Download Free Medical The Transition From Chronic Kidney Disease-CKD To Kidney Failure PowerPoint Presentation

The Transition From Chronic Kidney Disease-CKD To Kidney Failure PowerPoint Presentation

DOWNLOAD MEDICAL POWERPOINT PRESENTATION

About This Presentation

Description : Check out this medical PowerPoint presentation titled "The Transition from Chronic Kidney Disease (CKD) to Kidney Failure”.

This medical PowerPoint presentation is about the transition from Chronic Kidney Disease (CKD) to kidney failure.

Chronic kidney disease (CKD) is a progressive condition in which the kidneys gradually lose their ability to function properly over time. If left untreated or poorly managed, CKD can progress to end-stage kidney disease (ESKD), also known as kidney failure.

The transition from CKD to kidney failure typically occurs over a period of several years, and is marked by a gradual decline in kidney function. The severity of kidney disease is usually measured using a measure called the glomerular filtration rate (GFR), which measures how well the kidneys are filtering waste and excess fluid from the blood.

In the early stages of CKD, the kidneys may still be able to function adequately and patients may not experience any symptoms. However, as kidney function declines, patients may start to experience symptoms such as fatigue, swelling in the legs and feet, shortness of breath, and difficulty sleeping.

As kidney function continues to decline, patients may require treatment to manage their symptoms and slow the progression of the disease. This may involve changes to their diet, medications to control blood pressure and blood sugar, and the use of medications to protect the kidneys from further damage.

Eventually, as kidney function continues to decline, patients may develop end-stage kidney disease (ESKD), which is characterized by a GFR of less than 15 ml/min/1.73 m2. At this stage, patients will require kidney replacement therapy, such as dialysis or a kidney transplant, to survive.

Tags : Chronic Kidney Disease, kidney failure, end-stage kidney disease, ESKD, Nephrology, Nephrology PowerPoint presentation

Published on : Jun 07, 2023 | Views : 1190 | Downloads : 0

Shareable Url :

Embed Code :

Comment

Transcript

Slide 1-

Module 5: The Transition from Chronic Kidney Disease (CKD) to Kidney Failure The Diet Changes as CKD Develops and Progresses to Kidney Failure
Slide 2-

This professional development opportunity was created by the National Kidney Disease Education Program (NKDEP), an initiative of the National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health. With the goal of reducing the burden of chronic kidney disease (CKD), especially among communities most impacted by the disease, NKDEP works in collaboration with a range of government, nonprofit, and health care organizations to: raise awareness among people at risk for CKD about the need for testing; educate people with CKD about how to manage their disease; provide information, training, and tools to help health care providers better detect and treat CKD; and support health system change to facilitate effective CKD detection and management. To learn more about NKDEP, please visit: http://www.nkdep.nih.gov. For additional materials from NIDDK, please visit: http://www.niddk.nih.gov. Slide 2 of 93
Slide 3-

Meet our Presenters Slide 3 of 93 Theresa A. Kuracina, M.S., R.D., C.D.E., L.N. Ms. Kuracina is the lead author of the Academy of Nutrition and Dietetics’ CKD Nutrition Management Training Certificate Program and NKDEP’s nutrition resources for managing patients with CKD. Ms. Kuracina has more than 25 years of clinical dietetics experience focused on diabetes and CKD with the Indian Health Service (IHS). Until her retirement in 2017, she served as a co-coordinator for a diabetes self-management education program at the IHS Albuquerque Indian Health Center in New Mexico. For more than 9 years, she has supported NKDEP with expertise regarding medical nutrition therapy for diabetes and CKD patients, first as a member of the NKDEP’s Coordinating Panel and more recently as a senior clinical consultant for the Program.
Slide 4-

Meet our Presenters Slide 4 of 93 Andrew S. Narva, M.D., F.A.C.P. Dr. Narva is the Director of the National Kidney Disease Education Program (NKDEP) at the National Institutes of Health. Prior to joining the NKDEP in 2006, he served as Director of the Kidney Disease Program for the Indian Health Service (IHS). Dr. Narva continues to serve as the Chief Clinical Consultant for Nephrology for IHS and to provide care for patients at Zuni Pueblo through a telemedicine clinic. Dr. Narva is a member of the American Board of Internal Medicine Nephrology Subspecialty Board. He has served as a member of the Eighth Joint National Committee (JNC 8) Expert Panel, the National Quality Forum Renal Steering Committee, the Kidney Disease Outcomes Quality Initiative Work Group on Diabetes in Chronic Kidney Disease, and the Medical Review Board of End Stage Renal Disease Network 15.
Slide 5-

Participants will be able to: Slide 5 of 93 Identify the four treatment options for kidney failure. Differentiate between the diet recommendations for hemodialysis and peritoneal dialysis. Associate intestinal dysbiosis in kidney disease as a factor for inflammation in this population.
Slide 6-

Slide 6 of 93 An informed patient is better prepared Education may help patients to be successful in their self-management efforts. People with kidney disease may see many providers. Consistent messages are less confusing. You may not feel comfortable discussing treatment options, however, they may ask you questions about the diet changes.
Slide 7-

Kidney disease education is a Medicare benefit Slide 7 of 93 Covers up to 6 sessions eGFR < 30 Medicare Part B Requires referral like MNT Individual pays 20%, deductible applies https://www.medicare.gov/Pubs/pdf/11454.pdf
Slide 8-

Slide 8 of 93 The topics include many of the ones you already know about
Slide 9-

Slide 9 of 93 RENAL REPLACEMENT THERAPY Options
Slide 10-

Slide 10 of 93 Four options for treating kidney failure Renal replacement therapy (RRT) Hemodialysis In-center or home, three times a week or more frequently Peritoneal dialysis Daily, at home Kidney transplantation No RRT Supportive Care Active medical management
Slide 11-

Slide 11 of 93 USRDS 2016 Trends in ESRD prevalence by modality, 1996-2014
Slide 12-

Slide 12 of 93 Almost 90% of people initiating renal replacement therapy start on hemodialysis USRDS 2016 Trends in ESRD incidence by modality, 1999-2014
Slide 13-

Slide 13 of 93 Most people are not prepared for kidney failure People who are not prepared and need treatment do not have much choice. They may start hemodialysis using a temporary vascular access (catheter). In 2014, more than 80% of people started hemodialysis with a temporary vascular access. Discuss treatment choices early with progressive kidney disease. “Early” depends on the eGFR and the rate of decline.
Slide 14-

Coping with kidney disease and failure is challenging Slide 14 of 93 “I feel fine.” The signs and symptoms may not be obvious until kidney disease is advanced. “Why me?” Acceptance of any chronic illness including kidney disease takes time for most people. Kidney disease may progress to kidney failure. Kidney “failure” or “end stage renal disease” sound scary. Grief, fear and depression are not uncommon.
Slide 15-

Dialysis involves diffusion of substances across a semipermeable membrane Slide 15 of 93 Hemodialysis uses a dialyzer (artificial kidney) as the membrane. Peritoneal dialysis uses the peritoneum as the membrane. Substances diffuse down a gradient from high to low concentrations and are removed.
Slide 16-

Slide 16 of 93 Types of dialysis
Slide 17-

Dialysis replaces only a fraction of normal kidney function Slide 17 of 93 A normal kidney works “24/7.” Damaged kidneys (in CKD) still work nonstop but at a reduced level. Hemodialysis is an intermittent treatment; blood is filtered only during dialysis.
Slide 18-

Hemodialysis Slide 18 of 93
Slide 19-

Slide 19 of 93 A vascular access is needed for hemodialysis Temporary access is usually a catheter placed in a central vein. Permanent access types include arteriovenous (AV) fistula or graft. Access is usually placed in the non-dominant arm. Protect blood vessels in both arms; avoid venipuncture and IV catheter placement above the wrist.
Slide 20-

Slide 20 of 93 An AV fistula is the preferred access The artery is connected to a vein. A fistula takes 2 to 3 months to mature before it can be used. During maturation, the vein dilates and thickens. A fistula is less likely to become infected or clot, and provides better blood flow rates.
Slide 21-

Slide 21 of 93 An AV graft is another option A synthetic tube connects the artery and vein. A graft takes 2 to 3 weeks before it can be used. Grafts are more likely to become infected or clot than fistulas.
Slide 22-

Temporary access use should be minimized Slide 22 of 93 A venous catheter is inserted into a vein in the neck, chest, or leg near the groin, for short-term dialysis. This is only option when patient is not prepared and needs immediate hemodialysis. Catheters increase risk of infection, clotting, and inadequate dialysis. Catheter for temporary access
Slide 23-

Slide 23 of 93 The dialyzer is the artificial kidney Removal is based on size. Protein-bound substances are not usually removed. Amino acids are small enough to be dialyzed out of the blood. Glucose is removed. Water-soluble vitamins are removed to some degree.
Slide 24-

The hemodialysis prescription is individualized Slide 24 of 93 The goal is to achieve metabolic balance. Adequate dialysis depends on numerous factors including: Type and size of the dialyzer Blood flow rate Dialysate composition (similar to normal serum levels) Sodium, potassium, calcium, bicarbonate Time Individual patient factors such as body size and diet.
Slide 25-

Home hemodialysis allows people do longer or more frequent dialysis Slide 25 of 93 Increased dialysis allows a more normal diet and fluid intake. Most dialysis centers require a trained partner at home during treatment. Partner burn-out may be an issue.
Slide 26-

Slide 26 of 93 Peritoneal dialysis (PD) options PD requires surgery for catheter placement. PD is a continuous therapy providing a “steady state” which may be better tolerated than intermittent hemodialysis. Continuous ambulatory peritoneal dialysis (CAPD) is done manually. Continuous cycler-assisted peritoneal dialysis (CCPD) is automated.
Slide 27-

Slide 27 of 93 The peritoneal membrane is the semipermeable “filter” in PD Dextrose is the most common osmotic agent used in the dialysate. Osmotic gradient helps move water into the peritoneal cavity. Clearance affected by: Concentration gradient Size Permeability of the peritoneal membrane
Slide 28-

Slide 28 of 93 The peritoneal dialysis exchange
Slide 29-

Slide 29 of 93 PD prescription is individualized Dextrose solutions are used as osmotic agent. 1.25%, 2.5%, 4.25% concentrations Exchanges are 2–3 liters in volume. Dwell time and number of exchanges vary depending on peritoneal membrane characteristics.
Slide 30-

Slide 30 of 93 CAPD requires 4 or more manual exchanges per day
Slide 31-

Slide 31 of 93 The cycler does 3–5 automated exchanges during the night in CCPD
Slide 32-

Slide 32 of 93 Calories count in dextrose solutions Dextrose concentrations vary 1.25%, 2.5%, 4.25% Bag sizes vary 2-liter, 2.5-liter, 3-liter In CAPD, 60–70% is absorbed. The amount is higher due to longer dwell times. In CCPD, 40–50% is absorbed. Reference: McCann, 2009
Slide 33-

Slide 33 of 93 Estimate of calories from CAPD Four exchanges of 2-liter bags with 1.5% dextrose = 8 liters of 1.5% dextrose (grams dextrose/liter) = 120 grams of dextrose 3.4 kcal/gram of dextrose (120 grams of dextrose) x 3.4 = 408 calories 60–70% absorbed Total of about 250–290 calories are absorbed/day
Slide 34-

Slide 34 of 93 Kidney transplantation is a treatment, not a cure A deceased or living donor kidney is required. The transplant workup takes time; eligibility is strict. Requires major surgery. Need to take medications daily, including anti-rejection medication.
Slide 35-

A transplanted kidney is placed in the groin area Slide 35 of 93
Slide 36-

A kidney transplant from a living donor may be better than other treatments Slide 36 of 93 Preparing for Kidney Treatment You Have a Choice: http://ckddecisions.org/wp-content/themes/jhm/flipbook/Prepared2/HTML/index.html Number (out of 100) alive at the end of time period by treatment
Slide 37-

Anti-rejection medications should be taken every day – and may have side effects Slide 37 of 93
Slide 38-

A few more anti-rejection medications Slide 38 of 93
Slide 39-

The risk factors for new onset diabetes after a kidney transplant include: Slide 39 of 93 Older age Ethnicity African Americans and Hispanics > Whites Family history of diabetes Weight Positive Hepatitis C Immunosuppressant medication Corticosteroids (prednisone) Tacrolimus > cyclosporine Remember: Medicare covers MNT for a period of 36 months post-transplant. Ghisdal et al, Diabetes Care 2012:35:181-188
Slide 40-

Nutrition prescription: Transplant Slide 40 of 93 Transplant is a treatment, not a cure. May need a sodium restriction. May need to reduce calories to avoid weight gain. Food safety is very important. Medications may increase weight gain. Diabetes may be more difficult to manage.
Slide 41-

Supportive Care is active medical management with no RRT Slide 41 of 93 Choosing whether to start RRT is the patient’s decision. Encourage patient to inform family. Without RRT, uremic toxins accumulate. Complications can be treated. Provide comfort and palliative care.
Slide 42-

Slide 42 of 93 CHOOSING A MODALITY A brief look
Slide 43-

Slide 43 of 93 Choosing a modality: In-center hemodialysis May be a choice for someone who: Can travel to a dialysis center 3 times a week for scheduled treatments. Prefers trained staff to handle their treatments. Does not mind needle sticks. Is willing to follow a diet that includes numerous restrictions. Preparing for Kidney Treatment You Have a Choice http://ckddecisions.org/wp-content/themes/jhm/flipbook/Prepared2/HTML/index.html
Slide 44-

Slide 44 of 93 Choosing a modality: Home hemodialysis May be a choice for someone who: Wants to do their treatments at home. Has someone who is willing to be trained to help them with treatments at home. Is willing to do treatments most days of the week. Has room for the machine and to store the supplies. Does not mind needle sticks and self-cannulation. Preparing for Kidney Treatment You Have a Choice http://ckddecisions.org/wp-content/themes/jhm/flipbook/Prepared2/HTML/index.html
Slide 45-

Slide 45 of 93 Choosing a modality: Peritoneal dialysis May be a choice for someone who: Has no contraindicating abdominal pathology. Wants to do their own treatments at home. Is willing to do treatments every day. Has room to store supplies at home. CONSIDER: Diabetes may be harder to control due to the dextrose in the dialysate. Body-image can be an issue for some. Preparing for Kidney Treatment You Have a Choice http://ckddecisions.org/wp-content/themes/jhm/flipbook/Prepared2/HTML/index.html
Slide 46-

Intra-peritoneal insulin may be an option Slide 46 of 93 Insulin is absorbed into the portal vein and the liver is exposed to higher insulin levels than the periphery. Insulin may be injected into the bags of PD solution. The required dose may double or triple. Some insulin adheres to the bag and tubing. Lipids may be harder to control. Diabetes, Obesity and Metabolism, 2008
Slide 47-

Choosing a modality: Kidney transplant Slide 47 of 93 Preparing for Kidney Treatment You Have a Choice http://ckddecisions.org/wp-content/themes/jhm/flipbook/Prepared2/HTML/index.html May be a choice for someone who: Is healthy enough for surgery that can last up to 4 hours. Has a living donor or can wait for a deceased donor kidney. Is willing to take anti-rejection medications every day for the rest of their life. Understands that they will still need regular check-ups.
Slide 48-

People on RRT who have diabetes still need comprehensive diabetes care Slide 48 of 93 Often people on dialysis or who have a transplant consider their nephrologist to be their only doctor. They may not see their primary care provider routinely. Keep in mind: They still need to have their eyes, feet, heart, nerves, gums and teeth checked. As you educate them about the diet and treatment choices, review the need for ongoing diabetes care.
Slide 49-

The numbers can be improved Slide 49 of 93 In 2015, 34% of people with ESRD and diabetes received comprehensive diabetes monitoring which included an hemoglobin A1C, lipid test and a dilated eye exam 86.5% had at least one hemoglobin A1C test 71.8% had a lipid test 46.9% had a dilated eye exam In 2014-2015 flu season, about 72% had a flu shot USRDS 2017
Slide 50-

Supportive Care without dialysis or transplant may be the choice for an individual who: Slide 50 of 93 Feels treatment will not improve their health. Feels they have done what they wanted to do in life. Has family and friends who are in support of this decision. Preparing for Kidney Treatment You Have a Choice http://ckddecisions.org/wp-content/themes/jhm/flipbook/Prepared2/HTML/index.html
Slide 51-

Slide 51 of 93 THE DIET Discussing the options
Slide 52-

In-center hemodialysis is three times a week for 3 to 5 hours, leads to wider fluctuations Slide 52 of 93
Slide 53-

Slide 53 of 93 Diet for home hemo may be more liberal due to increased frequency of treatments
Slide 54-

Slide 54 of 93 PD is a continuous therapy – diet is a little more liberal Dextrose in dialysate adds calories
Slide 55-

Potassium restriction may be biggest difference between HD and PD diets Slide 55 of 93 NCM
Slide 56-

Complications continue into kidney failure Slide 56 of 93
Slide 57-

Complications and interventions Slide 57 of 93
Slide 58-

Slide 58 of 93 Complications and interventions References: Melamed & Thadhani. Clin J Am Soc Nephrol 2012;7:358-365
Slide 59-

Clinical Indicators, 2016 Slide 59 of 93
Slide 60-

Dialysis removes some phosphorus Slide 60 of 93 Adapted from: Waheed et al. Neprhrol Dial Transplant 2013; 28:2961-2968; USDA What We Eat in America, NHANES 2013-2014. For comparison NHANES data for average phosphorus intake: Men ≈1,600 mg day (range 1381-1747) 1,600 x 7 days = 11,200 mg phosphorus per week If 60% is bioavailable = 6,720 mg phosphorus per week
Slide 61-

Most protein-rich foods have phosphorus; egg white is the exception Slide 61 of 93 More typical intake 6 ounces steak 390 mg phosphorus 1 cup beans 240 mg phosphorus Phytates reduce absorption Still high potassium 2 egg whites 10 mg phosphorus https://www.cnpp.usda.gov/sites/default/files/usda_food_patterns/NutrientProfiles.pdf
Slide 62-

Take phosphate-binders with meals Slide 62 of 93 Reference: Gutenkunst, JRN 2016;26(4):209-218
Slide 63-

Healthy Eating Patterns Slide 63 of 93 Colorful vegetables Whole fruit Whole grains (half) A variety of proteins Low-fat or non-fat dairy or substitute Oils Limit sodium, saturated and trans fats, sugars
Slide 64-

Tips for eating healthy in dialysis Slide 64 of 93 Prepare foods from scratch. Choose foods without food additives. Prepare foods without salt and if needed, add a small amount at the table. Use liquid vegetable oil instead of solid fat. Eat protein-rich food with every meal. If serum potassium is high, use rice or noodles not potatoes (hemodialysis).
Slide 65-

Slide 65 of 93 https://www.fda.gov/Food/GuidanceRegulation/GuidanceDocumentsRegulatoryInformation/LabelingNutrition/ucm385663.htm For people who need to limit potassium, the new label includes potassium (in milligrams).
Slide 66-

Intestinal dysbiosis and kidney failure Slide 66 of 93 The composition of the microbiota may be altered in CKD and ESRD. Undigested proteins may enter the intestines leading to an increase in proteolytic bacteria. Proteolytic bacteria ferment the protein and generate uremic toxins. Uremia leads to an influx of urea into the GI tract. Bacteria which have urease ferment urea into ammonia leading to increased breath ammonia. People with CKD may have fewer saccharolytic bacteria due to reduced fiber intake. These types ferment dietary fiber into short chain fatty acids. References: Ramezani & Raj. J Am Soc Nephrol. 2014;25:657-670. Ramezani et al. Am J Kidney Dis 2016;67:483-498.
Slide 67-

Dysbiosis and impaired intestinal barrier may be a factor for systemic inflammation Slide 67 of 93 Colonic bacteria are the main source of pro-inflammatory uremic toxins. The intestinal barrier may be altered in uremia. Increased intestinal permeability may allow uremic toxins such as endotoxin to enter the bloodstream. Circulating endotoxin may activate pro-inflammatory cytokine production.
Slide 68-

Slide 68 of 93 Other factors that may mediate systemic inflammation in ESRD Accumulation of pro-inflammatory oxidized LDL coupled with HDL deficiency Higher numbers of monocytes which produce cytokines and reactive oxygen species (ROS) Impaired inhibitory activity of T lymphocytes Iron overload via intravenous iron Inflammatory cytokines may directly suppress appetite in peritoneal dialysis. Reference: Vaziri Semin Nephrol. 2016:36:112-118.
Slide 69-

The food groups with fiber Slide 69 of 93 Vegetables and fruit vary in potassium content. Boiling potatoes and tubers removes enough potassium. Leaching, or soaking, in water is not required. Legumes are rich in protein, potassium and phosphorus (and have the most fiber). Canned items tend to be lower in potassium as potassium leaches out into the liquid.
Slide 70-

Slide 70 of 93 Preparation impacts potassium in vegetables Generally speaking, potassium contents vary, when cooking: Canned < boiled < baked or roasted Frozen boiled < fresh boiled Boiled < microwaved Smaller pieces < larger pieces (chopped vs. spears) Generally speaking, for raw vegetables: Smaller pieces < larger pieces (grated vs. chopped) Juice has more based on comparable serving size (also counts as fluid)
Slide 71-

Tips for vegetables and hyperkalemia Slide 71 of 93 Choose lower potassium vegetables. Buy frozen vegetables without added sauces. Some frozen Asian stir fry mixes may have added soy sauce. Boil vegetables instead of microwaving them. Choose no-added salt canned vegetables, drain and rinse. Drain and rinse regular canned vegetables to lower sodium (and maybe some potassium). Top sandwiches with veggies such as green leaf lettuce, sliced cucumbers, grated carrots, and others. Add grated carrots and zucchini to meatloaf or meatballs. Top tacos with green cabbage and lettuce.
Slide 72-

Tips for fruit and hyperkalemia Slide 72 of 93 Choose lower potassium fruit. If a higher potassium fruit is preferred, eat a small amount. Canned fruits have less potassium than fresh. Drain and rinse. Dried fruit has more potassium than fresh or canned. Use peeled fruit for fruit salad. Although the fruit “nectars” are lower in potassium, they have added sugar and are low in fiber.
Slide 73-

Whole grains Slide 73 of 93 Whole grains have more potassium and phosphorus. Cereal and bread may be a source of sodium. Convenience or instant-type items may have sodium or other additives. Use the Nutrition Facts labels to compare products and choose the ones with less sodium. Phosphorus in whole grain yeast bread may be more bioavailable due to the phytase in the yeast.
Slide 74-

Plant-based food groups and minerals Slide 74 of 93 * Read labels to compare brands ↑ means higher amounts
Slide 75-

The food groups without fiber Slide 75 of 93 Meat, poultry, and fish contribute to potassium and phosphorus intake. Use items that are not canned or enhanced or have added solution (sodium). Dairy foods are high in sodium, protein, phosphorus, potassium, and fluid (milk). Use foods without food additives, if possible. Use liquid oils instead of solid fats in food preparation.
Slide 76-

Minerals in protein foods Slide 76 of 93 * Read labels to compare brands ↑ means higher amounts
Slide 77-

Eating out and kidney disease Slide 77 of 93 Restaurants and fast foods tend to be higher in sodium. Salad dressing portions tend to be large. Smaller, single items are still high in sodium. Double meat means more sodium, phosphorus and potassium. Some items have PHOS additives.
Slide 78-

Processed and fast foods may have more additives Slide 78 of 93 Reference: http://www.nal.usda.gov/fnic/foodcomp/search/
Slide 79-

Enhanced and fortified foods may have phosphorus, potassium and sodium Slide 79 of 93 * Phosphorus content varies among brands, depending upon calcium compound used (calcium phosphate, calcium citrate, etc.).
Slide 80-

Check the nutrition apps you recommend Slide 80 of 93 Do they include: fiber content? potassium content? phosphorus content?
Slide 81-

Summary: Treatment options Slide 81 of 93 Discuss the options early to allow time for the patient to adjust and make a decision. The diet will change with dialysis, more protein is needed to replace the losses. Hemodialysis has the most restrictive diet. Peritoneal dialysis calories add up. Transplant requires daily immunosuppressant medication. All the options—including supportive care—still require medications.
Slide 82-

Slide 82 of 93 And last… BUT NOT LEAST
Slide 83-

What about physical activity and exercise? Slide 83 of 93 People with kidney disease tend to be less active and have reduced physical functioning and performance. Physical inactivity is associated with increased mortality in both CKD and kidney failure. Results from studies about exercise training and dialysis patients suggest this training may reduce CVD risk. Although data is limited, recommending activity may be beneficial. Obtain clearance from the primary care provider. Hypoglycemia may develop, counsel appropriately.
Slide 84-

Slide 84 of 93 OTHER RESOURCES
Slide 85-

Slide 85 of 93 https://www.niddk.nih.gov/health-information/kidney-disease
Slide 86-

Slide 86 of 93 https://www.niddk.nih.gov/health-information/kidney-disease
Slide 87-

Slide 87 of 93 Reference: http://nkdep.nih.gov/resources.shtml
Slide 88-

Slide 88 of 93
Slide 89-

References Slide 89 of 93 Ghisdal L, Van Laecke S, Abramowicz MJ, Vanholder R, Ambramowicz D. New-onset diabetes after renal transplantation. Diabetes Care. 2012;35:181–188. Hanafusa N, Tessema Lodebo B, Kopple JD. Current uses of dietary therapy for patients with far-advanced CKD. Clinical Journal of the American Society of Nephrology. 2017; 12(7):1190–1195. Handelman GJ, Levin NW. Guidelines for vitamin supplements in chronic kidney disease patients: what is the evidence? Journal of Renal Nutrition. 2011;21(1):117–119. Ikizler TA. Optimal nutrition in hemodialysis patients. Advances in Chronic Kidney Disease. 2013;20(2):181–189. Johansen KL, Painter P. Exercise in individuals with CKD. American Journal of Kidney Diseases. 2011;59(1):126–134 Karaboyas A, Zee J, Brunelli SM, et al. Dialysate potassium, serum potassium, mortality, and arrhythmia events in hemodialysis: results for the dialysis outcomes and practice patterns study (DOPPS). American Journal of Kidney Diseases. 2016;69(2):266–277.
Slide 90-

Slide 90 of 93 Malliputtu SK, He JC, Uribarri J. Role of advanced glycation endproducts and potential therapeutic interventions in dialysis patients. Seminars in Dialysis. 2012;25(5):529–538. Melamed ML, Thadhani RI. Vitamin D therapy in chronic kidney disease and end stage renal disease. Clinical Journal of the American Society of Nephrology. 2012; 7:358–365. Nakanishi T, Hasuike Y, Nanami M, Yahiro M, Kuragano T. Novel iron-containing phosphate binders and anemia treatment in CKD: oral iron intake revisited. Nephrology Dialysis Transplantation. 2016; 31:1588–1594. Pluznick JL. Gut microbiota in renal physiology: focus on short-chain fatty acids and their receptors. Kidney International. 2016; 90:1191–1198. Preparing for Kidney Treatment: You have a choice. http://ckddecisions.org/wp-content/themes/jhm/flipbook/Prepared2/HTML/files/assets/basic-html/page1.html Accessed October 14, 2017 Ramezani A, Massy ZA, Meijers B, Evenepoel P, Vanholder R, Raj DS. Role of the gut microbiome in uremia: a potential therapeutic target. American Journal of Kidney Diseases. 2016;67(3):483–498. References
Slide 91-

Slide 91 of 93 Ramezani A, Raj DS. The gut microbiome, kidney disease, and targeted interventions. Journal of the American Society of Nephrology. 2014;25:657–670. Ritter CS, Slatopolsky E. Phosphate toxicity in CKD: the killer among us. Clinical Journal of the American Society of Nephrology. 2016;11:1088–1100. Sirich TL. Dietary protein and fiber in end stage renal disease. Seminars in Dialysis. 2015;28(1):75–80. Torlen K, Kalantar-Zadeh K, Molnar MZ, Vashistha T, Mehrotra R. Serum potassium and cause-specific mortality in a large peritoneal dialysis cohort. Clinical Journal of the American Society of Nephrology. 2012;7:1272–1284. U.S. Department of Agriculture, Agricultural Research Service. 2017. Total Nutrient Intakes: Percent Reporting and Mean Amounts of Selected Vitamins and Minerals from Food and Beverages and Dietary Supplements by Gender and Age, What We Eat in America, NHANES 2013-2014. www.ars.usda.gov/nea/bhnrc/fsrg Accessed December 5, 2017 United States Department of Agriculture Center for Nutrition Policy and Promotion. USDA Food Patterns. https://www.cnpp.usda.gov/sites/default/files/usda_food_patterns/NutrientProfiles.pdf References
Slide 92-

Slide 92 of 93 U.S. Department of Health and Human Services. Centers for Medicare & Medicaid Services. Your Medicare Coverage: Kidney disease education. Available from: https://www.medicare.gov/coverage/kidney-disease-edu.html Accessed June 22, 2018 United States Renal Data System. 2016 USRDS annual data report: Epidemiology of kidney disease in the United States. National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, 2016. U.S. Renal Data System website. https://www.usrds.org/2016/view/Default.aspx Accessed June 21, 2017. Vaziri ND. Safety issues in iron treatment in CKD. Seminars in Nephrology. 2016;36:112–118. Vaziri ND, Zhoa Y, Pahl MV. Altered intestinal microbial flora and impaired epithelial barrier structure and function in CKD: the nature, mechanisms, consequences and potential treatment. Nephrology Dialysis Transplantation. 2016;31:737-746. Waheed AA, Pedraza F, Lenz O, Isokova T. Phosphate control in end-stage renal disease: barriers and opportunities. Nephrology Dialysis Transplantation. 2013; 28:2961-2968. References
Slide 93-

Slide 93 of 93 National Kidney Disease Education Program. Chronic kidney disease (CKD) and diet: assessment, management and treatment. Treating CKD patients who are not on dialysis. An overview guide for dietitians. Revised April 2015. National Kidney Disease Education Program website. https://www.niddk.nih.gov/health-information/communication-programs/nkdep/identify-manage-patients/professional-education/chronic-kidney-disease-nutrition. National Kidney Disease Education Program. Eating right for kidney health tips for people with chronic kidney disease (CKD). Revised June 2014. NIH publication 14–7405. National Kidney Disease Education Program website. https://www.niddk.nih.gov/-/media/Files/Health-Information/Communication-Programs/NKDEP/eating-right-508.pdf Other Resources
Slide 94-

ppt slide no 94 content not found