Manual of Clinical Nutrition

Manual of Clinical Nutrition Management III- 116 Copyright © 2013 Compass Group, Inc.

NUTRITION CARE OUTCOMES and INTERVENTIONS IN CKD (Stage V)

RENAL REPLACEMENT THERAPY BASED ON PATIENT ASSESSMENT

PARAMETERS

I. Biochemical Parameters
Parameter^ Reference Rangea Goal for Dialysisb
(1,2)

Nutrition Intervention(1-3)

Sodium
135 - 145 mEq/L 135 - 145 mEq/L If high, assess sodium intake and hydration status.
If low, assess fluid intake.

Potassium 3.5-5.5 mEq/L 3.5-5.5 mEq/L If high, assess and limit potassium intake; modify
potassium in dialysate and medications.
If low, increase potassium intake and evaluate
dialysis and medications.

Glucose 80 - 100 mg/dL 80 - 200 mg/dL, or

<140 to 180 mg/dL

in critically ill

diabetic patients

(3,4)

If high, avoid excess carbohydrate consumption.

If low, assess total energy intake.

Consider evidence-based guidelines on glycemic

control in critical care patients and diabetic

patients (3,4,5).

Total Calcium

Ionized
Calcium

8.5-10.5 mg/dL

4.5-5.6 mg/dL

8.4-9.5 mg/dL

(If serum albumin is

low, use ionized

calcium or correct

for low serum

albumin)

If high, assess for the overuse of calcium

supplements, vitamin D supplements, or other

supplements that can increase calcium levels (6).

Recommend avoiding high-calcium and calcium-

fortified foods or the use of a calcium binder.

If low, recommend that calcium binders be taken

separately from meals, such as at bedtime (4,6).

Phosphorus 2.5-6.0 mg/dL 3.5-5.5 mg/dL If high, limit total phosphorus intake and evaluate
the use and timing of a phosphorus binder (6).
If low, add one serving of high-phosphorus food per
day or adjust binder.

Calcium-
phosphorus
product (7)

not available <55 mg^2 /dL^2 (7) Reduce serum phosphorus concentrations before
increasing calcium levels. Utilize vitamin D or
vitamin D analog per protocol.
Refer to K/DOQIc guidelines as needed (6).
Blood (serum)
urea
nitrogen

4 - 22 mg/dL <90-100 mg/dL If high, assess adequacy of dialysis and medications

(eg, steroids).

If low, assess protein and energy intake and

residual renal function.

Albumin
3.3-5.0 g/dL

4.0 g/dL
If low, assess and increase protein intake.
Consider impact of inflammatory metabolism.
Low total cholesterol (<150 mg/dL) also indicates
compromised nutritional status, especially in
adults older than 60 years.
Plasma intact
parathyroid
hormone

BioIntact
parathyroid
hormone

1 - 60 pg/mL

Institution-specific

reference range

>100-300 pg/mL

75 - 150 pg/mL

If high, evaluate phosphorus and calcium. The goal

is to establish limits in calcium range while

maintaining phosphorus levels. Adjust dosage of

calcitriol, paricalcitol, doxercalciferol, or Sensipar

(calcimimetic agent).

If low, evaluate dosage of calcitriol, doxercalciferol,

or paricalcitol. It may need to be reduced.

Refer to K/DOQI guidelines as needed (6).