Size Estimates 157
LABORATORY ASSESSMENT 158
Albumin 158
Alkaline Phosphatase 159
Aluminum 159
Ammonia 159
B12 (Vitamin) 160
Bicarbonate 160
Blood Urea Nitrogen 162
Calcium 162
Calcium Phosphate Product 164
Carbon Dioxide 164
Ceruloplasmin 164
Chloride 165
Cholesterol 165
Complete Blood Count 166
Creatinine 166
Creatinine Index 166
C-Reactive Protein 168
Fecal Fat Test 169
Ferritin 169
Folic Acid 170
Globulin 170
Glomerular Filtration Rate 170
Glucose 172
Hematocrit 173
Hemoglobin 173
Hemoglobin A1C 174
Iron 174
Kt/V 175
Magnesium 176
Mean Corpuscular Volume 176
Osmolality 176
Parathyroid Hormone, Intact 177
Phosphorus 178
Potassium 178
Prealbumin 179
Protein Equivalent of Total Nitrogen Appearance 179
Red Blood Cell Count 180
Reticulocyte Count 181
Reticulocyte Hemoglobin Content 181
Sodium 182
Total Iron Binding Capacity 183
Total Lymphocyte Count 183
Total Protein 184
Transferrin 184
Transferrin Saturation 185
Triglycerides 185
Uric Acid 185
Urine Protein (Microalbuminuria/Proteinuria Test) 186
URR% 186
Vitamin D 187
White Blood Cell Count 188
Zinc 188
REIMBURSEMENT REQUIREMENTS FOR RENAL MNT 189
IMPLEMENTING THE NUTRITION CARE PROCESS WITH KIDNEY PATIENTS 190
Chapter 8: Nutrition Support in CKD 192
ENTERAL FEEDING GUIDELINES 192
Commercial Macronutrient Supplements 193
PARENTERAL NUTRITION 195
IDPN 196
IPN 197
IPAA 198
Chapter 9: Nutrition Education 199
THE NATIONAL RENAL DIET 199
Exchanges vs. Choices 199
Protein 200
Carbohydrates 201
Sodium, Potassium, and Phosphorus 201
Fluids 207
Calories 208
Renal Food Guide Pyramid 209
Patient Education: Making the Renal Diet Work 210
CARBOHYDRATE COUNTING 213
TOOLS FOR CKD-FRIENDLY MEAL PREPARATION 213
Soaking Potatoes 213
Choosing Salt Substitutes 213
FOCUS ON FOOD LABELS 213
Chapter 10: Lifestyle Factors other than Diet 217
PHYSICAL ACTIVITY 217
SMOKING CESSATION 217
SLEEP 217
Chapter 11: Dietary Supplements and Kidney Care 219
VITAMINS AND MINERALS 219
Folate and B-Vitamins 219
Vitamin C 220
Niacin 220
Vitamin D 220
Iron 220
FISH OIL 227
L-CARNITINE 227
MISCELLANEOUS PRODUCTS 228
COMBINATION PRODUCTS DESIGNED FOR KIDNEY PATIENTS 228
References 229
Appendix: Renal Resources 245
Glossary 248
Abbreviations 258
Self-Assessment Questions 265
Answer Key 275
Explanations To Questions 276
About The Author 286
About Wolf Rinke Associates, Inc. 287
ABOUT THE AUTHOR
Nancy L. Kondracki is a registered dietitian with a Master of Science
degree in Nutrition and Dietetics from Florida International University
(Miami, FL), and a Bachelor of Arts in Biology from Franklin & Marshall
College (Lancaster, PA). She is an Independent Contractor in Greensboro,
NC who specializes in writing science-based articles for newsletters
and Web sites, developing CE courses, designing PowerPoint presentations,
and analyzing recipes and menus. She is active with both the Greensboro
and North Carolina Dietetic Associations, holding leadership positions
in both. She also serves on the Get Healthy Guilford childhood obesity
prevention coalition. Nancy has clinical experience, as well as serving
as past manager of Nutrition Projects at Nutrio Technologies, and Manager
of Nutrition Communications with the public relations firm GBA Health
Communications where she consulted on projects for several brands, including
Sweet'N Low®, Butter Buds®, and Ester-C®. Nancy is a recent
winner of the North Carolina Dietetic Association Emerging Leader Award,
and past winner of the Broward County (Florida) Dietetic Association
Recognized Young Dietitian and American Dietetic Association Outstanding
Dietetic Student awards.
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