Question

Case Scenario Juan is a 67 year old male with chronic kidney disease (CKD) stage 4 secondary to hypertension, which was undiagnosed for many years since he had not had regular checks with a medical provider. Family history includes father who died of stroke, and mother with type 2 diabetes currently on oral meds. He was referred for Medical Nutrition Therapy by his nephrologist who has seen him twice so far. The MNT service was approved for coverage based on Medicare guidelines. Patient is married with 1 adult child and 2 grandchildren in the home. Wife prepares most meals, traditional Mexican cuisine and he takes a prepared lunch when on the job as a construction worker. He is struggling to complete his tasks at work due to fatigue. He has not noticed a change in appetite, although some foods don't taste as good. Although he has some missing teeth, he reports that this does not affect his choice of foods or ability to eat. He does experience constipation more frequently. His diet is low in fiber and he indicates that he is more inactive or sedentary now then what just a year ago. Although he had not been accustomed to taking medications, his list now includes a diuretic, anti- hypertensives, statin, and sodium bicarbonate. He says he was advised by his primary care physician to decrease salt in his diet but his wife has struggled to adjust her cooking to restrict use of salt.

Which five micronutrients are of greatest concern in CKD? List each of these five nutrients in order of importance (greatest to least) along with the specify condition(s) of deficiency or potential toxicity concern that needs to be addressed.

Answer 1

Several micronutrients intake important for CKD and vitamin c, E, d, cobalamin, folate, magnesium, and potassium when it decrease there will be the risk of CKD.
Vitamin c:
It is a water-soluble vitamin, It absorbs the iron, repair the RBC, bone and other tissue and keeps the immune system healthy. Per day 60to100mg of vitamin c important for CKD patients including dialysis and nondialysis. high vitamin C supplements harm the digestive system and form kidney stones. source of vitamin c includes orange, lemon, kiwi, grapefruit, guava, papaya, broccoli, Brussel sprouts it helps for CKD patients to avoiding kidney complications.
vitamin E :
It is a fat-soluble vitamin. CKD patient needs 8 to 10mg per day to maintain kidney function, souces include spinach, broccoli, peanut, almonds, nuts, etc. It helps to protect cells from damage and lower the risk of health problems and reduce blood pressure. Vitamin E toxicity causes diarrhea, nausea, high bleeding, fatigue, etc.
Vitamin D:
It helps for CKD patients to lower the PTH production, improve calcium and phosphorus level. sources include salmon, tuna, sardine, and cod. vitamin D deficiency cause kidney disease, liver disease, and GI problems. vitamin D toxicity includes extraosseous calcification. the maximum intake of vitamin D for CKD patients is 50mcg for normal kidney function.
Cobalamin:
Vitamin B12 or cobalamin is a water-soluble vitamin for RBC formation and healthy nerve tissue and protein and tissue synthesis. B12 deficiency causes anemia and nerve damage. source of vitamin b12 includes egg, milk, poultry, meat, and fish. toxicity of vitamin B12 includes diarrhea, itching, peripheral vascular thrombosis, etc. and high risk for CKD and ESRD. The recommended dosage of cobalamin is 1.0mg/day for CKD patients.
Folate:
It is important for cell growth and metabolism. legumes, asparagus, eggs, leafy greens, been, broccoli, brussels sprouts rich in folate. it helps in the production of protein and RBC. 5mg/day for CKD patient recommended. toxicity of folate include nerve damage and reduce homocysteine levels.
Magnesium:
It helps for CKD patients to lower the risk of vascular calcification. high magnesium causes muscle weakness. sources of magnesium include leafy vegetables, nut, seed, whole grains, etc. intake of magnesium can low the development of vascular calcification in CKD.
Potassium:
It is helpful for maintaining blood pressure, maintaining acid, and base levels and counteract the level of sodium. potassium deficiency causes fatigue, cramping, and muscle weakness. source of potassium includes papaya, orange, banana, apricot, dry fruits, grapefruits, etc. per day 3.5 to 5mEq/l needed. healthy kidney removes excess potassium and helps maintain normal potassium levels. high potassium cause CKD.CKD patients should limit potassium intake to avoid complications.