Page 593 - Nutrition Essentials for Nursing Practice

C H A P T E R 2 1 Nutrition for Patients with Kidney Disorders 581

Box 21.4 TIPS FOR IMPLEMENTING NUTRITION THERAPY FOR CKD

■ Initially weigh or measure portion sizes and, thereafter, periodically spot-check
portion sizes for accuracy because either too little or too much protein in the diet can
cause uremic symptoms to return.

■ Be sure to eat a good breakfast if appetite decreases as the day progresses, which
may occur secondary to uremia.

■ Limit meat intake to less than 5 to 6 oz/day for most men and less than 4 oz/day for
most women. Think of meat as a side dish, not the main entrée.

■ Spread protein allowance over the whole day instead of saving it all for one meal.
■ Limit dairy products, including milk, yogurt, ice cream, and frozen yogurt, to ½ cup/

day. Nondairy creamers are a low-phosphorus alternative, but they can be high in
saturated fat.
■ Limit cheese to 1 oz hard cheese per day or ¹⁄3 cup cottage cheese per day.
■ Limit high-phosphorus foods to one serving or less per day. High-phosphorus foods
include beer, chocolate, cola, nuts, peanut butter, dried peas and beans, bran, bran
cereals, and some whole grains.
■ Do not add salt during cooking or at the table. Avoid processed foods, regular canned
vegetables, convenience foods, and seasonings that contain salt (e.g., onion salt,
lemon pepper, MSG).
■ Eat heart healthy by choosing lean meats, nonfat milk and dairy products, trans fat–
free margarines, and canola and olive oils.
■ Try highly seasoned or strongly flavored foods if uremia has caused a change in the
sense of taste.
■ Eat a consistent intake of carbohydrate with regularly timed meals to control blood
glucose levels, if appropriate.
■ Seek physician approval before using any vitamin, mineral, or supplement.

Nutrition Therapy

It has not been proven that nutrition therapy for AKI promotes recovery of kidney func-
tion or improves survival, but it is likely that nutritional support is beneficial (Academy
of Nutrition and Dietetics, 2012). The goal is to provide adequate amounts of calories,
protein, and other nutrients to prevent or minimize malnutrition; however, the metabolic
abnormalities that occur in hypercatabolic patients with AKI, such as accelerated protein
breakdown, increased energy expenditure, and an inability to use protein and calories
efficiently, make it difficult to achieve nutritional goals.

The American Society for Parenteral and Enteral Nutrition recommends enteral nutri-
tion if the GI tract is functional and that intensive care unit patients with AKI receive a
standard formula (Brown, Compher, and the ASPEN Board of Directors, 2010; McClave
et al., 2009). Enteral formulas with low electrolyte profiles specifically designed for renal
failure may be used if significant electrolyte abnormalities develop (McClave et al., 2009).
Parenteral nutrition is used if it is the only effective means of providing adequate nutrition.

Ideally, calorie requirements are determined by indirect calorimetry. When that is not
possible, an individualized assessment is recommended. Depending on the underlying
stress and the patient’s weight and nutrition status, calorie needs may range from 25 to
35 cal/kg/day or more, including calories provided through continuous renal replacement
therapy (CRRT). Protein recommendations are controversial and vary with the type of renal
replacement therapy used and the degree of catabolism. Protein should not be restricted as