chapter  8
14 Pages

Nutrition for Chronic Kidney Disease, Stages 1–3

Chronic kidney disease (CKD) is recognized as a global public health problem (Saran et al., 2010). Prevalence for adults in the United States is approximately 15% of the general population (WhaleyConnell et al., 2008). In addition, data from Europe, Australia, and Asia verify the high prevalence of CKD (Zhang et al., 2008). In the United States, disease-stage prevalence of CKD Stages 1, 2, and 3 is estimated to be 1.8%, 3.2%, and 7.7%, respectively (Whaley-Connell et al., 2008). Stages 1-3 account for most individuals with CKD. Individuals in the early stages of CKD have a higher risk of cardiovascular disease (CVD) morbidity and mortality than their risk of progression to kidney failure (Saran et al., 2010). A systematic review of population-based studies reported that prevalence of CKD was 7.2% in persons aged 30 years or older and 23.4%–35.8% in persons older than 64 years (Zhang et al., 2008). The high prevalence of CKD, chie¬y among older adults and those with diabetes and hypertension, implies that CKD is a de”nite threat to public health. New objectives from Healthy People 2010 show a greater emphasis on CKD versus the end-stage renal disease

8.1 General Principles: Chronic Kidney Disease, Stages 1-3 .................................................... 109 8.2 Nutrition Care ....................................................................................................................... 110

8.2.1 NKF-KDOQI™ Clinical Practice Guidelines for Nutrition .................................... 110 8.2.2 Medical Nutrition Therapy ....................................................................................... 110

8.2.2.1 Medicare Reimbursement .......................................................................... 110 8.3 Nutrition Intervention: Nutrition Prescription ...................................................................... 111

8.3.1 Protein ....................................................................................................................... 111 8.3.2 Energy ....................................................................................................................... 113 8.3.3 Lipids ........................................................................................................................ 113 8.3.4 Minerals .................................................................................................................... 114

8.3.4.1 Sodium ....................................................................................................... 114 8.3.4.2 Potassium ................................................................................................... 115 8.3.4.3 Phosphorus ................................................................................................. 115 8.3.4.4 Calcium ...................................................................................................... 116 8.3.4.5 Trace Elements ........................................................................................... 116

8.3.5 Vitamins ................................................................................................................... 116 8.3.5.1 Fat-Soluble Vitamins ................................................................................. 116 8.3.5.2 Water-Soluble Vitamins ............................................................................. 117

8.3.6 Fluid .......................................................................................................................... 119 8.3.7 Fiber .......................................................................................................................... 119

8.4 Websites ................................................................................................................................ 119 References ...................................................................................................................................... 120

from Healthy People 2010. These new objectives recognize this by proposing a reduction in the percentage of the U.S. population with CKD; reducing death rates among individuals with CKD; and increasing the percentage of individuals with CKD who know they have impaired renal function (Healthy People, 2010). Moreover, the establishment of a World Kidney Day in 2006 by the International Society of Nephrology and International Federation of Kidney Foundations was the result of recognition that CKD is a threat to global public health (Collins et al., 2006).