CKD Creatinine clearance - Cockroft- Gault formula (140-age) x body mass (kg) Serum creatinine concentration x 72 Female x coefficient 0.85

How to slow down the progress of CKD Documented efficacy Strict control of glicaemia (DM) Strict control of blood pressure ACE-I, Xartan Non-documented efficacy Reduction of protein in diet Dyslipidaemia treatment Partial correction of anaemia

HA in CKD Target values in treatment of HA in patients with CKD: proteinuria < 1g/d - <130/80mmHg proteinuria > 1g/d - <125/75mmHg

Disturbances in Ca-P balance Stage CKDGFRml/ min/ 1.73m² PTH pg/ml P mmol/l Ca mmol/l 1-2>60normal normal <

Disturbances in Ca-P balance Reduction of P intake in diet Medicines binding P in digestive tract: Calcium carbonicum Aluminium hydroxide (Alusal) Lantan salts Sewelamer (Renagel) Calcimimetics: cinecalcet (selectively stimulates calcium receptor in parathyroid glands)

CKD- diet Products rich in P: offal fish yolk milk and diary products, cheese; sausages, ham; soups (instant) coca cola turkey, duck, meat pastry bean cacao, nuts, chocolade, almonds mushrooms

Disturbances in Ca-P balance Ca X P product > 55 mg/dl (>4.4 mmol/l) Risk factor of: Death because of cardiovascular events Calcifications in soft tissues Recommendations: Reduction of calcium carb. dose Sewelamer Reduction of vit.D dose

CKD - diet 2. Stable period of time (1-3 stage of CKD)  Protein restriction 0.8g/kg/day  P mg/day  Salt intake reduction in case of HA  Energy kcal/kg/d, from carbohydrates and lipids

CKD - diet 3. Non-stable period of time PROTEIN Reduction of intake in order to diminish of urea production; One should reduce it gradually, max to 0.4 g/kg/d; 4 i 5 stage of CKD ( GFR<25 ml/min) 0.6 g/kg/d strict monitoring of nutrition every 1-3 months

CKD - diet Protein must contain essential amino acids Supplementation of keto-analogs of exogenous amino acids (Ketosteril)