Nutritional Management of Renal Disease

Joel D. Kopple, MD, editor of the book’s first three editions, is Professor Emeritus of Medicine and Public Health at the David Geffen School of Medicine at UCLA and UCLA Fielding School of Public Health, Los Angeles, CA, and is a member of the Division of Nephrology and Hypertension and The Lundquist Institute at Harbor-UCLA Medical Center, Torrance, California. Dr. Kopple was Chief of the Division of Nephrology and Hypertension at Harbor-UCLA Medical Center from 1982 to 2007. He has published over 600 scientific papers and book chapters and has edited or coedited 15 seminars and proceedings. Dr. Kopple is a former president of the National Kidney Foundation (NKF), the American Society of Parenteral and Enteral Nutrition, the International Society for Renal Nutrition and Metabolism, and the International Federation of Kidney Foundations and was a founder of World Kidney Day. Shaul G. Massry, MD, editor of the book’s first three editions, is Professor Emeritus of Medicine and Physiology and Biophysics at the Keck School of Medicine, University of Southern California, Los Angeles, California. He served as Chief of its Division of Nephrology from 1974 to 2000. He has published over 600 scientific papers and over 80 book chapters, and he is editor or coeditor of 28 books. Dr. Massry has received honorary doctorates from 14 universities across Europe, including the oldest and prestigious Charles University (Prague, Czech Republic), The University of Bologna (Italy), and the University of Padua (Italy). Dr. Massry is a former president of the National Kidney Foundation (NKF). Kamyar Kalantar-Zadeh, MD, PhD, MPH, editor of the book’s third edition and an Editor-in-Chief of the Journal of Renal Nutrition, is Professor of Medicine, Pediatrics, Public Health and Nursing Sciences, and Chief of Nephrology, University of California Irvine School of Medicine, Irvine, CA; Adjunct Professor of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA; and a staff physician in Veterans Affairs Hospital, Long Beach, CA. Dr. Kalantar is a former president of the International Society for Renal Nutrition and Metabolism and the International Federation of Kidney Foundations, co-chair of the joint steering committee of World Kidney Day, and Chair of the Medical Advisory Committee of the National Forum of the ESRD Networks. He has served as PI of a dozen National Institutes of Health grants and has coauthored over 800 manuscripts in peer-reviewed journals.

• Chapter 1. The Influence of Kidney Disease on Protein and Amino Acid MetabolismIntroductionCKD Interrupts the Components of Protein MetabolismDefining Muscle WastingMechanisms of Muscle WastingThe Ubiquitin-Proteasome SystemSynergism of Proteolytic Pathways Causes Muscle Wasting in CKDProteolytic Activities Present in Muscles of PatientsFactors Triggering Muscle Wasting in CKD and Other Catabolic StatesMyostatin and the Regulation of Muscle Protein WastingMyostatin in Muscle Increases in Catabolic ConditionsBeneficial Responses from Blocking Myostatin in Models of Muscle CatabolismBlocking Myostatin can Suppress CKD-Induced Muscle WastingCKD Changes the Concentrations of Certain Amino AcidsLinks Between Amino Acid and Protein MetabolismConclusionReferencesChapter 2. Carbohydrate Metabolism in Kidney Disease and Kidney FailureIntroductionInsulin ResistanceInsulin SecretionInsulin ClearanceHypoglycemiaCarbohydrate Metabolism in Patients with Renal Replacement TherapyTreatment of Diabetes Mellitus in Diabetics with CKDDrug Management in Diabetics with CKD (Figure 2.1)ReferencesChapter 3. Altered Lipid Metabolism and Serum Lipids in Kidney Disease and Kidney FailureIntroductionPlasma Lipid and Lipoprotein Profile in CKD/ESRD PatientsThe Nature and Mechanisms of CKD-Induced Lipid AbnormalitiesThe Nature and Mechanisms of Adverse Effects of Lipid Disorders in CKDTreatment of CKD-Associated DyslipidemiaPotential Adverse Effects of StatinsReferencesChapter 4. Uremic ToxicityIntroductionUremic Symptoms and SignsToxic Effects of Uremic Plasma or SerumDefinition of a Uremic ToxinImpact of Dialysis Treatment on Uremic ToxicityToxicity of Inorganic Substances in UremiaFree Water-Soluble Low-Molecular-Weight SolutesProtein-Bound SolutesMiddle MoleculesGeneral ConclusionsAcknowledgementReferencesChapter 5. Inflammation in Chronic Kidney DiseaseGeneral ConsiderationsMultifactorial Causes of Inflammation in Chronic Kidney DiseaseInflammation as a Cause of Protein-Energy WastingInflammation as a Catalyst of Other Risk FactorsOther Consequences of InflammationMonitoring InflammationTreatment of Inflammation in Chronic Kidney DiseaseReferencesChapter 6. Catalytic (Labile) Iron in Kidney DiseaseIntroductionDefinition of Catalytic (Labile) Iron and its Importance in Tissue InjuryRole of Catalytic Iron in Acute Kidney InjuryGentamicin-Induced Mobilization of Iron From Renal Cortical MitochondriaEvidence Suggesting a Role for Iron in Gentamicin-Induced Acute Renal Failure in RatsCatalytic Iron in Chronic Kidney Disease (Table 6.3)Catalytic Iron in Diabetic NephropathyCatalytic Iron in Chronic Kidney DiseaseConcluding CommentsReferencesChapter 7. Carbonyl Stress in UremiaIntroductionIncreased Age and other Protein ModificationsCarbonyl StressClinical Consequences of Carbonyl StressNutrition and Carbonyl StressReferencesChapter 8. Effect of Acidemia and Alkalemia on Nutrition and MetabolismIntroductionAcute Responses to Acidosis and AlkalosisComparing Effects of Acidemia to those of StarvationEndocrine Responses to AcidemiaCalcium MetabolismProtein MalnutritionMetabolic Acidemia Stimulates the Ubiquitin/Proteasome Proteolytic PathwayClinical Implications of Acidemia for Protein NutritionReferencesChapter 9. Prevention and Management of Cardiovascular Disease in Kidney Disease and Kidney FailureIntroductionCardiovascular Risk FactorsManagement of CVDConclusionReferencesChapter 10. Assessment of Protein and Energy Nutritional StatusIntroductionDefinition of Protein and Energy WastingAssessment of Protein MassAssessment of Protein and Energy HomeostasisSummary and RecommendationsReferencesChapter 11. Causes of Protein-Energy Wasting in Chronic Kidney DiseaseIntroductionCauses of Pew in CKDPathophysiology of Pew in CKDEndocrine and Hormonal DisordersEffect of Volume OverloadContribution of Co-MorbiditiesAltered Protein Kinetics in CKDNutrient Loss During DialysisInflammation: Agent Provocateur of PewRole of Metabolic AcidemiaOxidative Stress: Other Key PathwaysSummary and ConclusionReferencesChapter 12. Protein-Energy Wasting as a Risk Factor of Morbidity and Mortality in Chronic Kidney DiseaseIntroductionPertinent Outcomes in Patients with CKDAssociation of Measures of Nutrition with OutcomesNutrient Intake and OutcomesBody Size, Body Composition and OutcomesLaboratory Measures and OutcomeNutritional Scoring Systems and OutcomesNutritional Interventions and OutcomesConclusionsReferencesChapter 13. Effect of Nutritional Status and Changes in Protein Intake on Renal FunctionIntroductionRole of Specific AAFactors Mediating the Renal Response to Protein and Amino AcidsHumoral MediatorsLocal MediatorsIntrinsic Renal MechanismsEffects of Nutritional Status or Protein Deprivation on Renal FunctionLevels of Plasma Creatinine and Serum Urea Nitrogen in Patients with Protein-Energy MalnutritionConcentration and Dilution of the Urine in Patients with Protein-Energy MalnutritionAcid Excretion and Acid-Base Balance in Patients with Calorie-Protein MalnutritionEffects of Chronic Protein-Energy Malnutrition on Renal Sodium ExcretionEffects of Maternal Nutrition on Renal DevelopmentProtein Energy Wasting in Advanced Renal DiseaseReferencesChapter 14. Low Protein, Amino Acid and Ketoacid Diets to Slow the Progression of Chronic Kidney Disease and Improve Metabolic Control of UremiaIntroductionAssessing the Progression of Chronic Renal InsufficiencyProtein Intake and Chronic Renal Insufficiency: Experimental DataDietary Protein Intake: Clinical StudiesClinical Evidence of the Effects of Low Protein DietsConclusionReferencesChapter 15. Reducing Tryptophan Metabolites to Reduce Progression in Chronic Kidney FailureSearch for Uremic ToxinsMetabolism of Indoxyl Sulfate, a Tryptophan MetaboliteProtein Metabolite Theory as a Mechanism of CKD ProgressionIndoxyl Sulfate Induces Reactive Oxygen Species (ROS) in the KidneyRole of Organic Anion Transporters in Nephrotoxicity of Indoxyl SulfateIndoxyl Sulfate Reduces Klotho and Induces Senescence in the KidneyVascular Toxicity of Indoxyl SulfateClinical Effects of AST-120ConclusionReferencesChapter 16. Altering Serum Lipids to Reduce Progression of Chronic Kidney DiseaseKidney Disease and DyslipidemiaLipid Lowering and Pleiotropic Effects of StatinsStatins in Experimental Kidney DiseaseEffects of Dyslipidemia and Statins on the Progression of Kidney Disease in Human SubjectsReferencesChapter 17. Disorders of Phosphorus Homeostasis: Emerging Targets for Slowing Progression of Chronic Kidney DiseaseIntroductionRole of Dietary Phosphorus Intake in Disturbances of Mineral Metabolism in CKDDisorders of Phosphorus Homeostasis and Kidney Disease ProgressionDietary Phosphorus Restriction in CKD: Practical Considerations Moving ForwardConclusionsReferencesChapter 18. Alkalinization to Retard Progression of Chronic Kidney FailureEpidemiology of Metabolic Acidosis in Kidney DiseaseMechanism of Acidosis in CKDAnimal Models of Kidney Damage With AcidosisAnimal Models of TreatmentObservational Studies in HumansRecommendationsReferencesChapter 19. Calcium, Phosphate, PTH, Vitamin D and FGF-23 in Chronic Kidney DiseaseIntroductionCalcium MetabolismVitamin DPhosphate MetabolismParathyroid HormoneFibroblast Growth Factor 23 (FGF-23)Alterations in Mineral Metabolism in CkdPhosphate and Cardiovascular Disease (CVD)Phosphate and Vascular CalcificationsControl of Serum Phosphate in CKDDietary Phosphorus RestrictionInorganic Phosphorus and Food AdditivesDietary Phosphorus, Protein Intake and Phosphorus-Protein RatioPhosphorus Removal With DialysisPhosphate BindersTherapy With Vitamin D SterolsCalcimimeticsConclusionReferencesChapter 20. Phosphate Metabolism and Fibroblast Growth Factor 23 in Chronic Kidney DiseaseIntroductionPhosphate Metabolism in HealthPhosphate Metabolism Across the Spectrum of CKDThe Role of Phosphate and FGF-23 Excess in the Pathophysiology of CKD OutcomesTherapeutic Approaches to Lowering Phosphate and FGF-23 ExcessImpact of Dietary Phosphate on Phosphate/FGF-23 ExcessQuestions and ControversiesConclusionsAcknowledgmentsDisclosuresReferencesChapter 21. Vitamin D in Kidney DiseaseNormal Vitamin D MetabolismPrevalence and Etiology of Deficiency in The Vitamin D Axis in CKDImplicationsInterventionsOther CompoundsTherapeutic ConsiderationsSummaryAcknowledgementReferencesChapter 22. Nutritional Management of Water, Sodium, Potassium, Chloride, and Magnesium in Kidney Disease and Kidney FailureSodium and ChlorideWaterPotassiumMagnesiumReferencesChapter 23. Trace Elements, Toxic Metals, and Metalloids in Kidney DiseaseIntroductionAlterations in Essential Trace Elements in Patients With Kidney DiseaseAlterations in Nonessential Trace Elements, Metals, and Metalloids in Patients With Kidney DiseaseTrace Element Abnormalities in Renal-Specific SyndromesDiagnostic and Therapeutic ApproachesConclusionsReferencesChapter 24. Vitamin Metabolism and Requirements in Renal Disease and Renal FailureIntroductionStructure and Physiological Role of VitaminsVitamin Intake in Chronic Renal DiseaseVitamins Status in Chronic Renal DiseaseVitamins as Therapy for People with Kidney DiseaseRecommendations for Vitamin Supplementation and Vitamin Therapy in Renal DiseasesConclusionsReferencesChapter 25. Nutrition and Anemia in End-stage Renal DiseaseIntroductionIronVitamin CVitamin DFolic AcidVitamin B6 (Pyridoxine)Vitamin B12CarnitineGrowth Hormone and Insulin-Like Growth Factor-I (IGF-I)ReferencesChapter 26. Nutritional and Non-nutritional Management of the Nephrotic SyndromeIntroductionDietary ProteinAlbumin Homeostasis in the Nephrotic SyndromeDietary Protein and Renal InjuryEffects of the Nephrotic Syndrome on Solid Tissue ProteinsDietary Proteins as Potential Allergens Responsible for Renal DiseaseDietary FatThe Effect of Altered Glomerular Permselectivity on Lipid MetabolismCardiovascular Effects of Hyperlipidemia in the Nephrotic SyndromeThromboembolic ComplicationsEffects of Lipids on Renal DiseasePolyunsaturated Fatty AcidsDerangements in Divalent Cation Metabolism in the Nephrotic SyndromeDerangements in Salt and Water Metabolism in the Nephrotic Syndrome (Volume Homeostasis)Recommendations for Nutritional and Non-Nutritional Treatment of the Nephrotic SyndromeAcknowledgementsReferencesChapter 27. Nutrition and Blood PressureIntroductionObesity and Energy IntakeIndividual Nutrients, Miscellaneous Substances and Blood PressureNutritional Management Strategies for The Prevention or Treatment of HypertensionHealth Enhancing Diets and LifestylesLong-Term Adherence and Blood Pressure Responses to Health Enhancing LifestylesChallenges to Diet and Lifestyle Approaches for Preventing and Treating HypertensionConclusions and RecommendationsKey PointsReferencesChapter 28. Effect of Obesity and the Metabolic Syndrome on Incident Kidney Disease and the Progression to Chronic Kidney FailureIntroductionDefinitions of Obesity/Metabolic SyndromeObesity and Metabolic Syndrome as Risk Factors for Incident CKDObesity and Metabolic Syndrome as Risk Factors for Progression of CKDPathophysiology of Obesity on the KidneyEffect of Weight Loss Interventions on Kidney DiseaseConclusionReferencesChapter 29. Nutritional and Metabolic Management of Obesity and the Metabolic Syndrome in the Patient with Chronic Kidney DiseaseIntroductionObesity-Related Chronic Kidney Disease (CKD)Obesity-Related GlomerulopathyMeasuring GFRMetabolic SyndromeTreatment of Obesity and Obesity-Related Kidney DiseaseBariatric Surgery (see also Chapter 28)Metabolic SyndromeReferencesChapter 30. Bariatric Surgery and Renal DiseaseMagnitude of ProblemPathogenesis of ObesityClinical ManifestationsMedical TherapyRole of Bariatric Surgery in Treatment of Morbid ObesitySurgical Techniques of Bariatric Surgery (see Figure 30.1)Outcomes of Bariatric SurgeryRenal Disease and Morbid ObesityPathogenesis of Renal Disease in ObesityRole of Bariatric Surgery in Chronic Kidney DiseaseRole of Bariatric Surgery in Transplant CandidatesBariatric Surgery and NephrolithiasisOther Renal Effects of Bariatric SurgeryFuture ResearchReferencesChapter 31. Nutritional and Metabolic Management of the Diabetic Patient with Chronic Kidney Disease and Chronic Renal FailureIntroductionGlucose/Insulin HomeostasisValue of Glycemic Control, and its Determination in CKDHypoglycemiaDiabetes/Bone and Mineral MetabolismDietary Protein Intake and Diabetic Kidney DiseaseSalt Intake and Diabetic Kidney DiseaseReferencesChapter 32. Nutritional Management of Maintenance Hemodialysis PatientsIntroductionFactors Altering Nutrient Intake in Maintenance Hemodialysis PatientsLoss of Nutrients During Maintenance Hemodialysis TreatmentImportance of Pew and Diet as Patients Approach Esrd and Commence MHDAssessment of Nutritional Status in MHD PatientsAcidemia and Protein WastingGoals of Nutritional Management of MHD PatientsDietary Nutrient Requirements (see Table 32.3)Management of Pew in MHD PatientsTreatment of Acute Catabolic IllnessDaily or Long Duration Hemodialysis and Nutritional StatusReferencesChapter 33. Nutritional Management of End-Stage Renal Disease Patients Treated with Peritoneal DialysisIntroductionType of Peritoneal DialysisPeritoneal Dialysis SolutionsSpecific Effects of Peritoneal Dialysis on Nutritional Status and MetabolismDietary Recommendations for ESRD Patients Undergoing Peritoneal DialysisProtein-Energy Wasting in Peritoneal Dialysis PatientsManagement of Protein-Energy Wasting in Patients Treated with Peritoneal DialysisReferencesChapter 34. Nutritional Management of Kidney Transplant RecipientsIntroductionAnemiaBone DiseaseDiabetes MellitusDyslipidemiaHypertensionFood SafetyHypophosphatemiaOverweight/ObesityMalnutritionProtein and Energy RequirementsNutritional ManagementPretransplant Status and Posttransplant OutcomeConclusionAcknowledgementsReferencesChapter 35. Nutritional Management of the Child with Kidney DiseaseIntroductionEtiology of Protein-Energy WastingAssessment of Nutritional StatusNutritional RequirementsBone Mineral MetabolismAcid–Base and ElectrolytesVitamins and MicronutrientsNutrition ManagementReferencesChapter 36. Nutritional Management of Acute Kidney InjuryIntroductionMetabolic Environment of the Patient with AKIMetabolic Alterations Specifically Attributable to AKIMetabolic Interventions of Controlling CatabolismClinical Studies on Protein Catabolism in AKIAmino Acid/Protein Requirements in Patients with AKICarbohydrate MetabolismLipid MetabolismMicronutrients and the Antioxidant System in AKIElectrolytesMetabolic and Nutritional Factors and the Prevention and Therapy of AKIImpact of Renal Replacement Therapy (RRT) on Metabolism and Nutrient BalancesThe Effect of Nutrition Status and Nutrient Supply on PrognosisPractice of Clinical Nutrition in Patients with AKIOral Nutrition in Patients with AKINutritional Support in Patients with AKIEnteral Nutrition in AKIParenteral Nutrition in AKIComplications of Nutritional SupportMonitoring of Nutrition Support in Patient with AKIReferencesChapter 37. Nutritional Management of Patients Treated with Continuous Renal Replacement TherapyIntroductionModes of CRRTGeneric Effects of CRRT on Energy MetabolismSpecific Effects on Nutrient BalanceRecommendations on Nutritional TherapyConclusionAcknowledgementsReferencesChapter 38. Anorexia and Appetite Stimulants in Chronic Kidney DiseaseGeneral ConsiderationsPrevalence of Anorexia, Methods of Assessment and Clinical ImplicationsPathogenesis of Anorexia in CKDTreatment of Anorexia in CKDReferencesChapter 39. Oral and Enteral Supplements in Kidney Disease and Kidney FailureIntroductionOral and Enteral (Tube Feeding) Nutrition in CKD PatientsOral and Enteral Nutrition for Patients with Nephrotic SyndromeOral and Enteral Nutrition in Chronic Dialysis PatientsOral and Enteral Nutrition in Acute Kidney InjuryConclusionsReferencesChapter 40. Intradialytic Parenteral Nutrition, Intraperitoneal Nutrition and Nutritional HemodialysisIntroductionIntradialytic Parenteral Nutrition (IDPN)Randomized Prospective Controlled Trials of IDPNAdvantages and Disadvantages of IDPNIndications for IDPNIDPN in the United StatesNutritional Hemodialysis and Intraperitoneal NutritionReferencesChapter 41. Therapeutic Use of Growth Factors in Renal DiseaseIntroductionTreatment of Protein-Energy Wasting (PEW) in ESRD PatientsTherapeutic Use of Growth Factors in Renal DiseaseGrowth Factors in the Management of Wasting in Renal DiseaseConclusionReferencesChapter 42. Nutritional Prevention and Treatment of Kidney StonesIntroductionPathophysiology of Kidney Stone FormationGeneral Dietary Effects on Kidney StonesEffect of Diet Based on Urinary FindingsDietary Recommendations Based on Stone TypeObesity and Kidney StonesMelamine StonesReferencesChapter 43. Herbal Supplements in Patients with Kidney DiseaseIntroductionAcute Kidney InjuryChronic Kidney DiseaseFive Herbals with Some Proven EfficacyTransplantClinical ImplicationsReferencesChapter 44. Drug–Nutrient Interactions in Renal FailureIntroductionEffect of Food Intake on Drug AbsorptionEffects of Nutrients on Drug MetabolismInteractions of Food Supplements with DrugsDrug-Induced Nutritional DeficienciesTaurine and ACE-Inhibitor EffectsNutrient Interactions with Oral AnticoagulantsInteractions of Calcineurin Inhibitors with NutrientsEnteral Tube Feeding and Oral Drug AdministrationReferencesChapter 45. Exercise Training for Individuals with Advanced Chronic Kidney DiseaseIntroductionCharacteristics of Advanced CKD PatientsValue of Exercise and Physical Activity in Advanced CKDPrinciples of Exercise TrainingPatient AssessmentComponents of the Exercise Training PrescriptionExercise Training Program Design for Patients with Advanced CKDComponents of the Exercise Training SessionRisks of Exercise in the Advanced CKD PatientUrgent Need for Development of Renal Rehabilitation ProgramsSummaryReferencesChapter 46. Motivating the Kidney Disease Patient to Nutrition Adherence and Other Healthy Lifestyle ActivitiesIntroductionWhat is Motivational Interviewing?What isn’t Motivational Interviewing?PrinciplesHandling ResistanceEmpirical SupportApplications in Kidney Disease ManagementLearning Motivational InterviewingDissemination of Motivational InterviewingFuture Research Directions in Kidney Disease ManagementConclusionsReferencesColor PlatesIndex

"This is a useful tool for nephrologists, especially in the clinical setting. The easy readability and suggested applications will also attract medical students, internists, renal dietitians, nurse practitioners, and physician assistants…Nutrition with its emerging importance at the cellular level is sometimes overlooked in training medical students. This book provides ready access to both the science and clinical application needed to treat the CKD population." Rating: 3 Stars--Doody.com, February 28, 2014"The Third Edition of this classic translational text offers in-depth reviews of the metabolic and nutritional disorders prevalent in patients with renal disease."--Doody.com, April 24, 2013"This edition reflects changes in the field, such as the increased evidence on the importance of inflammatory, oxidative, and carbonyl stress, and the greater prevalence and severity of obesity and its clinical consequences; therapeutic strategies for obesity treatment in regard to chronic kidney disease prevention and treatment; the nutritional management of people receiving chronic renal replacement therapy; and methods for slowing the progression of chronic renal disease..."--Reference and Research Book News, February 2013