Mr. N is a 54-year-old man with a history of hypertension, coronary disease, peripheral vascular disease, gout, dyslipidemia, and chronic kidney disease (CKD) Stage III (MDRD eGFR 35 mL/min) who presents with a 10 kg weight gain over the last 2 months. The patient reports that he has not been very compliant with his diet or exercise program. Gout attacks have been frequent. Physical exam: Height 5′9″; Weight 97 kg, 213 lb; BMI 31. The patient has 7 cm JVD at 30° and 1+ bilateral lower extremity edema. The exam is otherwise unremarkable. Significant labs: creatinine 2.3 mg/dL, triglycerides: 346 mg/dL, serum bicarbonate: 19 mEq/L, potassium: 5.7 mEq/L, phosphorus: 5.5 mg/dL, and PTH: 220 pg/dL. Despite the presence of volume overload, his blood urea nitrogen (BUN) to Cr ratio is 20:1. The patient also has proteinuria (albumin to creatinine ratio: 830 μg/mg).


Cholesterol Zinc Obesity Phosphorus Starch 


  1. 1.
    Bailey JL, Franch H. Nutritional considerations in kidney disease: core curriculum 2010. Am J Kidney Dis. 2010;55(6):1146–61.PubMedCrossRefGoogle Scholar
  2. 2.
    Saab G, Whaley-Connell AT, McCullough PA, Bakris GL. CKD awareness in the United States: the kidney early evaluation. Program (KEEP). Am J Kidney Dis. 2008;52:382–3.PubMedCrossRefGoogle Scholar
  3. 3.
    Fouque D, Kalantar-Zadeh K, Kopple J, et al. A proposed nomenclature and diagnostic criteria for protein-energy wasting in acute and chronic kidney disease. Kidney Int. 2008;73(4):391–8.PubMedCrossRefGoogle Scholar
  4. 4.
    Teta D. Weight loss in obese patients with chronic kidney disease: who and how? J Ren Care. 2010;36 Suppl 1:163–71.PubMedCrossRefGoogle Scholar
  5. 5.
    Navaneethan SD, Yehnert H, Moustarah F, Schreiber MJ, Schauer PR, Beddhu S. Weight loss interventions in chronic kidney disease: a systematic review and meta-analysis. Clin J Am Soc Nephrol. 2009;4(10):1565–74.PubMedCrossRefGoogle Scholar
  6. 6.
    Chanutin A, Ferris EB. Experimental renal insufficiency produced by partial nephrectomy I. Control diet. Arch Intern Med. 1932;49:767–87.CrossRefGoogle Scholar
  7. 7.
    Chanutin A, Ludewig S. Experimental renal insufficiency produced by partial nephrectomy. V. Diets containing whole dried meat. Arch Intern Med. 1936;58:60–80.CrossRefGoogle Scholar
  8. 8.
    Franch HA, Mitch WE. Navigating between the Scylla and Charybdis of prescribing dietary protein for chronic kidney diseases. Annu Rev Nutr. 2009;29:341–64.PubMedCrossRefGoogle Scholar
  9. 9.
    Kontessis P, Jones S, Dodds R, et al. Renal, metabolic and hormonal responses to ingestion of animal and vegetable proteins. Kidney Int. 1990;38:136.PubMedCrossRefGoogle Scholar
  10. 10.
    Kopple JD. National kidney foundation K/DOQI clinical practice guidelines for nutrition in chronic renal failure. Am J Kidney Dis. 2001;37(1 Suppl 2):S66–70.PubMedCrossRefGoogle Scholar
  11. 11.
    Kopple JD. Pathophysiology of protein-energy wasting in chronic renal failure. J Nutr. 1999;129(1S Suppl):247–51.Google Scholar
  12. 12.
    Kaysen GA. Lipid and lipoprotein metabolism in chronic kidney disease. J Ren Nutr. 2009;19(1):73–7.PubMedCrossRefGoogle Scholar
  13. 13.
    Beto JA, Bansal VK. Medical nutrition therapy in chronic kidney failure: integrating clinical practice guidelines. J Am Diet Assoc. 2004;104(3):404–9.PubMedCrossRefGoogle Scholar
  14. 14.
    Axelsson TG, Irving GF, Axelsson J. To eat or not to eat: dietary fat in uremia is the question. Semin Dial. 2010;23(4):383–8.PubMedCrossRefGoogle Scholar
  15. 15.
    O’Seaghdha CM, Hwang SJ, Muntner P, et al. Serum phosphorus predicts incident chronic kidney disease and end-stage renal disease. Nephrol Dial Transplant. 2011;26(9):2885–90. doi: 10.1093/ndt/gfq808.PubMedCrossRefGoogle Scholar
  16. 16.
    Martin KJ, Gonzalez EA. Prevention and control of phosphate retention/hyperphosphatemia in CKD-MBD: what is normal, when to start, and how to treat? Clin J Am Soc Nephrol. 2011;6(2):440–6.PubMedCrossRefGoogle Scholar
  17. 17.
    Eknoyan G, Levin A, Levin NW. Bone metabolism and disease in chronic kidney disease. Am J Kidney Dis. 2003;42 Suppl 3:1–201.CrossRefGoogle Scholar
  18. 18.
    Peacock M. Calcium metabolism in health and disease. Clin J Am Soc Nephrol. 2010;5 Suppl 1:S23–30.PubMedCrossRefGoogle Scholar
  19. 19.
    Krikken JA, Laverman GD, Navis G. Benefits of dietary sodium restriction in the management of chronic kidney disease. Curr Opin Nephrol Hypertens. 2009;18(6):531–8.PubMedCrossRefGoogle Scholar
  20. 20.
    World Health Organization. Reducing salt intake in populations: report of a WHO forum and technical meeting. 2006; Paris, France.Google Scholar
  21. 21.
    Klaus D, Hoyer J, Middeke M. Salt restriction for the prevention of cardiovascular disease. Dtsch Arztebl Int. 2010;107(26):457–62.PubMedGoogle Scholar
  22. 22.
    Palmer BF. A physiologic-based approach to the evaluation of a patient with hyperkalemia. Am J Kidney Dis. 2010;56(2):387–93.PubMedCrossRefGoogle Scholar
  23. 23.
    Korgaonkar S, Tilea A, Gillespie BW, et al. Serum potassium and outcomes in CKD: insights from the RRI-CKD cohort study. Clin J Am Soc Nephrol. 2010;5(5):762–9.PubMedCrossRefGoogle Scholar
  24. 24.
    Spiegel D. Magnesium in chronic kidney disease: unanswered questions. Blood Purif. 2011;31:172–6.PubMedCrossRefGoogle Scholar
  25. 25.
    Lobo JC, Torres JPM, Fouque D, et al. Zinc deficiency in chronic kidney disease: a relationship with adipose tissue and atherosclerosis? Biol Trace Elem Res. 2010;135:16–21.PubMedCrossRefGoogle Scholar
  26. 26.
    Oakes EJ, Lyon TD, Duncan A, et al. Acute inflammatory response does not affect erythrocyte concentrations of copper, zinc and selenium. Clin Nutr. 2008;27:115.PubMedCrossRefGoogle Scholar
  27. 27.
    Hsieh YY, Shen WS, Lee LY, et al. Long-term changes in trace elements in patients undergoing chronic hemodialysis. Biol Trace Elem Res. 2006;109(2): 115–21.PubMedCrossRefGoogle Scholar
  28. 28.
    Handelman GJ, Levin NW. Guidelines for vitamin supplements in chronic kidney disease patients: what is the evidence? J Ren Nutr. 2011;21(1):117–9.PubMedCrossRefGoogle Scholar
  29. 29.
    Fissell RB, Bragg-Gresham JL, Gillespie BW, et al. International variation in vitamin prescription and association with mortality in the dialysis outcomes and practice patterns study (DOPPS). Am J Kidney Dis. 2004;44:293–9.PubMedCrossRefGoogle Scholar
  30. 30.
    Bossola M, Tazza L, Giungi S, et al. Anorexia in hemodialysis patients: an update. Kidney Int. 2006;70:417–22.PubMedGoogle Scholar
  31. 31.
    Akpele L, Bailey JL. Nutrition counseling impacts serum albumin levels. J Ren Nutr. 2004;14:143–8.PubMedCrossRefGoogle Scholar
  32. 32.
    American Heart Association Nutrition Committee, Lichtenstein AH, Appel LJ, et al. Diet and lifestyle recommendations revision 2006: a scientific statement from the American Heart Association Nutrition Committee. Circulation. 2006;114(1):82–96.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  1. 1.HumbleUSA
  2. 2.Renal DivisionAtlanta Veterans Affairs Medical Center and Emory University School of MedicineDecaturUSA

Personalised recommendations