सारांश
- The presentation focuses on the nutritional management of hyperphosphatemia in patients with chronic kidney disease (CKD), particularly stages 1 to 5. Dietary interventions aim to delay dialysis and manage conditions associated with end-stage renal disease. The speaker highlights the importance of controlling five key nutrients: protein, phosphorus, potassium, sodium, and fluids, referring to them as the "big five nutrients."
- Protein intake should be restricted in CKD stages 1-4 but increased to 1.2-1.5 g/kg during dialysis to compensate for protein losses. Potassium and phosphorus control are critical to prevent hyperkalemia and hyperphosphatemia, respectively. Fluid control is essential in stage 5 CKD to manage interdialytic weight gain.
- Hyperphosphatemia is a major concern, particularly from stage 2 CKD. Dietary phosphorus intake needs control, and phosphate binders are prescribed with every meal, even snacks, in stage 5. The speaker advises against calcium-based binders to prevent hypercalcemia. Studies suggest that patient teaching is the most effective management method.
- Renal osteodystrophy can begin as early as stage 2 CKD, making early phosphorus control crucial. The speaker references the Kidney Disease Outcomes Quality Initiative (KDOQI) guidelines from 2017 and 2022 for evidence-based practices. The 2017 recommendations include diagnosis of bone abnormalities and treatment of CKD-mineral bone disorders by targeting phosphate lowering.
- Hyperphosphatemia has negative effects such as lowering 1.25 Vitamin D levels, increasing FGF23, and stimulating parathyroid hormone, leading to secondary hyperparathyroidism. Common steps to manage serum phosphorus include avoiding high dietary phosphorus loads, evaluating actual phosphorus intake, and using phosphate binders. Lanthanum carbonate and sevelamer are mentioned as effective phosphate binders.
- Vitamin D supplementation reduces PTH levels, infection risk, and potentially slows CKD progression. Contradictions such as hypercalcemia should be noted. Patient education and guidance are important, emphasizing the importance of reading food labels, understanding organic vs. inorganic phosphorus, and actively participating in healthcare decisions. Resources like "My Food Coach" app, cookbooks by NKF, and fact sheets from kidney foundations were suggested.
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पोषण विभाग के प्रमुख, ईएचएस (अमीरात स्वास्थ्य सेवा) - इब्राहिम बिन हमद ओबैद अल्लाह अस्पताल और ओबैदल्लाह जेरिएट्रिक अस्पताल
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