Chronic Renal Disease

Chronic Renal Disease

Chronic renal disease also known as chronic kidney disease is a marked by gradual loss of kidney function. Kidneys play a critical role in filtering waste and unnecessary fluid from the blood. Often the early stages of renal disease reveal a few symptoms. However, in its advanced stage, high levels of fluid, waste, and electrolytes build up in the body show significant kidney failure (Piccoli et al., 2016). Sometimes, end-stage renal disease (ESRD) comes with other complications, including high blood pressure, nerve damage, anemia, weak bones, and poor nutritional health (Piccoli et al., 2016). Patients diagnosed with renal disease often experience emotional and psychological distress since it is a life-long condition. With advanced or ESRD, patients may become weak and lose the ability to function independently (Garneata et al., 2016). Family members are left to offer support, and they can also feel overwhelmed and stressed. The disease may also result in a massive financial ‘burden’ for the family because of the continuous treatment, medications, as well as the diet required for the patient. It is essential to explore existing evidence on how diet can help the patient and families improve the survival rate of a patient at an early or advanced stage of renal disease.

Picot Question: In patients with chronic renal disease does eating a renal diet compared to not eating a renal diet impact survival time within 10 years of diagnosis.

Garneata, L., Stancu, A., Dragomir, D., Stefan, G., & Mircescu, G. (2016). Ketoanalogue-supplemented vegetarian very low–protein diet and CKD progression. Journal of the American Society of Nephrology, 27(7), 2164-2176.

The article explores the importance of ketoanalogue-supplemented vegetarian very low-protein diet (VLPD) for patients with renal disease compared to the traditional low-protein diet (LPD). Given that LPDs diets have always been recommended for patients with kidney disease (KD), the study aims to see the effectiveness of vegetarian VLPD in promoting outcomes for patients. The study found that VLPDs provide relatively lower risk in patients and encourages a protein intake lower than 0.6g for optimal benefits.

The article conducted a randomized controlled trial that enables the researchers to collect data before and after the intervention. The process allowed the researchers to have a definite conclusion of the findings after comparing traditional LPD and vegetarian VLPD. The authors also articulated the information and data in an easy and understandable manner. The only limitation of the study is that a small sample was used, and this can make it difficult to generalize the findings to a larger population.

The article provides useful information that will support the EBP project. The article shows the importance of an effective renal diet in promoting the health outcomes of patients with kidney disease. It helps provide evidence-based findings of renal diets in promoting survival rates for patients with kidney disease.

Ko, G. J., Obi, Y., Tortoricci, A. R., & Kalantar-Zadeh, K. (2017). Dietary protein intake and chronic kidney disease. Current opinion in clinical nutrition and metabolic care, 20(1), 77.

The authors show that a high protein diet quickens the progression of renal disease, but a low protein diet (LPD) provides many clinical benefits for patients with renal disease. High protein diets increase intraglomerular pressure that lowers the filtration ability of the kidneys that causes high protein waste. Gradually, renal function declines because of glomerular damage caused by diets high in protein. The article recommends that people at an early stage of renal disease and those at end-stage renal failure (ESRD) should avoid protein sources such as red meat and consider low amounts of proteins such as poultry and fish.

The article clearly articulates and analyses previous evidence-based research on the effects of a high protein diet on renal disease. Through various subheadings, the information is easy to read and comprehend. Another strength of the study is that the authors also used recent sources and findings of renal disease and protein diets. The limitation of the study is that the authors did not conduct their own study to compare with existing research.

The study provides a comprehensive analysis of a protein diet in patients with kidney disease. It provides useful information that emphasizes the importance of a renal diet to promote survival rate for patients with KD. Given that all the information and data are from peer-reviewed sources, it will promote the EBP project in regard to renal disease and diet.

Mc Causland, F. R., Waikar, S. S., & Brunelli, S. M. (2012). Increased dietary sodium is independently associated with greater mortality among prevalent hemodialysis patients. Kidney international, 82(2), 204-211.

The authors state that increased sodium intake is independently linked to high risk of death and significantly higher ultrafiltration (UF) requirements. However, sodium intake does not have an independent link with pre-dialysis systolic blood pressure (SBP). Among patients undergoing hemodialysis, the article recommends restriction or reduction of dietary sodium. Increase sodium intake is associated with a higher rate of mortality among those with kidney problems.

One strength of the study is that a posthoc analysis was conducted to identify gaps in the study design. The study allowed the researchers to examine the contrasting views that sodium intake does or does not lead to an increase in mortality. Another strength identified is that the article explored previous studies and outcomes of sodium intake among people facing kidney failure. The limitation of the study is that the sample was predominantly black, which makes it difficult to generalize the results to all races and ethnicities.

The article is useful in providing evidence on the effect of sodium for people with renal problems. The study offers evidence-based research that supports its findings, and this will be used in the EBP project. More research needs to be conducted to have a better understanding of the effects of dietary sodium when dealing with renal disease.

Iseki, K., & Yamagata, K. (2016). A practical approach of salt and protein restriction for CKD patients in Japan. BMC nephrology, 17(1), 87.

The article asserts that for patients with progressive renal disease, salt, and protein restriction is vital to promoting chances of patient survival. The authors offer a manual dietician practice guide for patients. When it comes to salt, patients should practice low salt seasoning, processed food without salt, and cooking without salt. For protein, patients should try to limit all forms of proteins, consider vegetable proteins which have lower amino acids, protein intake should be below 60 g/day, and lipid intake should not go beyond 25% of the whole energy intake.

The article is effective in articulating the specific diet recommendations for salt and proteins. The study provides step-by-step guidelines that patients can use in daily life to maintain a safe diet when diagnosed with renal disease. The other strength of the article is that it provides images and tables of the required dietary intake for patients. The limitation identified is that the research is that it fails to conduct a study to find evidence that supports the data. However, it overcomes this by citing peer-reviewed sources.

The article will be used in the EBP project because it illustrates effective dietary plans for patients with progressive kidney failure. The specific nutritional requirements make it easier to understand how diet can promote health outcomes for patients. Given that it is backed by evidence-based research, it will be essential in the EBP project.

Piccoli, G. B., Nazha, M., Capizzi, I., Vigotti, F. N., Mongilardi, E., Bilocati, M., … & Versino, E. (2016). Patient survival and costs on moderately restricted low-protein diets in advanced CKD: equivalent survival at lower costs?. Nutrients, 8(12), 758.

The article explores the survival of dialysis-free patients on moderately restricted LPDs as opposed to VLPDs on patients with severe or progressive renal disease. The main finding from the research shows dialysis-free patients have equal or lower mortality rate compared to those on VLPDs. The survival rate was exceptionally high among younger patients.  The authors suggested that further studies would be needed to find more conclusive findings.

The strength of the study lies in the fact that the researchers followed patients using moderately restricted LPDs for a year. The researchers provided the food that the participants were consuming. The study ensured that dialysis was started based on clinical data that was regularly monitored and the symptoms of the patient. Another strength is that the researchers obtained informed consent from the participants before the start of the study. However, a limitation of the study is that the researchers did not incorporate different LPDs and various diet systems that would determine if all LPD diets are effective.

The study will be useful in the EBP project because it provides essential information about LPDs. It helps creates a compelling case that compares LPDs, which are most commonly easier for patients to follow compared to VLPDs. These differences in these diets will feature in the EBP project with the strengths and weaknesses of each of them.

Conclusion

Chronic renal disease is a condition where the kidneys fail to filter waste effectively. The disease can be distressing to patients and families because it is a life-long condition. It is, however, evident that health outcomes for patients can be achieved by observing a renal diet. Extensive research support limiting protein and sodium intake to increase the chances of survival.

References

Garneata, L., Stancu, A., Dragomir, D., Stefan, G., & Mircescu, G. (2016). Ketoanalogue-supplemented vegetarian very low–protein diet and CKD progression. Journal of the American Society of Nephrology, 27(7), 2164-2176.

Iseki, K., & Yamagata, K. (2016). A practical approach of salt and protein restriction for CKD patients in Japan. BMC nephrology, 17(1), 87.

Ko, G. J., Obi, Y., Tortoricci, A. R., & Kalantar-Zadeh, K. (2017). Dietary protein intake and chronic kidney disease. Current opinion in clinical nutrition and metabolic care, 20(1), 77.

Mc Causland, F. R., Waikar, S. S., & Brunelli, S. M. (2012). Increased dietary sodium is independently associated with greater mortality among prevalent hemodialysis patients. Kidney international, 82(2), 204-211.

Piccoli, G. B., Nazha, M., Capizzi, I., Vigotti, F. N., Mongilardi, E., Bilocati, M., … & Versino, E. (2016). Patient survival and costs on moderately restricted low-protein diets in advanced CKD: equivalent survival at lower costs?. Nutrients, 8(12), 758.