Brigitte Leclercq

G r a d u a t e d S t e l l e n b o s c h ( 2 0 1 1 )

C o m m u n i t y s e r v i c e y e a r : F r e r e H o s p i t a l ( 2 0 1 2 )

M a s t e r s i n k i d n e y n u t r i t i o n ( 2 0 1 2 - n o w )

P a n o r a m a D i e t i t i a n s & T y g e r v a l l e y V i r g i n A c t i v e ( 2 0 1 3 / 2 0 1 4 )

A D S A m e d i a s p o k e s p e r s o n ( 2 0 1 3 )

E n t h u s i a s m f o r n u t r i t i o n

L e a d a h e a l t h y l i f e s t y l e : r u n n i n g , b a k i n g , o u t d o o r s

D e f i n i t i o n o f C R F

C l a s s i f i c a t i o n

S l o w i n g t h e p r o g r e s s i o n

D i a l y s i s

C a u s e s o f i n a d e q u a t e i n t a k e

R o l e a s a d i e t i t i a n

D i e t a r y m a n a g e m e n t

S o d i u m / f l u i d r e s t r i c t i o n s

P o t a s s i u m r e s t r i c t i o n s

P h o s p h a t e r e s t r i c t i o n s

U s e f u l w e b s i t e s

A b n o r m a l i t i e s o f k i d n e y s t r u c t u r e / f u n c t i o n

P r e s e n t > 3 m o n t h s

W i t h i m p l i c a t i o n s f o r h e a l t h

B a s e d o n c a u s e , G F R c a t e g o r y , a l b u m i n u r i a c a t e r g o r y

H e t e r o g e n o u s d i s o r d e r a f f e c t i n g k i d n e y s t r u c t u r e / f u n c t i o n

w i t h d i f f e r e n t c l i n i c a l p r e s e n t a t i o n – r e l a t e d t o

c a u s e , s e v e r i t y , p r o g r e s s i o n

P r e v i o u s l y c l a s s i f i e d b y N K F K D O Q I a n d d i v i d e d i n t o 5 s t a g e s

o f s e v e r i t y ( G F R a l o n e )

KDIGO, 2013

June 2014

NKDEP, June 2014

Therapeutic goal Relevance Diet intervention

Control BP Slows progression ↓CVD risk ↓ albuminuria

1500mg sodium / day ↓ weight

Manage DM Slows progression

Low GI foods Diabetic friendly diet

Manage potassium (GFR < 30ml/min)

Prevents peripheral neuropathy

1500-2700mg potassium / day

Manage phosphate ( GFR <45ml/ min)

CKD-MBD Atherosclerosis → CVD

800 – 1000mg / day Bioavailibility of phosphate

↓ albuminuria Improves BP Improves metabolic acidosis Improves hgt control Improves CKD-MBD

Restrict protein to 0.6-0.8 g/kg Restrict protein to 0.8 -1g/kg (DM) Type of protein

E S R D - r e n a l f x d e t e r i o r a t e s s o m u c h t h a t a c c u m u l a t e d w a s t e

i n t e r f e r e w i t h n o r m a l b o d y f u n c t i o n s & p h y s i o l o g i c a l c h a n g e s

c a n ’ t b e c o n t r o l l e d w i t h m e d i c a t i o n / d i e t

C a r e f u l l y p l a n n e d t o p r e v e n t m o r t a l i t y & m o r b i d i t y

S A : G F R < 1 5

o r s y m p t o m s o f u r a e m i a

f l u i d o v e r l o a d

p o o r l y c o n t r o l l e d B P

e v i d e n c e o f m a l n u t r i t i o n

Schrier, 2009; Lacson et al, 2009

D i e t n o t t a s t y

N a u s e a , v o m i t i n g

M e d i c a t i o n

P s y c h o l o g i c a l f a c t o r s

F o o d s e c u r i t y

S m o k i n g

H D : t i r e d , D E S

P D : a b d o m i n a l d i s t e n t i o n , g l u c o s e a b s o r p t i o n , p e r i t o n i t i s

I n a d e q u a t e d i a l y s i s ( ↓ K t / v )

↓ c o g n i t i v e f x

G I p r o b l e m s

Acceptable food choices

Diversity & availability of food

Timing of message

Literacy of message and understanding reasons to change

diet

Prevent complications/ PEW/ Nutrient

deficiencies

I n d i v i d u a l i z e

S t a r t e a r l y

M u l t i d i s c i p l i n a r y

R e v i e w 3 - 4 m o n t h l y

I n t e n s i v e i n i t i a l c o u n s e l i n g w i t h f o l l o w u p e v e r y 1 - 2 m o n t h s

KDIGO, 2013

P r e v e n t d e f i c i e n c i e s

C o n t r o l e d e m a & s e r u m e l e c t r o l y t e s

S o d i u m & f l u i d r e s t r i c t i o n

P o t a s s i u m r e s t r i c t i o n

P r e v e n t C K D - M B D ( r e n a l o s t e o d y s t r o p h y )

P h o s p h a t e r e s t r i c t i o n

P b i n d e r , c a l c i u m s u p p l .

D i e t m u s t b e :

P a l a t a b l e

A t t r a c t i v e

KDIGO, 2013

S A LT

N o a d d e d s a l t ( 1 / 2 t s p )

L i m i t p r o c e s s e d & c a n n e d f o o d

N B b e v e r a g e i n t a k e

N B r e s t a u r a n t m e a l s

W A T E R / F L U I D S

D r d e c i s i o n t o m a k e

U s u a l l y 5 0 0 - 1 0 0 0 m l / d a y

T i p s f o r t h i r s t

I c e b l o c k s

L e m o n w a t e r / l e m o n s w e e t s

I c e c o l d w a t e r

D i s t r i b u t e f l u i d t h r o u g h o u t d a y

N B r o l e : n e r v e r e g u l a t i o n a n d m u s c l e c o n t r a c t i o n

I m p a i r e d r e n a l F x : a c c u m u l a t e i n b l o o d

I m p a i r e d n e r v e r e g u l a t i o n

I m p a i r e d a b i l i t y o f h e a r t t o c i r c u l a t e b l o o d

A i m : 3 . 3 - 5 . 3

D i e t p r e s c r i p t i o n : < 2 0 0 0 m g P o t a s s i u m

M e d s w h e n n e c e s s a r y

N B : L e a c h v e g e t a b l e s ( p o t a t o / s w e e t p o t a t o )

SA Renal Exchange Lists, 2012

M i n e r a l i n f o o d ( a n d w i t h c a l c i u m ) = e s s e n t i a l f o r h e a l t h y

b o n e s

C R F - k i d n e y s c a n ’ t e x c r e t e p h o s p h a t e → a c c u m u l a t e s i n b l o o d

A i m : < 1 . 8 m m o l / l

D i e t p r e s c r i p t i o n : < 1 0 0 0 m g P h o s p h a t e ( 1 7 m g / k g )

P h o s p h a t e b i n d e r N B w i t h m e a l s

A i m : < 1 . 8 m m o l / l

D i e t p r e s c r i p t i o n : < 1 0 0 0 m g P h o s p h a t e ( 1 7 m g / k g )

L a t e l y , n o t j u s t a m o u n t o f p h o s p h a t e t h a t i s i m p o r t a n t

T y p e ( o r g a n i c / i n o r g a n i c )

S o u r c e ( p l a n t / a n i m a l )

B i o a v a i l a b i l i t y o f p h o s p h a t e

Chauveau et al., 2013

Chauveau et al., 2013

Food additives

Animal proteins

Plant proteins

80%

60%

30%

Organic

Inorganic

Dairy Eggs Meat Fish

Chicken

Dried beans Legumes

A v o i d f o o d h i g h i n p h o s p h a t e

O f f a l ( l i v e r , k i d n e y s )

N u t s

D r i n k s c o n t a i n i n g m i l k

C h e e s e s p r e a d / c h e d d a r / f e t a c h e e s e

C o l a d r i n k s ( C o k e , T a b , C o k e l i g h t )

B e e r

M i l k / y o g h u r t = m a x ½ g l a s s p e r d a y

SA Renal Exchange Lists, 2012

M i l k→ r i c e / s o y m i l k

C h e e s e→ s o u r c r e a m / c r e a m c h e e s e / c o t t a g e c h e e s e

C o k e→ l e m o n a d e , c r e a m s o d a

I c e c r e a m→ s o r b e t / s h e r b e t

C h o c o l a t e o r n u t s→ j e l l y b e a n s / h a r d c a n d y / u n s a l t e d p o p c o r n /

u n s a l t e d p r e t z e l s

C h o c o l a t e c o o k i e s / c a k e → s h o r t b r e a d , v a n i l l a c a k e / w a f e r s

B r a n , o a t w h o l e w h e a t c e r e a l s → c e r e a l s m a d e f r o m c o r n / r i c e

W h o l e w h e a t b r e a d→ w h i t e / b r o w n b r e a d

P e a n u t b u t t e r→ j a m / h o n e y

B r o w n / w i l d r i c e→ w h i t e r i c e , w h i t e p a s t a ( h e r b s a n d m a r g a r i n e )

P r o c e s s e d m e a t s→ f r e s h / f r o z e n i t e m s

SA Renal Exchange Lists, 2012

w w w . k i d n e y . o r g

w w w . r e n a l s m a r t . c o . z a

w w w . r e n a l s m a r t . c o . z a

F a c e b o o k s u p p o r t p a g e f o r p a t i e n t s : “ l e t ’ s t a l k d i a l y s i s ”