Nutrition in Kidney Disease (Nutrition and Health)

This third edition of this text is organized into seven sections that address the educational needs of dietitians around the world who seek current information about nutritional management of chronic kidney disease (CKD). Part I addresses the differences in the epidemiology of CKD and renal replacement therapy worldwide, such as environmental, ethnic, cultural, political and macroeconomic factors. Part II includes a thorough review of the components of the nutrition assessment, which includes information about psychosocial issues affecting nutritional status in kidney disease and drug-nutrient interactions, and parts III and IV review preventative strategies for common disorders associated with CKD such as hypertension, type 2 diabetes, obesity and cardiovascular disease are provided, and current evidence-based treatment recommendations for the nutrition management of non-dialyzed, dialyzed and transplanted adults are addressed. Part V presents the nutritional concerns of CKD populations with special needs (i.e., pregnancy, infancy, childhood, adolescence and the elderly). The nutrition management of other disorders associated with kidney disease are covered in Part VI; these include protein-energy wasting and the inflammatory response, bone and mineral disorders, nephrotic syndrome, nephrolithiasis, and acute kidney injury. Lastly, Part VII is devoted to cutting-edge research on topics of concern in nutrition in kidney disease such as the gut microbiome including pre- and probiotics, appetite regulation, advanced glycation end products, physical activity and structured exercise, and dietary patterns including plant-based diets. When appropriate, the new clinical practice guidelines in nutrition for individuals with CKD are integrated into the chapters. The third edition of Nutrition in Kidney Disease will be a highly informative resource for nephrologists, nutrition scientists, nutritionists, and researchers and students whose research, practice, and education includes nutrition and kidney disease. Foreword Preface Organization and Content Features Series Editor Page Objectives and Organization of the Volume Part I: Foundations for Clinical Practice and Overview Part II: Components of Nutrition Assessment Part III: Preventative Strategies for Chronic Kidney Disease Among Adults Part IV: Chronic Kidney Disease in Adults Treated By Renal Replacement Therapies Part V: Nutrition in CKD Among Special Needs Populations Part VI: Nutritional Management of Other Disorders that Impact Kidney Function Part VII: Additional Nutritional Considerations in Kidney Disease Conclusions Series Editor Biography About the Volume Editors Acknowledgment Contents Contributors Part I: Foundations for Clinical Practice and Overview Chapter 1: Epidemiology and Changing Demographics of Chronic Kidney Disease in the United States and Abroad Introduction Chronic Kidney Disease The Assessment and Definition of CKD Prevalence International Comparison of CKD Prevalence CKD Prevalence in Subgroups Trends in CKD Prevalence Reasons for International Differences in CKD Prevalence Progression of CKD Renal Replacement Therapy (RRT) RRT Epidemiology Reasons for International Differences in Access to RRT RRT Prognosis and Outcomes Comprehensive Conservative Care Prevention of Important Risk Factors for CKD Conclusion References Chapter 2: History of Dietary Protein Treatment for Non-dialyzed Chronic Kidney Disease Patients Introduction Dietary Protein Intake in CKD from the Late 1800s to 1950s Dietary Protein Intake in CKD in the 1960s and 1970s Essential Amino Acid and Ketoacid-Supplemented Very-Low-Protein Diets The Modification of Diet in Renal Disease (MDRD) Study Variations in Low-Protein Diets Low-Protein Food Products Dietary Protein Therapy in the Present Day Evidence-Based Guidelines and Consensus Statements on Dietary Protein Intake in CKD High-Protein Diets and Kidney Disease Conclusion References Chapter 3: Kidney Function in Health and Disease Introduction Anatomy of the Kidney Renal Corpuscle Proximal Tubule Thin Limb of Henle’s Loop Distal Tubule Collecting Duct Interstitium Blood Supply Clinical Evaluation of Kidney Function Kidney Function in Disease States Fluid, Electrolyte, and Acid-Base Disturbances Acute Kidney Injury Chronic Kidney Disease Nephrotic Syndrome Nephritic Syndrome Tubulointerstitial Diseases Vascular Diseases Diabetic Nephropathy Podocytopathies IgG4-Related Diseases Conclusion References Part II: Components of the Nutritional Assessment Chapter 4: Anthropometric Assessment in Kidney Disease Introduction Anthropometric Techniques Weight and Height Measurements Skinfold and Circumference Measurements Frame Size Reference Data Conclusion References Chapter 5: Biochemical Nutritional Assessment in Chronic Kidney Disease Introduction Biochemical Assessment of Nutritional Status Negative Acute Phase Reactant (APR) Proteins: Serum Albumin, Prealbumin (Transthyretin), and Transferrin Serum Albumin Serum Prealbumin (Transthyretin) Serum Transferrin Positive Acute Phase Reactants (APR): Inflammatory Markers Electrolytes Serum Potassium Metabolic Acidosis Assessment of Nutritional Status Blood Urea Nitrogen and Protein Catabolic Rate Blood Urea Nitrogen Protein Nitrogen Appearance/Protein Catabolic Rate Serum Creatinine, Creatinine Clearance, and Creatinine Index Serum Total Cholesterol Conclusion References Chapter 6: Nutrition-Focused Physical Examination and Assessment in Chronic Kidney Disease History of the Nutrition-Focused Physical Examination The Nutrition-Focused Physical Examination (NFPE) Getting Started with the Nutrition-Focused Physical Examination General Inspection Anthropometric Data and Body Composition Assessment of Fluid Status Skin, Hair, and Nails Eyes Muscle and Fat Wasting Orofacial Examination Head and Face Cranial Nerve (CN) Assessment Trigeminal Nerve (CN V) Facial Nerve (CN VII) Glossopharyngeal Nerve (CN IX) and Vagus Nerve (CN X) Spinal Accessory Nerve (CN XI) Hypoglossal Nerve (CN XII) Examination of the Oral Cavity Oral Manifestations of CKD Taste Changes Periodontal Disease Orofacial Physical Findings Associated with Specific Nutrient Deficiencies Diet Absorption Losses Medications Micronutrients Most Affected in CKD with Observable Physical Findings Vitamin C Thiamin Pyridoxine Folic Acid Physical Findings Related to Micronutrient Deficiencies Conclusion References Chapter 7: Dietary Assessment in Kidney Disease Introduction Purpose and Utility of Dietary Intake Assessment Methodology of Dietary Intake Assessment 24-H Recall Automated Multiple-Pass Method The Automated Self-Administered 24-H Recall (ASA24®) Food Frequency Questionnaire Block FFQ Diet History Questionnaire Willett FFQ FFQ Data Analysis Diet Record or Diary Application of Dietary Intake Assessment to Dietary Guidelines Dietary Intake Assessment of Individuals Dietary Intake Assessment of Groups Evidence Assessment of the 24-H Recall, the AMPM Assessment of the FFQ Use of Biomarkers in Assessing Dietary Intake Doubly Labeled Water and Urine Urea Nitrogen for Assessment of Dietary Energy and Protein Intake Association of Urinary Sodium Levels with Dietary Intake Plasma Ascorbic Acid, Carotenoids, and Vitamin A Levels for Assessing Dietary Intake Association of Serum Uric Acid Levels and Urinary Isoflavones with Dietary Intake Applications to Kidney Disease Settings Acute Kidney Injury Chronic Kidney Disease Nondialysis CKD Small Studies Automated, Multiple-Pass Method FFQ Diet Record Large Cohort and Cross-Sectional Studies Automated, Multiple-Pass Method FFQ Dialysis The FFQ in Dialysis Diet Records in Dialysis Transplantation The FFQ in Kidney Transplantation Diet Records in Kidney Transplantation Recommendations for Kidney Disease References Chapter 8: Psychosocial Issues Affecting Nutritional Status in Kidney Disease Introduction Depression Anxiety Loneliness Food Insecurity Limited Health Literacy Self-Efficacy Social Support Potential Strategies for Mitigating Psychosocial Factors That Negatively Impact Nutrition and Bolstering Those Which Can Help Enhance It Depression Anxiety Loneliness Food Insecurity Limited Health Literacy Self-Efficacy Social Support Conclusion References Chapter 9: Drug-Nutrient Interactions Introduction Types of Interactions Important Drug-Nutrient Interactions Continuous Enteral Nutrition Medication and Food Timing Considerations Renal Disease Considerations Renal Transplant Considerations Herbal Product Considerations Conclusion References Part III: Preventative Strategies for Chronic Kidney Disease Among Adults Chapter 10: Hypertension Introduction Current Dietary Recommendations For Hypertension and Chronic Kidney Disease The Joint National Committee (JNC) and American Heart Association (AHA)/American College of Cardiology (ACC) Recommendations Weight Loss Dietary Interventions Sodium Epidemiological Versus Individual Sodium Assessment: Limitations of Urinary Sodium Dietary Sodium Sources in the Typical American Diet Dietary Sodium Intake Recommendations Dietary Sodium Restriction in CKD Potassium Benefits of Potassium Current Intake Dietary Potassium Recommendations Concerns About Hyperkalemia in CKD Magnesium Calcium Other Nutrients [68] Dietary Patterns DASH Diet Mediterranean Diet Ongoing Research The Gut Microbiota and Blood Pressure Central Blood Pressure Conclusion References Chapter 11: Diabetes Mellitus and Chronic Kidney Disease (Stages 1–5) Introduction Prevalence and Screening Glycemic Control Lipids Blood Pressure Medical Nutrition Therapy (MNT) Weight Management and Energy Needs Estimation Dietary Strategies For Carbohydrate (CHO) Management Quantity Quality Glycemic Index Fiber Carbohydrate Conclusion and Final Recommendations Protein Guidelines for Diabetes and CKD Dietary Fat Recommendations Diet Patterns Alcohol Nutritive and Nonnutritive Sweeteners ESKD and DM Hemodialysis Peritoneal Dialysis Medical Nutrition Therapy on Dialysis Malnutrition and Dialysis Fluid Control Diabetic Gastroparesis MNT Summary Monitoring Glycemic Control Hypoglycemia/Uremia Pharmacological Management of Diabetes Within CKD Antihyperglycemic Agents Sick Day Medication List Insulin Conclusion Case Study Case Questions and Answers References Chapter 12: Implications and Management of Obesity in Kidney Disease Introduction Defining Obesity Measuring Kidney Parameters in Obese Individuals Epidemiology and Trends in Obesity Obesity and Clinical Risk Normal Kidney Function and CKD Stages 1–4 CKD Stage 5D (ESRD) Kidney Transplant Recipients Influence of Obesity on Kidney Function, Structure, and Health Kidney Mass Renal Hemodynamics Proteinuria Histologic Changes Molecular Findings Obesity-Related Glomerulopathy and Glomerulosclerosis Animal Models of Weight Gain and Loss Pathogenesis of Obesity-Related Kidney Disease Intraglomerular Hypertension Podocyte Depletion Nephron Endowment Renin-Angiotensin-Aldosterone Axis Sympathetic Activation Obstructive Sleep Apnea Insulin Resistance and the Metabolic Syndrome Lipotoxicity Fatty Kidney Adipocyte Secretory Products Strategies and Benefits of Weight Reduction Chronic Kidney Disease Stages 1–5 End-Stage Renal Disease (Stage 5D) Kidney Transplant Recipients Conclusion References Chapter 13: Nutritional Management of Cardiovascular Disease Introduction Pathophysiology Lipid Metabolism Other Metabolic Factors Existing Clinical Practice Guidelines and Peer-Reviewed Recommendations Assessment Biochemical Physical Nutritional Intervention Lifestyle Dietary Determination of Nutrition Prescription Amount and Type of Dietary Fat Incorporation of the Type of Carbohydrate, Dietary Fiber, and Plant Sterols Pharmacological Conclusion Case Questions and Answers References Part IV: Chronic Kidney Disease in Adults Treated by Renal Replacement Therapies Chapter 14: CKD Stages 1–5 (Nondialysis) Introduction Quantity vs. Quality Malnutrition in CKD Protein Needs Energy Needs Calculating Nutrient Needs in Underweight and Obese Conditions Micronutrients and Supplements Comorbidities of CKD Diabetes Cardiovascular Disease Hypertension Dyslipidemias Mineral and Bone Disorders Anemia Iron Deficiency ESA Therapy IgA Nephropathy Omega-3 (n-3) Polyunsaturated Fatty Acids Low Antigen Content Diet Self-Management Behavior and Medical Nutrition Therapy Conclusion Case Study Case Questions and Answers References Chapter 15: Maintenance Hemodialysis Introduction Factors Influencing Nutritional Status Inflammation Anorexia Acidosis Fluid Volume Dialysis-Related Losses Hemodialysis Adequacy Nutrient Recommendations Energy Conventional Hemodialysis Nocturnal Hemodialysis/Short Daily Hemodialysis Protein Conventional Hemodialysis Protein Nitrogen Appearance (PNA) or Protein Catabolic Rate (PCR) Nocturnal Hemodialysis/Short Daily Hemodialysis Sodium and Fluid Conventional Hemodialysis Nocturnal Hemodialysis/Short Daily Hemodialysis Potassium Conventional Hemodialysis Nocturnal Hemodialysis/Short Daily Hemodialysis Calcium, Phosphorus, Parathyroid Hormone, and Calcitriol/Vitamin D Analogs Conventional Hemodialysis Calcium Balance Parathyroid Hormone (PTH) and Calcitriol/Vitamin D Analogs Phosphorus Nocturnal Hemodialysis/Short Daily Hemodialysis Lipids Conventional Hemodialysis Nocturnal Hemodialysis/Short Daily Hemodialysis Vitamins, Minerals, and Trace Elements Maintenance Hemodialysis (Conventional, Nocturnal, Short Daily Hemodialysis) Water-Soluble Vitamins Vitamin B-6 Folic Acid Vitamin C Vitamin B-12 Other Water-Soluble Vitamins Fat-Soluble Vitamins Vitamin A Nutritional Vitamin D (Cholecalciferol, Ergocalciferol) Vitamin E Vitamin K Minerals and Trace Elements Aluminum Copper Iron Magnesium Selenium Zinc Conclusion Case Study Case Questions and Answers References Chapter 16: Peritoneal Dialysis Introduction Factors Influencing Nutritional Status PD Adequacy Nutrient Recommendations in Peritoneal Dialysis Energy Protein Protein Nitrogen Appearance in Peritoneal Dialysis Nutrition Support Sodium and Fluid Potassium Calcium/Phosphorus/Vitamin D Lipids Fiber Vitamins, Minerals, and Trace Elements Water-Soluble and Fat-SolubleVitamins Minerals and Trace Elements Conclusion Case Study Case Questions and Answers References Chapter 17: Nutrition Support in Hemodialysis and Peritoneal Dialysis Introduction Targets for Nutrition Support in Hemodialysis and Peritoneal Dialysis Patients Nutrition Counseling Oral and Enteral Nutritional Supplementation Intradialytic Parenteral Nutrition Intraperitoneal Parenteral Nutrition Conclusion Case Study Case Questions and Answers References Chapter 18: Kidney Transplantation Introduction Kidney Transplant Nutrition Pretransplant Phase Pretransplant Obesity Pretransplant Malnutrition Pretransplant Diabetes Peritransplant Phase Induction Therapy Maintenance Therapy Calcineurin Inhibitors Antiproliferative Agents Corticosteroids m-TOR Inhibitors Common Transplant Admission Findings Hypophosphatemia Hyperglycemia Delayed Graft Function Nutrition Requirements Calories and Protein Transplant Admission (First Week) Early Posttransplantation (Weeks 2–8) Late Posttransplantation (>8 Weeks) Carbohydrate and Fat Sodium Vitamins, Minerals, and Trace Elements Common Posttransplant Findings Posttransplant Weight Gain Posttransplant Diabetes Bone Disease Acute Kidney Injury Dehydration CKD Progression Diarrhea Dyslipidemia Cardiovascular Disease Other Important Posttransplant Education Topics Alcohol Consumption Food Safety Herbals Food–Drug Interactions Conclusion Case Study Pretransplant Case Questions and Answers – Pretransplant Peritransplant Case Questions and Answers – Peritransplant Posttransplant Case Questions and Answers– Posttransplant References Part V: Nutrition in Chronic Kidney Disease Among Special Needs Populations Chapter 19: Pregnancy Introduction Confirmation of Pregnancy CKD (Prior to Dialysis) Dialysis Energy and Protein Needs Vitamins and Minerals Weight Gain and Serum Albumin Medications Breastfeeding Conclusion Case Study Case Questions and Answers References Chapter 20: Infancy, Childhood, and Adolescence Introduction Etiology of CKD in Children Treatment Modalities Linear Growth Adequacy of Weight Gain and Nutritional Intake Assessment Nutrient Requirements Energy Protein Carbohydrates, Fats, and Lipid Management Vitamins and Minerals Sodium Potassium Phosphorus and Calcium Fluid Age-Related Intervention and Monitoring Infants and Toddlers (Ages 0–3 Years) Children (Ages 4–12) Adolescents (Ages 13 and Older) Enteral Nutrition Oral Supplementation Tube Feeding Parenteral Nutrition Intradialytic Parenteral Nutrition (IDPN) Transplant Transition Conclusion Case Study Case Questions and Answers References Chapter 21: The Aging Adult and Chronic Kidney Disease Introduction Kidney Senescence: Loss of Glomeruli and Functioning Nephrons Renal Functional Changes Associated with Aging Estimates of Kidney Function Aging and CKD Risk Risk Reduction of CKD and ESRD in the Older Adult Treat and Control Hypertension Treat Hyperlipidemia Diabetes Management Frailty Increased Falls Risk Vascular Dementia Review of Normal Physiological Changes Associated with Aging Nutritional Deficits in the Elderly Medical Nutrition Therapy for the Older Adults with Chronic Kidney Disease Renal Replacement Therapy Conclusion Case Study Case Questions and Answers References Part VI: Nutritional Management of Other Disorders that Impact Kidney Function Chapter 22: Protein-Energy Wasting/Malnutrition and the Inflammatory Response Introduction Interrelation Between Nutritional Disturbances and Inflammation in CKD Causes of Inflammation in CKD Gut Microbiota in CKD: The Crosstalk Between Nutrition and Inflammation Proinflammatory Dietary Pattern: Another Factor Exacerbating Uremic Inflammation Food as Medicine: Using Food as a Therapeutic Approach to Control Inflammation Low-Protein Diet to Nondialyzed CKD Patients Higher Intake of Fruits, Vegetables, Whole Grains, Beans, Nuts, Prebiotics, and Probiotics Polyunsaturated Fatty Acid Supplementation Energy and Protein Supplementation to Reverse PEW Conclusion References Chapter 23: Bone and Mineral Disorders Introduction Pathogenesis of Bone and Mineral Abnormalities in CKD Bone Manifestations Bone Biopsy Radiography, Pulse Pressure, and Electron Beam Computed Tomography Bone Mineral Density Biochemical Markers of Bone and Mineral Metabolism in CKD Treatmentof CKD-MBD Dietary Modification Pharmacologic Treatments Phosphate Binders Vitamin D and Analogs Nutritional Vitamin D Calcimimetics Alternative Dialysis Therapies Patient Education Parathyroidectomy (PTX) Treatment Options for Adynamic Bone Conclusion Case Study Case Question and Answer References Chapter 24: Nephrotic Syndrome Introduction Definition of Nephrotic Syndrome Causes of Nephrotic Syndrome Complications of Nephrotic Syndrome Sodium Retention (Edema) Hypercoagulability (Thrombophilia) Hyperlipidemia Progressive Renal Injury Infection Nutritional Depletion Treatment of Nephrotic Syndrome Specific Treatment Nonspecific Treatment Pharmacologic Management Nutritional Management Conclusion References Chapter 25: Nephrolithiasis Introduction Pathophysiology Supersaturation and Stone Formation Symptoms and Diagnosis Symptoms Diagnosis Imaging 24-hour Urine Test and Interpretation Adequacy of Urine Sample Interpretation of 24-hour Urine Collection Risk Factors Genetic Risk Factors Environmental Risk Factors Dietary Risk Factors Fluid Intake Calcium Oxalate Sodium Protein and Uric Acid Stones Potassium Magnesium Phytates Vitamin and Herbal Supplements Types of Stones and Treatment Urologic Management of Stones: Surgical Removal of Stones Medical and Dietary Interventions of Various Types of Kidney Stones General Nutrition Assessment Calcium Stones: Calcium Oxalate and Calcium Phosphate Stones Calcium Oxalate Stones Medical Management Nutritional Management Fluid Dietary and Supplemental Calcium Intake Dietary Sodium Dietary Oxalate Acid-Forming Foods or Animal Protein Calcium Phosphate Stones Uric Acid Stones Medical Management Nutritional Management Cystine Stones Medical Management Nutritional Management Struvite/Staghorn Calculi Nutritional Management Special Considerations Diabetes Mellitus Hypertension Cardiovascular Disease Chronic Kidney Disease Gastrointestinal Disease–Related Medical Conditions, Gastric Bypass Surgery, and Kidney Stones Gastrointestinal Disease Bariatric Surgery Conclusion Practical Rules of Thumb Acknowledgement Case Studies Case 1 Case Questions and Answers Case 2 Case Questions and Answers References Chapter 26: Acute Kidney Injury Function of the Kidneys Acute Kidney Injury Renal Replacement Therapy Nutrition Management of the AKI Patient Nutrition Assessment Oral Intake and Supplements Specialized Nutrition Support Tube-Feeding Formulas Tube-Feeding Management Guidelines for Administration Parenteral Nutrition Support Use of Parenteral Nutrition Nutrient Substrates Protein Carbohydrate Fat Parenteral Additives Fluid and Electrolytes Vitamins and Trace Minerals Initiation and Monitoring of Parenteral Nutrition Support Discontinuing Parenteral Nutrition Monitoring Clinical and Laboratory Parameters Nutritional Requirements in AKI Energy Requirements Protein Requirements Fat Requirements Vitamins and Trace Elements Fluid, Electrolytes, and Mineral Needs Conclusion Case Study Case Questions and Answers References Part VII: Additional Nutritional Considerations in Kidney Disease Chapter 27: The Gut Microbiome Introduction Gut Microbiota in CKD Probiotics Prebiotics Synbiotics Diet Composition Conclusion References Chapter 28: Appetite Regulation Introduction Role of the Central Nervous System Role of the Gastrointestinal System Gastric Signaling Ghrelin Intestinal Signaling Upper Intestinal Signaling Cholecystokinin (CCK) Lower Intestinal Signaling Glucagon-Like Peptide-1 (GLP-1) Oxyntomodulin Peptide PYY Pancreas Signaling Pancreatic Polypeptide Amylin Insulin Role of Ingested Food-Derived Metabolites Metabolites Derived from Protein Metabolism Metabolites Derived from Fatty Acid Metabolism Metabolites Derived from Carbohydrate Metabolism Role of Adipose Tissue Leptin Nesfatin-1 Role of Inflammation Behavioral and Environmental Factors Appetite Regulation in Chronic Kidney Disease Taste and Olfactory Function Alterations and Modifications of Eating Preferences Altered Central Regulation of Appetite Altered Levels of Circulating Molecules Known to Mediate Appetite Leptin Ghrelin Others Visfatin GLP-1 CCK FGF-21 Inflammation Altered Amino Acid Profile Conclusion References Chapter 29: Advanced Glycation End Products Introduction What Are Advanced Glycation End Products (AGEs) and How Do They Cause Disease? Evidence Linking AGEs and Kidney Disease In Vitro Studies Animal Studies Human Data Effects of Acute Oral AGE Loads Observational Studies Clinical Trials with Dietary AGE Restriction CKD Patients Without Diabetes Patients with Diabetes without CKD An Oral AGE Binder in CKD Patients with Diabetes Healthy Subjects and Patients with the Metabolic Syndrome How Does a Low-AGE Diet Work? How to Implement and Recommend a Low-AGE Diet Conclusion References Chapter 30: Physical Activity and Exercise in Chronic Kidney Disease Introduction Benefits of Exercise Guidelines and Special Considerations for Exercise in CKD Assessing Outcomes from Exercise Interventions Benefits of Exercise in CKD and End-Stage Kidney Disease (ESKD) Endurance Exercise in CKD and Its Benefits Endurance Exercise, Aerobic Capacity, and Physical Function Endurance Exercise and Markers of Cardiovascular Function and Risk Endurance Exercise and QOL Resistance Exercise in CKD and Its Benefits Studies Combining Endurance and Resistance Training Studies Combining Exercise and Nutritional Supplementation Other Exercise Strategies Balance Training HIIT and SIT Exercise for Weight Loss for Transplant Promoters and Inhibitors of Involvement in Exercise Deficiencies in the Literature Conclusion and Future Directions Case Study Case Questions and Answers References Chapter 31: Dietary Patterns Introduction What Is a Dietary Pattern? Dietary Patterns and Incident CKD (Free from CKD Populations) CKD Incidence and the DASH Diet CKD Incidence and the Mediterranean Diet CKD Incidence and Vegetarian/Plant-Based Diets CKD Incidence and Diets Consistent with the Dietary Guidelines for Americans Dietary Patterns in Established CKD Populations CKD Outcomes and the DASH Diet CKD Outcomes and the Mediterranean Diet CKD Outcomes and Plant-Based/Vegetarian Diets CKD Outcomes and Diets Consistent with Dietary Guidelines Should the Renal Diet Be Liberalized in Line with a Healthy Dietary Pattern? The Food Group Synergy of Healthy Dietary Patterns Healthy Dietary Patterns Promote a Higher Intake of Fruits and Vegetables Healthy Dietary Patterns Promote Complex Carbohydrates That Are Higher in Dietary Fiber Healthy Dietary Patterns Promote Lower Intake of Red and Processed Meat and Have Higher Plant-Animal Protein Ratios Healthy Dietary Patterns Promote Healthy Fats, Eggs, and Low-Fat Dairy Healthy Dietary Patterns Are Inherently Lower in Sodium Healthy Dietary Patterns Are Abundant Sources of Polyphenols, Which May Reduce Cardiovascular Risks for CKD Progression Safety Profile of a Plant-Based Dietary Pattern in the Kidney Disease Population Conclusion References Chapter 32: Herbal and Other Natural Dietary Supplements Introduction Dietary Supplements Efficacy and Safety of Dietary Supplements Dietary Supplements and Kidney Disease Dietary Supplements with Potential Protective Effects Dietary Supplements to Avoid in Kidney Disease Dietary Supplements and Kidney Dysfunction Considerations for Healthcare Providers Conclusion Resources References Chapter 33: Vitamin and Trace Element Needs in Chronic Kidney Disease Introduction Vitamin B1: Thiamin Vitamin B2: Riboflavin Niacin: Vitamin B3 Vitamin B6: Pyridoxine Folate Cyanocobalamin: B12 Homocysteine Pantothenic Acid Vitamin C Fat-Soluble Vitamins Vitamin A Vitamin E Vitamin K Minerals and Trace Elements Copper Molybdenum Magnesium Manganese Selenium Zinc Conclusion References Chapter 34: Factors Affecting Dietary Adherence and Strategies for Improving Adherence in Chronic Kidney Disease Introduction Definitions Dietary Adherence Factors Affecting Dietary Adherence Social and Economic Factors Psychological Factors Health-Care Team and System-Related Factors Condition-Related Factors Therapy-Related Factors Patient-Related Factors Strategies for Achieving Dietary Adherence Use of Technology in Monitoring Dietary Adherence Conclusion References Chapter 35: Effective Communication and Counseling Approaches Introduction The Transtheoretical Model Inquiries and Responding to Patients Closed-Ended Questions Leading Questions Open-Ended Questions Respond Using Reflective Listening Social Learning Theory and Self-Efficacy Behavior Modification and Cognitive Behavioral Therapy (CBT) Cognitions Cognitive Distortions Cognitive Restructuring Goal Setting Motivational Interviewing Special Considerations for Patients Receiving Hemodialysis Future Directions Conclusion Case Study Case Questions and Answers References Chapter 36: Comparative Effectiveness Research and Renal Nutrition Introduction Challenges for Nutrition Outcomes Research Defined Types of Outcomes Evidence-Based Practice Guidelines Implementation Science: Practice Guidelines and Patient Care Conclusion References Chapter 37: Suggested Resources for the Practitioner Introduction Evidence-Based Practice Guidelines Academy of Nutrition and Dietetics Evidence Analysis Library (EAL) KDOQI Clinical Practice Guidelines KDOQI Clinical Practice Guideline for Nutrition in CKD: 2020 Update KDIGO Clinical Practice Guidelines Diet-Related Resources and Food Lists Nutrient Composition of Foods Food Sources of Potassium Food Sources of Phosphorus Protein Quality in Foods Oxalates in Food Vitamin Recommendations and Supplementation in CKD Assessment Tools Internet Sites Mobile Apps Conclusion References Index This third edition of this text is organized into seven sections that address the educational needs of dietitians and other health care professionals around the world who seek current information about nutritional management of chronic kidney disease (CKD). Part I addresses the differences in the epidemiology of CKD and renal replacement therapy worldwide, such as environmental, ethnic, cultural, political and macroeconomic factors. Part II includes a thorough review of the components of the nutrition assessment, which includes information about psychosocial issues affecting nutritional status in kidney disease and drug-nutrient interactions, and parts III and IV review preventative strategies for common disorders associated with CKD such as hypertension, type 2 diabetes, obesity and cardiovascular disease, and current evidence-based treatment recommendations for the nutrition management of non-dialyzed, dialyzed and transplanted adults are addressed. Part V presents the nutritional concerns of CKD populations with special needs (i.e., pregnancy, infancy, childhood, adolescence and the elderly). The nutrition management of other disorders associated with kidney disease are covered in Part VI; these include protein-energy wasting and the inflammatory response, bone and mineral disorders, nephrotic syndrome, nephrolithiasis, and acute kidney injury. Lastly, Part VII is devoted to cutting-edge research on topics of concern in nutrition in kidney disease such as the gut microbiome including pre- and probiotics, appetite regulation, advanced glycation end products, physical activity and structured exercise, and dietary patterns including plant-based diets. When appropriate, the new clinical practice guidelines in nutrition for individuals with CKD are integrated into the chapters. The third edition of Nutrition in Kidney Disease will be a highly informative resource for nephrologists, nutrition scientists, nutritionists, and researchers and students whose research, pract ice, and education includes nutrition and kidney disease