Clinical Nutrition practice in chronic kidney diseases

Topic outline

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  General

  WELCOME TO THE COURSE CLINICAL NUTRITION PRACTICE IN CHRONIC KIDNEY DISEASES!

  This course is focused on the nutritional management of chronic kidney diseases. We will learn general information about chronic kidney diseases and their stages. Each class will highlight the most important disorders in chronic kidney disease and nutritional methods for their correction. During the course, we will review cases to enhance understanding of the management of complications in chronic kidney disease (CKD). We welcome students who are interested in kidney disease and nutrition with appropriate pre-requisite completion.

  
  

  
  

  Course duration - 1 ECTS (25 hours)
  Goals of the course:

  The goal of the course is to increase knowledge on a variety of CKD‘s stages, complications. They will also learn about nutritional management there complications for apply that knowledge to their clinical practice
   At the completion of the course, students should be able to:
  ✔ explain the guidelines of nutritional therapy for chronical kidney diseases (especially for CKD1-5D),
  ✔ can create nutritional strategy for correcting hyperkalemia, hyperphosphatemia
  ✔ can calculate level of protein in various CKD‘s stages
  ✔ can carry out nutritional medical consultations.

  
  

  Important! Each section includes theoretical and practical questions. To consolidate the material, students will be required to solve clinical problems and present their solution for discussion.

  • Support and working on the course: QUESTIONS and Feedback Forum
  • Glossary for the topic Chronic kidney disease
  • Syllabus File
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  Topic 1. Chronic Kidney Disease (CKD)

  
  
  

  Learning Goal:  Understand the different stage of kidney disease, renal replacement therapy  and nutritional recommendations for CKD
  
  

  After the lesson you will be able to:       
  

  1. Define and describe the importance of the glomerular filtration rate (GFR) in the setting of compromised kidney function

  2. Сalculate the GFR 

  3. Describe state pros and cons of various types of renal replacement therapies 

  4. Create different nutritional patterns for patients with CKD depending on individual needs

  
  

      Plan of work:
      I PART - basic information about  CKD - 3 units (1 units class activity and 2 unit self-preparation)
  

      II PART - nutritional management of CKD - 3 units (1 units class activity and 2 unit self-preparation)

  
  

  
  

  • I PART. Chronic Kidney Disease (CKD1-5) Lesson

    The lecture presents material on the definition of CKD, the stage of CKD, and links to a calculator. During the lecture, the student will need to complete 2 tasks: 1 task - calculate your own glomerular filtration rate, taking into account serum creatine, age and gender, and also determine whether there are signs of CKD; Task 2 - assess the degree of progression of CKD.
    

  • I PART. Information on Kidney Transplantation URL
  • I PART. Information about dialysis URL
  • II PART. Nutritional management of CKD URL
  • Discussing the topic and receiving feedback Forum
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  Topic 2. Protein Foods for the patients of the Chronic Kidney diseases (CKD1-5D)

  
  

  
  

  Learning Goal:  Understanding protein metabolism and recommendations for dietary protein intake in CKD

  
  

  After this lesson you will be able to:

  1.    Describe and calculate daily requirement  protein for the patients of the Chronic Kidney diseases (CKD1-5D)
  2.    Calculate protein portions
  3.    Describe and calculate animal and vegetable protein sources
  4.    Create recommendation of the protein diet on the clinical situations  patients of kidney disease

      Plan of work:   2,6  units (117 min) class activity and 4 units (180 min) Self-preparation

  
  

  • Protein CKD File
  • An example of calculating protein per daily serving for patients with CKD URL
  • KIDNEY DISEASE AND PROTEIN File
  • Strategy of choice protein to patients with CKD File
  • Protein portion File
  • Types of Proteins URL
  • Case 1 "Рrotein intake in a patient with diabetes mellitus" Assignment

    Dear students!
    Respond:  Please, read the case of the patient in the case study below and submit a diet plan as a pdf file. You need to use the materials that are presented in Topics 2. When drawing up a plan, you can give preference to national dishes, drinks, according to the composition of food elements.
    Deadline: Participate until xx.XX.XXXX.

    Grading: 0-49 points - unsatisfactory, 50-69 points - satisfactory, 70-89 - good, 90-100 - excellent.

    
    Case study 1: A 52-year-old type 2 diabetic patient with CKD 5. Receives dialysis.  GFR 9 ml/min/1.73 m2. 
    His fasting glucose is 310 mg/dL (70 mg/dL). His laboratory results showed blood urea nitrogen level of 34.4 mg/dL (8-23 mg/dL), serum creatinine level of 3.61 mg/dL (0.5-1.3 mg/dL), total protein level of 55 g/l (60-80 g/l).  Proteinuria is 0.2 g/l.

  • Presentation File
  • protein URL
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  Topic 3. Hyperphosphatemia in patients with the Chronic Kidney diseases (CKD1-5D)

  
  

  Learning Goal: Understanding the role of phosphorus and low-phosphorus diets for the treatment of people with CKD (CKD1-5D)     

  
  

  After the lesson you will be able to:                          

  1. Describe and calculate daily requirement phosphorus for the patients of the Chronic Kidney diseases (CKD1-5D)
  2. Describe and calculate animal and vegetable phosphorus sources 
  3. Create  a low-phosphorus diets for patients of the Chronic Kidney disease

  
  

  Module duration: 2,6 units (117 min) class activity and 4 units (180 min) work with guidelines and create a phosphorus-restricted dieta for patient with CKD

  
  

  • Сause of hyperphosphatemia File

    This file provides information about the causes of hyperphosphatemia. 
    

     

  • Phosphate homeostasis, monitoring and managment of hyperphosphatemia in patients with the Chronic Kidney diseases Book

    This section presents material on the significance of hyperphosphatemia in patients with CKD, Dietary Therapy for Managing Hyperphosphatemia

  • Examples of Patient Education Infographics to Reduce Phosphorus Loading File
  • Discussing the topic and receiving feedback Forum
  • Case 2 "Daily food plan for patients with hyperphosphatemia on the hemodialysis" Assignment

    Dear students!
    

    Respond:   Please, read the case of the patient below and submit a diet plan as a pdf file. You need to use the materials that are presented in Topics 2 and 3. When drawing up a plan, you can give preference to national dishes, drinks, according to the composition of food elements.
    Deadline: Participate until xx.XX.XXXX.
    Grading: 0-49 points - unsatisfactory, 50-69 points - satisfactory, 70-89 - good, 90-100 - excellent.

    Case 2: A 55-year-old male patient with underlying type 2 diabetes mellitus, hypertension, and chronic kidney disease presented. GFR 7 ml/min/1.73 m2. His weight is 70 kg. The creatinine level is 14 mg/dL (normal range: 0.5-1.3 mg/dL), receives рemodialysis. His laboratory results showed blood urea nitrogen level of 80.4 mg/dL (8-23 mg/dL), serum creatinine level of 15.61 mg/dL (0.5-1.3 mg/dL), total protein level of 65 g/l (60-80 g/l), serum phosphate level of 9.3 mg/dL (2.5-5.5 mg/dL), total calcium level of 8.9 mg/dL (8.4-10.2 mg/dL), vitamin D (25(OH)D) level of 5.71 ng/mL (30-100 ng/mL) and parathyroid hormone level of 100 pg/ml (9-55 pg/mL). 

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  Topic 4.Hyperkalemia and its diet correction in a treatment of patients with the Chronic Kidney diseases (CKD1-5D)

  Learning Goal: Understanding homeostasis, excretion of potassium and dietary potassium is the focus of these recommendations with CKD

  

  After the lesson you will be able to:
  

  • Describe and calculate daily requirement  potassium for the patients of the Chronic Kidney diseases (CKD1-5D)
  • Describe and calculate potassium sources
  • Create recommendation of the lower amount of potassium, diet on the clinical situations  patients of kidney disease.

  Module duration: 2,4 unit (108 min) class activity and 4 unit (180 min) work with guidelines and create a potassium-restricted diet for patient with CKD

  
  

  • The methabolism of potassium URL
  • The daily potassium requirements calculator URL
  • Potassium in CKD Diet URL
  • DIET ON THE PATIENTS WITH KIDNEY DISEASE. LOW-POTASSIUM DIET File
  • NKF Guide to Potassium (infographic) File
  • Dietary Approach to Hyperkalaemia in Patients with Decreased Kidney Function Database
  • Discussing the topic and receiving feedback Forum
  • Case 3 "Daily food plan for CKD patients with Hyperkalemia" Assignment

    Dear students!
    

    Respond:   Please, read case 3 of the patient below and submit a diet plan as a pdf file. You need to use the materials that are presented in Topics 2, 3, 4. When drawing up a plan, you can give preference to national dishes, drinks, according to the composition of food elements.
    Deadline: Participate until xx.XX.XXXX.
    Grading: 0-49 points - unsatisfactory, 50-69 points - satisfactory, 70-89 - good, 90-100 - excellent.
    
    

    Case 3: A 52-year-old type 2 diabetic patient with CKD 4 is referred to you for evaluation of hyperkalemia (6.9 mEq/L). GFR 23 ml/min/1.73 m2. 
    His fasting glucose is 310 mg/dL (70 mg/dL). His laboratory results showed blood urea nitrogen level of 34.4 mg/dL (8-23 mg/dL), serum creatinine level of 2.61 mg/dL (0.5-1.3 mg/dL), total protein level of 65 g/l (60-80 g/l), serum phosphate level of 6.3 mg/dL (2.5-5.5 mg/dL), total calcium level of 8.4 mg/dL (8.4-10.2 mg/dL), vitamin D (25(OH)D) level of 25.71 ng/mL (30-100 ng/mL) and parathyroid hormone level of 55 pg/ml (9-55 pg/mL). Proteinuria is 1.0 g/l.

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  Topic 5.The nutritional support of patients with the Chronic Kidney diseases (CKD1-5D)

  Learning Goal: The nutritional support  of patients with CKD
                               
  Рurpose:

  Create dietary recommendations taking into account material from topics 1-4 for patients with different stages of CKD
  

  
  

  2,2 unit =99 min self-preparation

  • Case 4 "The nutritional support of patients with the Chronic Kidney diseases" Assignment

    Dear students! This is the last case, which includes information from topics 1-4.
    Respond:   Please, read the case of the patient below and submit a diet plan as a pdf file. You need to use the materials that are presented in Topics 1, 2, 3, 4. When drawing up a plan, you can give preference to national dishes, drinks, according to the composition of food elements.
    Deadline: Participate until xx.XX.XXXX.
    Grading: 0-49 points - unsatisfactory, 50-69 points - satisfactory, 70-89 - good, 90-100 - excellent.

    
    

    Case 4: A 52-year-old type 2 diabetic patient with CKD 5, receives dialysis. Аnuria. His fasting glucose is 310 mg/dL (70 mg/dL). His laboratory results showed blood urea nitrogen level of 40.4 mg/dL (8-23 mg/dL), serum creatinine level of 4.21 mg/dL (0.5-1.3 mg/dL), total protein level of 45 g/l (60-80 g/l), serum phosphate level of 6.3 mg/dL (2.5-5.5 mg/dL), serum potassium of 6.3 mmol/l (3.5-5.5 mg/dL), total calcium level of 8.4 mg/dL (8.4-10.2 mg/dL), vitamin D (25(OH)D) level of 25.71 ng/mL (30-100 ng/mL) and parathyroid hormone level of 55 pg/ml (9-55 pg/mL). 

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  Topic 6: Overview of nutrition. Nutrition Management for CKD

  Learning Goal:  To do analisis, create a personal nutritional treatment plan and nutrition coaching

  
  

  This is the final lesson! This lesson will include a discussion of:
    - student solutions of the Case 4;
    - dietary approaches, depending on the stage of CKD, eating habits and national customs

  • Your Guide to Create a Balanced Kidney-Friendly Meal File
  • Discussion of different diets for CKD Forum
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