Nutrition for Chronic Kidney Disease

About

➀ Read and Learn

The following course content

Introduction   

Chronic Kidney Disease (CKD) is a serious but common medical diagnosis characterized by kidney damage impeding the kidney’s ability to remove waste and maintain a normal blood pressure (1). More than one in seven adults suffer with CKD. Furthermore, more than nine of ten adults are not aware that they have CKD (2). Because of the severity of this condition, it is vital for nurses to understand the importance of managing nutrition to improve CKD symptoms and underlying causes.  

Definition 

Chronic Kidney Disease (CKD) is a medical condition where the kidneys become damaged overtime, leading to poor blood filtering. As this toxic waste accumulates in the bloodstream, extra fluid is retained leading to increased blood pressure. This condition also increased risk for heart disease, stroke, and even premature mortality (2).  

Assessment 

Assessing a client with chronic kidney disease can provide a baseline of the client’s current condition and outline the needs necessary for developing their treatment plan. The nurse should review a client’s demographics, including age, sex, and race or ethnicity. These demographics can impact a client’s risk for developing CKD. In fact, CKD is most common in clients aged 65 or older – accounting for 34% of adults, followed by 12% of clients aged 45-64, and 6% of adults aged 18-44 (2). 

In addition to demographics, the nurse should assess a client for symptoms experienced, potential causes, current complications. Part of this assessment should involve reviewing diagnostic tests, medications, and current nutritional habits. Symptoms a client may report when experiencing CKD include foamy urine, polydipsia and polyuria, itchy or dry skin, nausea, fatigue, weight loss, loss of appetite, trouble concentrating, numbness, swelling in the lower extremities, achy muscle, cramping, shortness of breath, vomiting, trouble sleeping, or foul-smelling breath (1).   

Some causes or risks for CKD include diabetes, hypertension, heart disease, obesity, elderly, family history of CKD or kidney failure, personal history of an acute kidney injury (AKI), and smoking cessation and use of tobacco products. Additional causes may include glomerular disease, inherited conditions such as polycystic kidney disease, autoimmune conditions including lupus, sever infections such as sepsis, and other kidney concerns including kidney cancer, kidney stones, urinary tract infections, hydronephrosis, and kidney or urinary tract abnormalities before birth (1).   

This condition can lead to additional complications or comorbidities. These include cardiovascular disease, hypertension, anemia, metabolic acidosis, mineral and bone disease, hyperkalemia, and kidney failure. Transversely, some conditions can cause or worsen CKD, including cardiovascular disease, diabetes, hypertension, or acute kidney injury (1). 

Diagnosis for this condition includes two simple tests. Estimated glomerular filtration rate (eGFR) is a blood test that identifies if the kidneys are removing waste and extra water from the body. This calculation looks at creatinine and cystatin C. Results of this test should be between 90-120, while 60-90 identifies early-stage kidney disease, 15-60 identifies kidney disease, and 0-15 identifies kidney failure (3). Urine Albumin-Creatinine Ratio (uACR) checks for albumin and creatinine. Lower than 30 mg/g is considered normal, while 30 to 299 mg/g is considered moderately increased, and 300 mg/g is considered severely increased (4).   

Nutrition for clients with CKD include limited salt intake. Less than 2300 mg per day is recommended from all food and drink consumed per day. Using lab results, potassium, phosphorus, and calcium intake from diet may be adjusted to bring all within normal limits. While sodium is the primary concern for clients with CKD, potassium, phosphorus, and calcium are all part of electrolyte balancing needs.   

Nutritional Assessment Tools 

Before developing and implementing a nutritional plan for a client with CKD, a nutritional assessment should be conducted. Methods for dietary assessment can include gathering and reviewing food diaries or 24-hour recalls. Biochemical markers relevant to CKD should also be assessed, including serum electrolytes, creatinine, and urea. Additionally, anthropometric measurements should be considered including weight, body mass index, and edema (2). 

Using this information, the nurse can evaluate a client with CKD for nutritional needs or adjustments. This data is helpful in determining individual dietary requirements. The client’s stage of CKD will also impact nutritional needs. Additionally, it is vital for the nurse to identify risk factors and challenges specific to CKD (2). 

Epidemiology 

The prevalence and impact of CKD is significant. According to the Centers for Disease Control and Prevention, CKD is more common among clients aged 65 or older, at 35% prevalence, followed by 45 to 64 years of age, at 12% prevalence, then 18 to 44 years of age at 6% prevalence. CKD is slightly more common in women at 14% prevalence, as compared to men at 12% prevalence. Additionally, 16% of non-Hispanic black, 13% of non-Hispanic Asian, and 14% of Hispanic adults have CKD (5). CKD places a significant burden on the healthcare system as well as the client’s quality of life. Globally, CKD is a serious economic burden, increasing substantially as severity of the diagnosis increases (6).  

Role of Nutrition in CKD Management 

Dietary habits can influence the progression or control of CKD. Due to the unique role of the kidneys in the metabolism of nutrients, clients lose the ability to excrete solutes and maintain homeostasis. Nutrient intake modification and monitoring thus becomes critical related to its impact on health outcomes and potential to progression towards kidney failure, quality of life, morbidity, and mortality. Nutritional interventions are a central component of clients with non-dialysis CKD, as well as prevention of overweight and possible protein energy wasting (7). Dietary recommendations for clients with CKD include a low protein diet, keeping daily intake between 0.55 to 0.6 mg of dietary protein per kilogram of ideal boy weight. In severe cases, a very low protein diet where intake stays between 0.28 to 0.43 g of dietary protein per kilogram of ideal body weight per day (8).  

Pathophysiology 

The mechanisms of kidney damage and progression of CKD are necessary when caring for clients with this diagnosis. CKD is characterized by chronic or progressive injuries that lead to ongoing kidney fibrosis or destruction of the normal kidney structure. The three parts of kidneys can be impacted by this, including the glomeruli, tubules and interstitium, and vessels. During CKD, these injuries manifest as glomerulosclerosis, tubulointerstitial fibrosis, and vascular sclerosis (9).  

The nutritional implications of CKD can improve or deteriorate the client’s condition. The impairment of kidney function that occurs in CKD promotes specific alteration in nutrient metabolism. This alteration also induces a pro-inflammatory state. These alterations affect the nutritional status, leading to increased morbidity and mortality rates (10).  

Clinical Signs and Symptoms 

The clinical signs and symptoms of CKD progression includes nausea, vomiting, loss of appetite, fatigue and weakness, sleep disturbance, oliguria, decreased mental sharpness, muscle cramps, swelling of feet and ankles, persistent pruritus, chest pain due to uremic pericarditis, shortness of breath due to pulmonary edema from fluid overload (11).  

These symptoms associated with the progression of CKD can impact a client’s nutritional status and dietary requirements. For example, nausea and vomiting can impact appetite and reduce nutrient intake. This potential malnutrition can increase fatigue and weakness. This further complicates the client’s overall status, as physical activity, cramps, and swelling may occur. The progression and interconnectedness of these symptoms mean a client’s best options for improved outcomes is to prioritize nutritional status.  

Dietary considerations for clients with CKD should focus on improving client comfort, the clients’ specific needs, and medical goals. Small, frequent meals may help combat nausea and vomiting while maintaining caloric intake. The nurse should emphasize nutrient-dense foods to meet dietary requirements. To reduce the risk of fluid overload, monitor fluid intake closely. Sodium and potassium may also be necessary to manage symptoms including muscle cramps and hypertension. Finally, incorporating foods that are low in phosphorus reduces the risk of mineral imbalances.  

Beyond the physical aspect of nutrition, the nurse should consider addressing the psychosocial aspect of nutrition. The nurse should provide education surrounding meal planning, easy-to-prepare recipes, and strategies to enhance meal appeal for improved diet adherence. Referring a client to a nutritionist can also be beneficial. Registered dieticians are trained in addressing nutritional deficits in clients with CKD, as well as addressing the symptoms related to nutrient deficiencies.   

Self-Management 

Empowering clients with CKD is an important aspect of nursing care. To do this, clients must be equipped with the knowledge and tools necessary for self-management. In regard to CKD diet, education plays a critical role in understanding, adhering to, and taking actively participating in improving their nutrition. Clients should be educated on how to monitor symptoms, assess changes in appetite, weight, and fluid retention, as well as remaining vigilant about getting regular lab test completed. Additionally, clients should be aware of the importance of tracking food consumption to maintain dietary awareness and observe patterns for changes necessary to diet.  

Practical recommendations should be provided to clients for diet adherence and lifestyle modifications. Ensuring these are simple to follow increases adherence to recommended changes and routines. These recommendations should include setting realistic expectations, such as gradual progression towards dietary restrictions. Others can include meal planning, shopping lists, small frequent meals, and tracking intake. Providing a supportive, non-judgmental environment is also necessary for clients to make lifestyle and diet modifications.  

Beyond the nurse, providing and encouraging support systems for the client during diet and lifestyle modifications will improve its success. These resources can include having family follow a similar diet, access to support groups, online forums, and educational workshops. Additionally, connecting a client to a therapist can ensure any emotional connections to poor diet habits can be addressed from a psychosocial aspect. Lastly, scheduling regular follow-up appointments provides an opportunity for the client’s progress to be assessed and fine tuned according to challenges and limitations a client may be facing.  

Conclusion

Chronic Kidney Disease is a serious and common medical diagnosis, impacting older adults more common than younger age groups. It is vital for the nurse to understand the importance of nutrition in the CKD client’s outcomes. Supporting a tailored dietary approach to their holistic healthcare plan ensures clients are set up for the best success when attempting to stop progression of this disease. Through supporting clients to understand their medical diagnosis, the importance of regular check-ups, reason for adjusting their nutrient intake, and practical ways to make these lifestyle changes, clients can have improved quality of life when living with CKD.  

➁ Complete Survey

Give us your thoughts and feedback

➂ Click Complete

To receive your certificate