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Optimal Dietary Management for Chronic Renal Disease: Essential Nutrient Intake Guide

This guide provides key insights into the recommended dietary intake of proteins, lipids, carbohydrates, vitamins, minerals, fluids, and energy for individuals with chronic renal disease at different stages and age groups, considering treatments like HD and PD. It emphasizes the importance of nutrient balance and restriction to maintain overall health and manage specific conditions like hyperlipidemia and anemia.

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Optimal Dietary Management for Chronic Renal Disease: Essential Nutrient Intake Guide

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  1. Main points • Dietary protein intake • Lipids/fats • Carbohydrates • Vitamins and minerals • Fluid • Energy intake

  2. Dependence on… • Age • Stage of CRD (based on GFR ) • Treatment (conservative, HD, PD)

  3. Restricted (0,75-1,0g/kg/day) (combined with ketoacids) Equivalent to or above WHO recommendations for healthy children Dietary protein intake 2 studies (250 children)- 124-Protein reduced diet 126- ~RDA Reducing protein intake does not appear to have a significant impact in delaying the progression to ESKD in children Cochrane Database Syst Rev. 2007 Oct 17(4): CD006863

  4. Adults Blood cholesterol level <4,5 mmol/l Diet manipulation Statins Children - Age dependence Lipids/fats

  5. Carbohydrates/ Energy intake • Carbohydrates should be used to maintain the required daily energy intake • Energy intake- 100% of estimated average requirement (if vomiting - +30% of EAR)

  6. Vitamins • Vitamins - reasonable to give as for normal children • Vit A -hypercalcaemia, anaemia and hyperlipidaemia • Vit D – if PTH (better active forms) • Folic acid – good in GFR <40 ml/min/1,73 m2, but no dosage recommendations

  7. Minerals • Dietary phosphate may need to be restricted when the GFR falls below the normal range, and almost always when below 50 ml/min/1.73 m2. • Phosphate binders • Iron, copper and zinc – anemia (i/v iron), EPO • Potassium, sodium

  8. Fluid / water • Adjust according clinical data (reduced GFR, oedema, hypertension)

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