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Newsletter Archives
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Protein Intake and Chronic Kidney Disease (CKD) in the Elderly Resident
Can there be too much protein? It has long been recognized that adequate protein intake is needed throughout the life cycle and a necessary nutrient in tissue building and repair. For residents in long-term care facilities, adequate protein intake is a key component in a positive nitrogen balance that allows for healing of a variety of skin issues—including pressure ulcers, stasis or diabetic ulcers, skin tears, surgical incision sites and bone fractures. Providing adequate nutrients to residents to support the healing process is a key function of the facility nursing and food service departments. CMS looks closely to see that facilities are providing timely/ adequate nutrition for any needed healing to each resident. The National Kidney Foundation (NKF) estimates 1 in 9 adults in the U.S. have some level of kidney function impairment. As kidney function declines with age and frequently further decreased with the various diseases and conditions that we see with the aging (i.e., diabetes, hypertension, frequent UTI’s, proteinuria, among others), we can expect those residents over the age of 70 years in LTC facilities to have a much higher incidence of renal insufficiency than the “1 in 9” estimate. Functions of the kidneys include the elimination of waste products (including urea from the metabolism of protein) from the blood and maintaining a balance between fluids and electrolytes. If the kidneys are not functioning at normal levels, blood urea nitrogen (BUN) levels will be elevated as urea remains in the blood. As well as being an indicator of hydration, BUN and creatinine levels can help identify patients who have impairment in kidney function for the clinician to take appropriate action to address their needs. The NKF has established five (5) stages of CKD to help diagnose and treat renal impairment. Glomerular filtration rate (GFR) is usually accepted as the best overall index of kidney function in health and disease; and, can be estimated with the Cockcroft-Gault equation, using the patient’s age, sex, and serum creatinine levels. A resident with an eGFR of < 60 indicates a mild to moderate renal insufficiency. GFR of 15 or less indicates severe renal insufficiency and is the usual level when dialysis or other treatment is initiated. Research has shown that the progression of renal disease in individuals with mild to moderate renal insufficiency can be halted or delayed with diet and medication. In CKD with GFR’s of 15-59, the NKF recommends 0.6 to 0.8g of protein per kg body weight per day, with at least 60% of high biological value in addition to treating the disease state of HTN or uncontrolled blood sugar levels in diabetes, etc. Blood urea nitrogen levels can be elevated for a wide variety of causes including the side effects of diuretic, cardiac glycoside therapy and antibiotics; infections; sepsis; shock; CHF and fluid restrictions; as well as an impairment in renal function with azotemia (BUN > 50), in addition to dehydration which is frequently the most often considered problem associated with an elevated BUN. With the geriatric patient that has mild to moderate renal insufficiency as indicated by the GFR, a diet very high in protein can put additional stress on renal function and further elevate BUN and creatinine levels due to excess urea nitrogen levels due to the body’s inability to filter out and excrete high levels of ingested protein. When the protein in the diet (85 grams minimum with 58 gms HBV protein in the General diets per Ill. Regs.) is combined with supplemental items such as shakes, 2 cal per cc supplements (that provide an additional 20 gms protein per 8 oz.), super cereal and other fortified products often used, protein powders, supplemental drinks containing primarily Arginine and Glutamine amino acids, as well as other liquid high protein products, its possible that a patient that has some level of renal insufficiency receives well over 2 or 3 grams protein per kg weight—well over the level recommended to help prevent further deterioration of kidney function. In evaluating lab values in patients and providing adequate nutrients to meet their nutritional needs—including needs for anabolism and wound healing, as well as evaluating hydration status, it may be beneficial to consider that ingesting a very high protein diet can be “Too Much” for an elderly patient whose GFR is between 15 and 59 (mL/min/1.73m ). While the residents’ actual intake of the diet and supplements needs to be considered, a more moderate approach to protein supplementation may be more appropriate for these residents. |
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Previous Newsletter Articles
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14.01.09
Holidays
The holiday season is an enjoyable time of family get-togethers and parties. Too many parties can mean an over indulgence of food and unwanted calories. Now that the holidays are behind us, it is time to get back on track with some healthy habits. Here are some healthy tips to…
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22.12.09
Holidays
As the holidays approach we like to celebrate by entertaining friends and family, throwing parties, and preparing feasts. From the buffet table to the office party, food moves center stage throughout the holiday season. Food safety is the most important ingredient in preparing food for the holidays. Be sure to…
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05.02.09
Clinical Nutrition
Restorative Dining Programs can Improve Outcomes, Promote Well-being, Reduce Risk, and Boost Payment
All people involved in the caregiving process must be focused on the purpose of caregiving in the broadest sense to help the resident be as comfortable and functional for as long as possible. Restorative programs…
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14.06.11
General Nutrition
Chances are pretty good that you know someone who is on a gluten-free diet. A gluten-free diet is prescribed for someone who has celiac disease. Celiac disease is a lifelong autoimmune condition affecting adults and children. If someone with celiac disease consumes foods containing gluten, the food will not be…
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27.09.11
Healthy Lifestyle
According to studies, omega-3 fatty acids, also known as polyunsaturated fats (PUFAs), have numerous health benefits and help reduce risks of certain chronic diseases. Omega-3 fatty acids are also important in brain function, normal growth and development of fetus, according to some research. Although the body does not make them,…
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28.02.12
General Nutrition
"Ice cream, ice cream!" many of us would shout when we heard the music playing from the ice cream truck. How can you forget hearing that distinct carnival sounding music, begging your parents for money and running out to get a summer time treat? These food trucks were basically meant…
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04.02.11
General Nutrition
Many people have allergies or intolerances to food. Food intolerances are rarely life-threatening but food allergies can be. Food allergies are complex and can be outgrown or can develop later in life after eating a certain food safely for years. Scientists estimate that 11 million Americans suffer from true food…
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04.10.10
Regulations
Date marking can be a confusing regulation to understand and implement in your food service operation. Here are some clarifications to this code, which is Illinois Food Code Section 750.151.
Why must date marking be done? It controls the growth of Listeria monocytogenes and assures the food is discarded…
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28.10.11
Clinical Nutrition
The American Dietetic Association, the world's largest organization of food and nutrition professionals, will change its name effective January 2012 to the Academy of Nutrition and Dietetics. The announcement of the name change was made recently at the ADA's 2011 Food & Nutrition Conference & Expo in San Diego, Calif.…
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04.01.11
General Nutrition
When you think of seasonal foods the first things that most likely come to mind are mouthwatering foods of summer; golden corn on the cob, crisp green beans, juicy watermelon and fresh berries. The long cold days of winter may have you dreaming of summertime foods and outdoor activities but…
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