Dedication	6
	Foreword	8
	Preface	10
	Organization and Content	10
	Features	10
	Series Editor Page	12
	About Series Editor	20
	About Volume Editors	24
	Acknowledgements	28
	Contents	30
	Contributors	34
	Part IFoundations for Clinical Practice and Overview	37
	Chapter 1: Kidney Function in Health and Disease	38
	Introduction	38
	Clinical Evaluation of Kidney Function	41
	Kidney Function in Disease States	42
	Summary	45
	References	45
	Chapter 2: Global Perspective of Kidney Disease	46
	Introduction	46
	Epidemiology of CKD and ESRD	47
	Provision of Renal Replacement Therapy	48
	Modality Use	51
	Nutrition as a Risk Factor and Key Intervention	54
	Summary	56
	References	56
	Chapter 3: Dietary Assessment in Kidney Disease	59
	Introduction	60
	Purpose and Utility of Dietary Intake Assessment	60
	Methodology of Dietary Intake Assessment	62
	24-h Recall	63
	Automated Multiple-Pass Method	63
	The Automated Self-Administered 24-h Recall	63
	Food Frequency Questionnaire	66
	Block FFQ	66
	Willett FFQ	66
	Diet History Questionnaire	67
	FFQ Data Analysis	67
	Diet Record or Diary	67
	Application of Dietary Intake Assessment to Dietary Guidelines	68
	Dietary Intake Assessment of Individuals	68
	Dietary Intake Assessment of Groups	68
	Evidence	70
	Assessment of the 24-h Recall, the AMPM	70
	Assessment of the FFQ	71
	Use of Biomarkers in Assessing Dietary Intake	71
	Doubly Labeled Water and Urine Urea Nitrogen for Dietary Energy and Protein Intake Assessment	72
	Plasma Ascorbic Acid, Carotenoids, and Vitamin A Levels for Assessing Dietary Intake	72
	Association of Serum Uric Acid Levels and Urinary Isoflavones with Dietary Intake	72
	Applications to Kidney Disease Settings	73
	Acute Kidney Injury	73
	Chronic Kidney Disease	74
	Nondialysis CKD	74
	Small Studies	74
	Large Cohort and Cross-Sectional Studies	75
	Dialysis	76
	The FFQ in Dialysis	76
	Diet Records in Dialysis	76
	Transplantation	77
	The FFQ in Kidney Transplantation	77
	Diet Records in Kidney Transplantation	77
	Recommendations for Kidney Disease	77
	References	78
	Chapter 4: Anthropometric Assessment in Kidney Disease	83
	Weight and Height Measurements	86
	Skinfold and Circumference Measurements	87
	Somatogram	88
	Frame Size	88
	Somatotyping	88
	Reference Data	88
	Summary	89
	References	89
	Chapter 5: Biochemical Nutritional Assessment in Chronic Kidney Disease	91
	Introduction	91
	Biochemical Assessment of Nutritional Status	92
	Protein–Energy Nutritional Status	93
	Serum Albumin	94
	Serum Prealbumin	95
	Serum Creatinine and Creatinine Index	95
	Serum Total Cholesterol	96
	Serum Transferrin	96
	Markers of Inflammation	96
	C-Reactive Protein and Proinflammatory Cytokines	97
	Nutritional Adequacy and Management	98
	Protein Intake	98
	Metabolic Acidosis	98
	Summary of Biochemical Assessment	99
	References	100
	Chapter 6: Nutrition Physical Assessment in Chronic Kidney Disease (CKD)	103
	Rationale for Performing a Nutrition Physical Examination	103
	Nutrition-Focused Physical Examination	104
	Approach to Tissue-Specific Physical Assessment	105
	Physical Examination	105
	Observing Oral Tissues	105
	Scalp, Hair, and Skin Findings	106
	Examination of the Eyes	106
	Examination of the Nails	106
	Physical Findings and Functional Deficits in Niacin, B 6, and Zinc Imbalance	107
	Niacin	107
	Vitamin B 6	109
	Vitamin B 6 Deficiency	109
	Vitamin B 6 Toxicity	111
	Zinc	111
	Zinc Deficiency	111
	Zinc Toxicity	115
	Placing Physical Findings Within the Clinical Context of the Patient	115
	Summary of the Nutrition Physical Assessment	115
	References	118
	Part IIChronic Kidney Disease Among Adults	124
	Chapter 7: Hypertension	125
	Introduction	125
	Nutrients and Blood Pressure	126
	Sodium	126
	Potassium	126
	Calcium and Dairy Foods	127
	Magnesium	127
	Protein	128
	Fatty Acids	128
	Vitamin C	128
	The DASH Diet	129
	Dietary Recommendations for Hypertension	130
	The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) Recommendations	130
	KDOQI Guidelines	130
	Summary	131
	References	131
	Chapter 8: Diabetes Mellitus and Chronic Kidney Disease (Stages 1–5)	134
	Introduction	134
	Pathophysiology of Diabetic Nephropathy	135
	Goals of Therapy	138
	Microvascular Complication Prevention	138
	Macrovascular Complication Prevention	138
	Hypertension Management	140
	CVD Risk Management	140
	Medical Nutrition Therapy	141
	Energy Needs and Weight Management	141
	Dietary Strategies for Carbohydrate (CHO) Management	143
	Glycemic Index	143
	Fiber	145
	Protein Guidelines for Diabetes and CKD	145
	Dietary Fat Recommendations	147
	Special Considerations	147
	Hypoglycemia/Uremia	147
	Hyperglycemia and Potassium	148
	Dietary Changes	148
	Alcohol	148
	Nutritive and Non-nutritive Sweeteners	148
	Vitamin D	149
	MNT Summary	149
	Medicare Reimbursement for MNT	150
	Pharmacological Management of Diabetes Within CKD	150
	Oral Anti-hyperglycemic Agents	150
	Medications Targeting Insulin Resistance	151
	Metformin	151
	Thiazolidinediones	151
	Medications Targeting Insulin Secretion	153
	Sulphonylureas	153
	Meglitinides	153
	Incretin-Based Therapies	154
	Medications Targeting Postprandial Glucose	154
	Insulin	154
	Other Medications	155
	Self-Monitoring of Blood Glucose	155
	ESRD and DM	155
	Hemodialysis	156
	Peritoneal Dialysis	156
	Monitoring Glycemic Control	157
	Medical Nutrition Therapy on Dialysis	158
	Malnutrition	158
	Fluid Control	159
	Gastroparesis	159
	Summary	159
	Case Study	160
	Questions	160
	References	161
	Chapter 9: Dyslipidemias	168
	Introduction	168
	Pathophysiology	169
	Existing Clinical Practice Guidelines and Peer-Reviewed Recommendations	169
	Assessment	170
	Biochemical	170
	Physical	170
	Nutritional	171
	Intervention	171
	Lifestyle	171
	Dietary	172
	Determination of Nutrition Prescription	172
	Amount and Type of Dietary Fat	173
	Incorporation of Type of Carbohydrate, Dietary Fiber, and Plant Sterols	174
	Pharmacological	175
	Summary	176
	References	176
	Chapter 10: Implications and Management of Obesity in Kidney Disease	178
	Introduction	178
	Case Scenario	179
	Defining Obesity	179
	Measuring Kidney Parameters in Obese Individuals	180
	Epidemiology and Trends in Obesity	181
	Obesity and Clinical Risk	182
	Chronic Kidney Disease Stages 1–4	182
	End-Stage Renal Disease (Stage 5)	183
	Kidney Transplant Recipients	185
	Influence of Obesity on Kidney Function, Structure, and Health	185
	Kidney Mass	186
	Renal Hemodynamics	186
	Proteinuria	186
	Histologic Changes	186
	Molecular Findings	187
	Obesity-Related Glomerulopathy and Glomerulosclerosis	187
	Animal Models of Weight Gain and Loss	188
	Pathophysiology of Obesity-Related Kidney Disease	189
	Dietary Protein	189
	Podocyte Depletion	189
	Intraglomerular Hemodynamics	190
	Renin-Angiotensin-Aldosterone Axis	190
	Sympathetic Activation	190
	Obstructive Sleep Apnea	190
	Insulin Resistance and the Metabolic Syndrome	190
	Lipotoxicity	191
	Fatty Kidney	191
	Adipocyte Secretory Products	191
	Prevalence of Obesity-Related Kidney Disease	191
	Weight-Loss Strategies and Benefits	192
	Chronic Kidney Disease Stages 1–4	192
	End-Stage Renal Disease (Stage 5)	193
	Kidney Transplant Recipients	193
	References	193
	Part IIIKidney Disease in Adults Treated by Renal Replacement Therapies	201
	Chapter 11: Dialysis	202
	Introduction	202
	Factors Influencing Nutritional Status	203
	Nutrient Recommendations in Dialysis	205
	Energy	205
	Hemodialysis	205
	Peritoneal Dialysis	205
	Nocturnal Hemodialysis/Short Daily Hemodialysis	206
	Protein	208
	Hemodialysis	208
	Peritoneal Dialysis	208
	PNA: Hemodialysis and Peritoneal Dialysis	208
	Nocturnal Hemodialysis/Short Daily Hemodialysis	209
	Nutrition Support	209
	Sodium and Fluid	209
	Hemodialysis	209
	Peritoneal Dialysis	210
	Nocturnal Hemodialysis/Short Daily Hemodialysis	210
	Potassium	211
	Hemodialysis	211
	Peritoneal Dialysis	211
	Nocturnal Hemodialysis/Short Daily Hemodialysis	212
	Calcium/Phosphorus/Vitamin D	212
	Hemodialysis and Peritoneal Dialysis	212
	Nocturnal Hemodialysis/Short Daily Hemodialysis	213
	Lipids	214
	Hemodialysis	214
	Peritoneal Dialysis	214
	Nocturnal Hemodialysis/Short Daily Dialysis	214
	Vitamins, Minerals, and Trace Elements	215
	Water-Soluble Vitamins	215
	Fat-Soluble Vitamins	216
	Minerals and Trace Elements	217
	Summary	218
	Case Study	218
	Case Questions and Answers	219
	References	220
	Chapter 12: Transplantation	225
	Introduction	225
	The Pre-transplant Phase	226
	The Acute Post-transplant Period	227
	Nutritional Requirements	227
	Protein	227
	Energy	229
	Carbohydrate	229
	Fat	229
	Sodium	229
	Potassium	229
	Vitamins, Minerals, and Trace Elements	230
	Herbals	230
	Common Problems Post-transplant in the Acute Care Setting	230
	Inadequate Intake	230
	Hyperglycemia	231
	Gastrointestinal Issues	231
	Mineral and Bone Disorders	231
	Hyperkalemia	232
	The Chronic Post-transplant Phase	232
	Nutritional Requirements	232
	Calcium and Phosphorus	233
	Vitamins and Other Minerals	233
	Pharmacology Update	233
	Cyclosporine A or CsA (Sandimmune/Neoral)	233
	Tacrolimus (Prograf/FK506)	235
	Mycophenolate Mofetil or MMF (CellCept/RS-61443)	236
	Sirolimus (Rapamycin/Rapamune)	236
	Azathioprine (Imuran)	236
	Corticosteroids (Prednisone, Prednisolone, Methylprednisolone, Solu-Medrol, Solu-Cortef)	236
	Other Agents	237
	Long-Term Care Challenges	237
	Cardiovascular Disease	237
	Obesity	238
	New-Onset Diabetes After Transplantation (NODAT)	239
	Hypertension	239
	Mineral and Bone Disorder	239
	General Considerations	239
	Interactions	239
	Food Safety	240
	Summary	240
	Case Study	240
	Case Study Questions	241
	References	243
	Chapter 13: Protein-Energy Wasting	246
	Introduction	246
	Protein-Energy Wasting (PEW): Definition and Etiology	247
	Assessment of Protein-Energy Wasting	249
	Inflammation and Kidney Disease Wasting	251
	Consequences of PEW	251
	Refractory Anemia	251
	Atherosclerotic Cardiovascular Disease	252
	Reverse Epidemiology	253
	Management of PEW	253
	Summary	254
	References	255
	Chapter 14: Acute Kidney Injury	258
	Function of the Kidneys	258
	Acute Kidney Injury	259
	Renal Replacement Therapy	260
	Nutrition Management of the AKI Patient	260
	Nutrition Assessment	260
	Oral Intake and Supplements	261
	Specialized Nutrition Support	262
	Tube Feeding Formulas	263
	Tube Feeding Management	263
	Guidelines for Administration	264
	Parenteral Nutrition Support	265
	Use of Parenteral Nutrition (PN)	265
	Intradialytic Parenteral Nutrition Support	265
	Nutrient Substrates	266
	Protein	266
	Carbohydrate	266
	Fat	266
	Parenteral Additives	267
	Fluid and Electrolytes	267
	Vitamins and Trace Minerals	267
	Initiation and Monitoring of Parenteral Nutrition Support	268
	Discontinuing Parenteral Nutrition	268
	Monitoring Clinical and Laboratory Parameters	268
	Nutritional Requirements in AKI	268
	Energy Requirements	269
	Protein Requirements	269
	Fat Requirements	270
	Vitamins and Trace Elements	270
	Fluid, Electrolytes, and Mineral Needs	271
	Summary	271
	References	271
	Chapter 15: Bone and Mineral Disorders	274
	Introduction	274
	Pathogenesis of Bone and Mineral Abnormalities in CKD	277
	Bone Manifestations	279
	Bone Biopsy	281
	Radiography, Pulse Pressure, and Electron Beam Computed Tomography	281
	Bone Mineral Density	282
	Biochemical Markers of Bone and Mineral Metabolism in CKD	282
	Treatment of CKD-MBD	284
	Dietary Modification	285
	Outline Placeholder	287
	Nutritional Vitamin D	289
	Calcimimetics	290
	Alternative Dialysis Therapies	291
	Patient Education	291
	Parathyroidectomy	291
	Treatment Options for Adynamic Bone	291
	Summary	292
	Case Presentation	292
	References	293
	Chapter 16: Physical Activity and Exercise	297
	Introduction	297
	Physical Activity, Exercise, and Their Classification	298
	Benefits of Exercise in the General Population	298
	Potential Benefits of Increased Physical Activity Among Patients with CKD	299
	Risks of Physical Activity	304
	Approach to Prescribing and Promoting Physical Activity in the CKD Population	305
	Case Study	308
	Physical Function Evaluation (Fig.  16.4) [ 1 ]	308
	Recommended Activity	310
	Follow-Up Evaluation (6 Months)	310
	Physical Function Testing	310
	References	311
	Part IVNutrition in Chronic Kidney Disease Among Special Needs Populations	314
	Chapter 17: Pregnancy	315
	Background	315
	Confirmation of Pregnancy	316
	Dialysis Regimen	316
	Energy and Protein Needs	317
	Vitamins and Minerals	318
	Weight Gain and Serum Albumin	318
	Medications	319
	Breastfeeding	319
	Summary	319
	Case Study	320
	Questions	321
	References	321
	Chapter 18: Infancy, Childhood, and Adolescence	323
	Introduction	324
	Etiology of CKD*	324
	Treatment Modalities*	324
	Linear Growth	325
	Adequacy of Weight Gain and Nutritional Intake	325
	Assessment	327
	Nutrient Requirements	330
	Energy	331
	Protein	332
	Carbohydrate, Fats, and Lipid Management	333
	Vitamins and Minerals	334
	Sodium	336
	Potassium	337
	Phosphorus and Calcium	338
	Fluid	340
	Age-Related Intervention and Monitoring	340
	Infants and Toddlers (Ages 0–3)	340
	Children (Ages 4–12)	342
	Adolescents* (Ages 13 and Older)	343
	Enteral Nutrition	343
	Oral Supplementation	343
	Tube Feeding	344
	Parenteral Nutrition	346
	Intradialytic Parenteral Nutrition	346
	Intraperitoneal Amino Acid Dialysis*	347
	Transplant	347
	Transition	349
	Summary*	350
	Case Study*	350
	Questions	350
	References	351
	Chapter 19: The Aging Adult	357
	Introduction	357
	Profile of Older American	358
	Marital Status and Living Arrangements	358
	Economic Status	358
	Normal Physiological Changes	358
	Sensory	359
	Skin	359
	Respiratory	359
	Cardiovascular	359
	Gastrointestinal	359
	Musculoskeletal	360
	The Kidneys	360
	Aging and Kidney Function	360
	Aging and CKD Risk Factors	361
	Heightened Risks in Older Adults with CKD	361
	Hypotension	362
	Increased Falls Risk	362
	Vascular Dementia	362
	Protein Energy Wasting	362
	Anemia Management	363
	Bone Disease Management	363
	Geriatric Focus	363
	Barriers to Care	363
	Geriatric Assessment	364
	Summary	365
	Case Study	366
	Questions	366
	References	367
	Chapter 20: Nephrotic Syndrome	369
	Definition of Nephrotic Syndrome	369
	Causes of Nephrotic Syndrome	370
	Complications of Nephrotic Syndrome	371
	Sodium Retention (Edema)	371
	Hypercoagulability (Thrombophilia)	372
	Hyperlipidemia	372
	Progressive Renal Injury	372
	Infection	373
	Nutritional Depletion	373
	Treatment of Nephrotic Syndrome	373
	Specific Treatment	374
	Nonspecific Treatment	374
	Pharmacologic Management	374
	Nutritional Management	375
	Summary	375
	References	376
	Chapter 21: Nephrolithiasis	378
	Introduction	378
	Symptoms and Diagnosis [ 9 ]	379
	Evaluation of New Stones	379
	Evaluation of Recurrent Stones and Follow-up	380
	Stone Formation	380
	Supersaturation (SS) and Stone Formation	380
	Interpretation of Biochemical and Urine Tests	381
	The 24-h Urine Collection	381
	Risk Factors for Kidney Stone	383
	Urine Volume	384
	Hypercalciuria	384
	Hyperoxaluria	385
	Hypocitraturia	385
	pH	386
	Uric Acid	386
	Dietary Factors	387
	Sodium	387
	Potassium	387
	Protein	388
	Calcium	388
	Magnesium	388
	Vitamin C	389
	Other Dietary Factors	389
	Nutrition Assessment and Recommendation	389
	Common Mistakes	389
	Practical Rule of Thumb	389
	General Recommendations	391
	Summary	393
	Case Studies	393
	Case #1 (Table  21.10)	393
	Case #2 (Table  21.11)	394
	References	395
	Part VAdditional Nutritional Considerations in Kidney Disease	397
	Chapter 22: Public Policy and Renal Nutrition Practice: Past, Present, and Future	398
	Public Policy and Renal Nutrition Practice: Past, Present and Future	398
	The Role of Federal and State Governments	399
	Direct Payment to Nutrition and Dietetics Practitioners	399
	The MNT Benefit	400
	What You Can Do to Promote Patient Access to Nutrition Care Provided by RD/Ns	401
	References	401
	Chapter 23: Dietary Supplements	402
	Introduction	402
	Dietary Supplements	403
	Box 23.1 Definition of Dietary Supplement [ 3 ]	403
	Efficacy and Safety of CAM Therapies	403
	Box 23.2 Deciding For or Against the Use of Dietary Supplements	404
	Box 23.3	404
	Dietary Supplements and Kidney Disease	404
	Dietary Supplements with Potential Protective Effects	405
	Dietary Supplements to Avoid in Kidney Disease	405
	Dietary Supplements and Kidney Dysfunction	406
	Considerations for Healthcare Providers	406
	Summary	407
	Resources	407
	References	408
	Chapter 24: Vitamin and Trace Element Needs in Chronic Kidney Disease	409
	Introduction	409
	Vitamin B1: Thiamin	410
	Vitamin B2: Riboflavin	410
	Niacin: Vitamin B3	411
	Vitamin B6: Pyridoxine	412
	Folic Acid	412
	Cyanocobalamin: B12	413
	Homocysteine	413
	Pantothenic Acid	414
	Vitamin C	414
	Fat-Soluble Vitamins	415
	Vitamin A	415
	Vitamin E	416
	Vitamin K	417
	Minerals and Trace Elements	418
	Copper	418
	Molybdenum	418
	Magnesium	419
	Manganese	419
	Selenium	419
	Zinc	420
	Summary	420
	References	421
	Chapter 25: Issues Affecting Dietary Adherence	425
	Introduction	425
	Definitions	425
	Dietary Adherence	426
	Factors Affecting Dietary Adherence	426
	Social and Economic Factors	426
	Health-Care Team and System-Related Factors	427
	Condition-Related Factors	428
	Therapy-Related Factors	428
	Patient-Related Factors	428
	Behavior Change Models	428
	Stages of Change	429
	Strategies for Achieving Dietary Adherence	429
	Summary	431
	References	431
	Chapter 26: Counseling Approaches	432
	Introduction	432
	The Transtheoretical Model	433
	Inquiries and Responding to Patients	434
	Closed-Ended Questions	434
	Leading Questions	435
	Open-Ended Questions	435
	Respond Using Reflective Listening	436
	Social Learning Theory and Self-Efficacy	437
	Behavior Modification and Cognitive Behavioral Therapy	437
	Cognitions	438
	Cognitive Distortions	438
	Cognitive Restructuring	439
	Goal Setting	439
	Motivational Interviewing	440
	Special Considerations for Patients Receiving Hemodialysis	441
	Future Directions	442
	Summary	442
	Case Study	442
	Questions for Case Study	443
	Answers to Case Study	443
	References	444
	Chapter 27: Outcomes Research	446
	Introduction and Overview	446
	Challenges for Nutrition	447
	Outcomes Research Defined	448
	Types of Outcomes	449
	Evidence-Based Practice Guidelines	450
	Practice Guidelines and Patient Care	451
	Dialysis Outcomes and Practice Patterns Study	451
	Summary	452
	References	452
	Chapter 28: Suggested Resources for the Practitioner	455
	Introduction	455
	Evidence-Based Practice Guidelines	455
	NKF KDOQI Practice Guideline Statements	456
	Academy of Nutrition and Dietetics Chronic Kidney Disease (Non-dialysis) Medical Nutrition Therapy Protocol	465
	Diet-Related Resources and Food Lists	467
	Nutrition Composition of Foods	467
	Food Sources of Potassium	467
	Food Sources of Phosphorus	468
	Protein Quality in Foods	468
	Oxalates in Food	470
	Vitamin Recommendations and Supplementation in CKD	470
	Assessment Tools	470
	Internet Sites	476
	Tablet and Smartphone Applications	476
	Summary	478
	References	478
	Index	480