CKD

Creatinine clearance - Cockroft- Gault formula(140-age) x body mass (kg)Serum creatinine concentration

x 72

Female x coefficient 0.85

How to slow down the progress of CKD

Documented efficacy Strict control of glicaemia (DM) Strict control of blood pressure ACE-I, Xartan

Non-documented efficacy Reduction of protein in diet Dyslipidaemia treatment Partial correction of anaemia

HA in CKD

Target values in treatment of HA in patients with CKD:

proteinuria < 1g/d - <130/80mmHg

proteinuria > 1g/d - <125/75mmHg

Disturbances in Ca-P balance

Stage CKD

GFRml/min/1.73m²

PTHpg/ml

Pmmol/l

Cammol/l

1-2 >60 normal normal normal

3 30-59 35-70 0.9-1.5

normal

4 15-29 70-150 0.9-1.5

2.1-2.4

5 <15 150-300

1.1-1.8

2.1-2.4

Disturbances in Ca-P balance Reduction of P intake in diet Medicines binding P in digestive

tract: Calcium carbonicum Aluminium hydroxide (Alusal) Lantan salts Sewelamer (Renagel)

Calcimimetics: cinecalcet (selectively stimulates calcium receptor in parathyroid glands)

CKD- diet Products rich in P:

offal fish yolk milk and diary products, cheese; sausages, ham; soups (instant) coca cola turkey, duck, meat pastry bean cacao, nuts, chocolade, almonds mushrooms

Disturbances in Ca-P balance

Ca X P product > 55 mg/dl (>4.4 mmol/l)

Risk factor of:Death because of cardiovascular eventsCalcifications in soft tissuesRecommendations:Reduction of calcium carb. doseSewelamerReduction of vit.D dose

CKD - diet

2. Stable period of time (1-3 stage of CKD)

Protein restriction 0.8g/kg/day P 800-1000 mg/day Salt intake reduction in case of

HA Energy 30-35 kcal/kg/d, from

carbohydrates and lipids

CKD - diet

3. Non-stable period of timePROTEIN

Reduction of intake in order to diminish of urea production;

One should reduce it gradually, max to 0.4 g/kg/d;

4 i 5 stage of CKD ( GFR<25 ml/min) 0.6 g/kg/d

strict monitoring of nutrition every 1-3 months

CKD - diet

Protein must contain essential amino acids

Supplementation of keto-analogs of exogenous amino acids (Ketosteril)