Manual of Clinical Nutrition

Nutrition Care Outcomes and Interventions in Chronic Kidney Disease

Manual of Clinical Nutrition Management III- 117 Copyright © 2013 Compass Group, Inc.

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

Nutrition Intervention(1-3)

Hematocrit

Hemoglobin

Transferrin
saturation

Men: 38%-50%

Women: 36%-45%

Men: 13-18 g/dL

Women: 12-16 g/dL

20%-50%

33%-36%

11 - 12 g/dL

20%-50%

If high, check the dose of epoetin or other

erythropoiesis-stimulating agents. If low, check

ferritin stores, transferrin saturation, and iron

stores; increase epoetin or other erythropoiesis-

stimulating agent. If no response, check folate and

vitamin B 12 levels (8).

Ferritin 12 - 800 ng/L 100 - 800 ng/L If high, decrease iron supplementation; check for
chronic inflammation.
II. Medications
Drug Approaches
Phosphate binders Phosphate binders may decrease level of dietary phosphorus restriction.

Diuretics If effective, diuretics may decrease level of sodium restriction. Diuretics may

increase blood urea nitrogen levels and decrease potassium levels.

III. Other Parameters

Parameter Goal Approaches

Interdialytic weight gain 1 - 2 lb/day

2%-5% of body weight^ (9)

If high, limit fluid and sodium intake.

If low, modify fluid intake.

Dialysis adequacy assessed by

urea kinetic modeling (1):

Kt/V (URR)d

nPNA (1-3)

Kt/V >1.2 or URR <65 in

hemodialysis (1)

Weekly Kt/V >2.0,

creatinine clearance >60

L/week per 1.73 m^2 in

CAPD (1)

nPNA >1.2 (2,3)

Evaluate adequacy of dialysis and protein

metabolism.

Refer to guidelines (1-3) for detailed discussion of

urea kinetic modeling.

Glomerular filtration intake and

creatinine clearance

Based on stage of CKD (1-5) See discussion of glomerular filtration rate

earlier in this section.

Urine Albumin-to-Creatinine

Ratio (UACR)

< 30 mg/g UACR estimates 24 –hour urine albumin

excretion. Albuminuria is present when UACR

is > 30 mg/g and is a marker for CKD. This

parameter is used to diagnoise and monitor

kidney disease. Change in albuminuria may

reflect response to therapy and risk for

progression. Refer to K/DOQI guidelines.

Hypertension

Heart failure

Edema

<130/80 mm Hg (Grade IV)* (10)

Individualized based on

symptoms

Individualized based on

symptoms

Restrict sodium.

Restrict sodium and fluid as needed

Restrict sodium and fluid as needed

Hypotension >90/60 Assess sodium and fluid intake.

Urine output Individualized based on

symptoms

Adjust fluid intake based on urine output to

maintain stable dry weight.

Food intake >80% estimated energy

expenditure (1)

Modify nutrition treatment plan and diet

restrictions to increase food intake.