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The difference between groups has been 7Department of Pediatric diabetes queensland healthy shopping generic glucotrol xl 10 mg overnight delivery, Medical Institute diabetes prevention quiz order glucotrol xl 10mg line, M diabetes eye exam 10mg glucotrol xl. Anophthalmia and microphthalmia (A/M) are common birth defects that are Introduction: Etiology of hearing impairment is very heterogeneous diabetes levels in dogs order cheapest glucotrol xl and glucotrol xl. In 206 patients, we have also carried out analyses of nally inherited, frameshift mutation, c. Homozygous and compound heterozygous velopmental glaucoma that had no extraocular anomalies (Khan et al. Pro the gene is expressed in corneal epithelium and is secreted to the extracel portion of the subjects without having any pathogenic allele, reached 61%. Asp171Asn) in wolframin gene, in a patient presenting Low-Frequency Hearing Loss A. A novel mutation, healthy controls with respect to the distributions and numbers of genotypes c. Functional characterization will be performed in order sociated with susceptibility to disease. Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Kurtz10, J. The majority of these cases (70 %) are non-syndromic, about 2 % of 5 Descartes, Paris, France, Laboratoire de biochimie et genetique moleculaire, Hopital these are X-linked. This hearing loss is often progressive, with temporal bone abnorma Hopital Purpan, Toulouse, France, 9Medecine et d’endocrinologie, Hopital du Cluzeau, lities and stapes fixation. W325R) and in a fourth patient an al defined by the association of anosmia and hypogonadotropic hypogonadism ready known missense mutation c. Recent advances in molecular genetics have allowed the determination of the genetic cause of non-syndromic hearing loss, but a large percentage of patients still remain with unidentified cause. It points an imminent need for new methodological strategies for the detection of an increased number of P03. Ploski3; the contribution of selected changes in the etiology of deafness in Brazil. We 1The Institute if Phisiology and Pathology of Hearing, Warsaw, Poland, 2Department of analyzed a group of 45 individuals with non-syndromic hearing loss that Histology and Embryology, Medical University of Warsaw, Warsaw, Poland, 3Department were previously screened for mutations in main deafness genes, and that of Medical Genetics, Medical University in Warsaw, Warsaw, Poland. The cause of hearing loss can be ge were identified two mutations in heterozygous, p. R301Q mutation was found in ho of more than 40 genes involved in pathogenesis of nonsyndromic hearing mozygous, explaining the etiology of deafness, and the p. Sartorato: inheritance, we performed linkage analysis using Affy 10K chip and exome None. Ploski3; tified particularly in exon 8, this domain seems to have a crucial function in 1The Institute of Physiology and Pathology of Hearing, Warsaw, Poland, 2Department of the cochlea. Histology and Embryology, Medical University of Warsaw, Warsaw, Poland, 3Department of Medical Genetics, Medical University in Warsaw, Warsaw, Poland. Danilenko; 1Institute of Genetics and Cytology, National Academy of Sciences, Minsk, Belarus, the hearing process. According to our previous data, the carrier rate of 35delG in ferentially affecting the low frequencies without significant influence on the Belarus is twice higher than European average (5. The results obtained are necessary Association of Mitochondrial Uncoupling Protein Gene 2 with for further genetic testing of Belarus patients with non-syndromal hearing Congenital Sensorineural Hearing Loss in Pediatric Patients loss. In the affected siblings of the index family, the intronic mutati gnificant association with congenital sensorineural hearing loss patients. Insertion homozygote genotype and I allele were found higher in mutations in non-coding regions of “optic atrophy plus” patients. Collins3; 1Department of Medical Genetics, University of Antwerp, Antwerp, Belgium, 2Department Material and Methods: Patient fibroblasts harbouring the c. Institut Jacques Monod, Equipe Genetique et Genomique du Developpement Gonadique, Arts7, A. Florentin-Arar: Conclusion: Here we report on compound heterozygosity or homozygosity None. With 1Institute of Human Genetics, Rambam Health Care Campus, Haifa, Israel, the Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel, 3Faculty of Social the reported allele-specific sensory neuronal expression, the brain receives Welfare and Health Sciences, University of Haifa, Haifa, Israel. A “barcode” of missense and nonsense variants thus underlies a isolated microphthamia/anophthalmia in nine affected individuals. This gene seems One auxiliary gene variation appears to affect sensitivity to a specific odo to be the key enzyme in the formation of a retinoic acid gradient along the rant, suggesting a novel odorant processing mechanism. These efforts now dorso-ventral axis during the early eye development and also in the deve also assist in an on-going whole exome sequencing study of 66 Jewish fami lopment of the olfactory system. Analyzing the Val71Met mutation using Mutation Taster online predicts lar basis of general olfactory sensitivity. The effect of the missense mutation on the enzymatic activity was studied in vitro but results T. In summary, we re port on nine affected individuals from consanguineous kindred, bearing a P03. Genetic analysis of insensitivity to pain in hunting dogs: a model for Otosclerosis is a frequent cause of hearing impairment in the Caucasian po human sensory neuropathies pulation characterized by abnormal resorption and deposition of the bone J. Since only a few genes responsible for human homologous power and for which association was robustly replicated in previous studies neuropathies have been identified, we took advantage of the dog model to with several independent populations, this seems very unlikely. We are thoroughly investigating this locus through a capture sequencing strategy since, interestingly, it contains candidate genes P03. Poliakov; the aim of our study was to investigate the genetic variation of 16 genes Research Center for Medical Genetics, Moscow, Russian Federation. In the first control group (882 individuals) the allele frequency of G863A, Results and conclusion: Preliminary analysis showed differences (p<0, 05) A1038V and G1961E were 0. That support the hypothesis that polymorphism in genes involved in diffe Heterozygous carrier frequency of G863A is high in Europe (1:18 in Nort rent pathways could be associated with increased susceptibility to develop hern Europe), but it is significantly lower in Russia (1:294). Coppieters; 1 2 copy number variants in fibromyalgia suggest a role for the central Center for Medical Genetics Ghent, Ghent University, Ghent, Belgium, Biogazelle, Ghent, Belgium, 3Department of Ophthalmology, Ghent University Hospital, Ghent, Belgium. Purpose: Genetic testing of Stargardt disease, a frequent retinal dystrophy, Vidal4, 5, J. The aim of this study was to elucidate genetic susceptibility factors of 99% of previously identified variants. This chip was used to analyse aniridia patients with deletion current were found at the heterozygous state for both mutants. Erginel-Unaltuna; We describe the case of a girl that was born to nonconsanguineous parents Institute for Experimental Medical Research, Department of Genetics, Istanbul, Turkey. At birth was factors that plays an important role in the regulation of many physiologi diagnosed subaortic Perimembranous Ventricular Septal Defect, so therapy cal processes. She had also left renal and both were shown to be important for cardiovascular diseases like athe pielectasy. In a family abnormalities in heart rhythm (paroxysmal supraventricu scription factor, this study offers a potential therapeutic treatment for the lar tachycardia) was also described in literature. Extensive studies carried out in patients with congenital cardiac defects demonstrated the involvement of this gene in the development of cardiac N. There were no significant differences in occurrence of additional car differentiation. By combination of the six genetic hypoplasia of the B-segment, as opposed to only 55% and 64% of hearts factors, the odds ratio has risen to 4. Here we present the first reported homozygous smoothened diphosphonates has been used with good results. The suspected dactyly and skin syndactyly of the second and third toes of both feet. Echocardiography revealed calcifications in aorta and A novel homozygous missense mutation p. Functional studies in fibroblasts of ve calcifications until the iliac arteries with low flow in renal arteries. Actually, agonist purmorphamine, these results, together with the previously descri patient is 6 and asymptomatic.

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Puiu1; 1University of Medicine &Pharmacy blood sugar level after eating purchase genuine glucotrol xl on-line, Timisoara diabetes insipidus webmd purchase glucotrol xl from india, Roumania diabetes diagnosis a1c 10mg glucotrol xl with amex, Timisoara uncontrolled diabetes signs and symptoms 10mg glucotrol xl fast delivery, Romania, S. Imagistic evaluation was made by cra nial ultrasound for infants under 18 months. The sleep study sho activated receptor gamma and liver X receptor beta gene expression E. Cerebral and cervical Schwarzman; 1National Research Centre „Kurchatov Institute“ B. Arghirescu: are important during the early development of atherosclerotic plaques. The goal of the present study was to assess the presence of extensively investigated. Abnormalities appear in skeletal, ocular and cardiovascular ents from Russian populations. Khusnutdinova: Background: Psoriasis is a chronic inflammatory disease which is thought None. Histology was done on the sections and National Institute of Mother and Child, Warsaw, Poland. Conclusions: Our study suggests that the Interleukin-1 genetic Noonan like dysmorphic features (high forehead, hypertelorism, posteriorly polymorphisms are not critical in the pathogenesis of psoriasis. Detailed clinical, anthropometric and molecular studies will Gene Variants of the Catalase, Gutathione Peroxidase 1, Endothelial be discussed with natural history of the disorder in each of the cases. Previous patient from Russia studies of vitiliginous melanocytes showed that an imbalance between oxi D. Vitamin D receptor gene polymorphism influences on bone mineralization and metabolism in juvenile idiopathic arthritis. Larionova5; 1State Pediatric Medical University, Saint-Petersburg, Russian Federation, 2Department J01. Research Institute for Children‘s Orthopedics, Saint-Petersburg, Russian Federation. Also, the management steps to improve facial and oclussal aspects are Results: no differences in TaqI and Cdx2 haplotypes, genotypes and alleles described. Slyadnev2; Morphologic Microscopy, Discipline of Molecular and Cellular Biology, Timisoara, 1The Turner Scientific and Research Institute for Children s Orthopedics, Saint Romania, 2University of Medicine and Pharmacy “Victor Babes” of Timisoara, Petersburg, Pushkin, Russian Federation, 2Lumex Ltd, Saint-Petersburg, Russian Department of Morphologic Microscopy, Discipline of Genetics, Timisoara, Romania, Federation, 3Pediatric Medical University, Saint-Petersburg, Russian Federation. Polymorphisms Arg72Pro 4ex, ins/del16bp 3in, G/C 6in can determine activity of the P53 protein the key protein of intrinsic apo Apert syndrome is a type of acrocephalosyndactylia that belongs to the ptosis pathway. We identified significant difference of exon genotype Arg72Pro in performed since. In lower limbs the syndactyly is present in all the fingers where 16, 7%, ÐÐ – 12, 2% è 0%). Kanavakis1; 1University of Athens, Department of Medical Genetics, School of Medicine, Athens, According to literature data, the patients with Apert syndrome and 2 p. Pro253Arg mutation have a more improved craniofacial appearance after Greece, “Aghia Sophia“ Children‘s Hospital, Athens, Greece. Neurofibromatosis Type I is a genetic disorder that affects 1 in 3, 000 indivi duals worldwide and is characterized by cafe-au-lait spots, Lisch nodules in A. Belengeanu: the eye, multiple cutaneous neurofibromas and increased susceptibility to None. The gene is large and codes for at least three alter Detection and characterisation of Molecular biomarkers associated natively spliced transcripts. Its major manifestations include tall stature, long thin limbs and arachnodactyly, pectus excavatum/carinatum, myopia, mitral valve prolap se and regurgitation, and dilation of the aortic root (occasionally leading to J01. Symptoms can appear at any age and vary Ankyloblepharon-Ectodermal Defects-Cleft Lip/Palate Syndrome due greatly between patients, even within the same family. National d‘Hygiene, Rabat, Morocco, 3Service d‘odontologie pediatrique-Prevention, Mutation screening revealed the presence of three novel mutations in three Faculte de Medecine Dentaire, Universite Mohamed V Souissi, Rabat, Morocco. Ile808LeufsX41); one missense mu rare autosomal dominant disorder with multiple congenital anomalies. Until now, mal defects (sparse frizzy hair; skin defects; nail alterations; dental chan we did not find any large gene rearrangements. All mutations result diagnosis and to allow proper genetic counselling to patients and families. Alonso: the early diagnosis of this syndrome are important to implement appropri None. Relationship between vitamin D receptor and collagen type I alpha-1 chain gene polymorphism with bone metabolic markers in children with congenital scoliosis I. Control group 31 with congenital scoliosis due to TaqI and 3731À/G vitamin D receptor apparently healthy children (20 boys and 11 girls). Statistical significance of Materials and methods: 154 children (63 boys and 91 girls) with congeni differences between groups was assessed using 2 tests. The genotype distribution was were performed by polymerase chain reaction with restriction fragment in accordance with Hardy-Weinberg equilibrium for all variants. Prothrombotic Gene Polymorphisms in Young Patients with Cerebrovascular Accident I. Wilimska1; 1 2 Cerebrovascular diseases which are affected by genetic and environmen Department of Medical Genetics, Usti nad Labem, Czech Republic, the Institute of Molecular Genetics, Novy Jicin, Czech Republic. Their incidence increases with age and these are the most frequently encountered ones among neu Our case is a family, where Marfan syndrome was diagnosed during gene rological diseases. The objective of this study was to investigate thrombotic tic counseling in pregnancy. Marfan syndrome is a systemic disease of con gene polymorphisms that may take place in formation of cerebrovascular nective tissue characterized by a variable combination of cardiovascular, diseases in young adults. The incidence vascular accident) below age of 51, thrombotic gene polymorphisms were of Marfan syndrome is approximately 1 in 5, 000 worldwide and there is no evaluated. We observed that together with these polymorphisms smoking hy palate, mitral valve prolapse, ascending aorta dilatation. Molecular genetic pertension and existence of family story increased the available risk. Smirnov3; polymorphisms in children with primary systemic vasculitis, 1Federal centre heart blood and endocrinology, Saint-Petersburg, Russian Federation, vasculitis associated with autoimmune diseases and in healthy 2Scintific researcher orthipedic institusion aftre by G. Federation, 3Saint Petersburg Electrotechnical University, Saint-Petersburg, Russian N. There was no difference in prevalence and onset and sialic acid levels are not among the commonly recognized risk factors of hypertension, presence of hypercholesterolemia and obesity. Our findings provide strong evidence dial infarction and significantly more events of stroke than in patients with for the existence of this relation. Zhuraev; Idiopatic Arthritis Institute of Clinical Pathology Lviv National Medical University after Danylo Halytski, I. We atherosclerosis which results in decreased supply of blood to the heart is observed abnormal activation of Sonic hedgehog (Shh), a major pathway its major cause. Genetic analysis including linkage analysis and exome Ofd1 inducible-mediated inactivation at birth does not affect ciliogenesis sequencing was performed on the pedigree. Functional analysis was done in the cortex, suggesting a developmental stage-dependent role for a basal to access the effect of the identified causative mutation on protein locali body protein in ciliogenesis. Thus, the present study identifies Ofd1 as a Novel mutations involved in Bardet-Biedl syndrome developmental disease gene that is critical for forebrain development and S. Valverde2; 1University of Vigo (equal contribution), Vigo, Spain, 2University of Vigo, Vigo, Spain. And genes, 27 and 39 patients respectively, by direct sequencing and analysis most of patients with conotruncal defects carry a hemizygous microdeleti with specific software. Four of these pathogenic changes are without dysmorphic features or additional congenital abnormalities. Grassi: of Medical Genetics, Institute of Mother and Child, Warsaw, Poland, 3Genetic Clinic None. Medgen, Warsaw, Poland, 4Department of Medical Genetics, the Children’s Memorial Health Institute, Warsaw, Poland, 5Department of Child and Adolescent Psychiatry, the Medical University of Warsaw, Warsaw, Poland, 6Pediatrics and Neurology of Children, Silesian Medical University, Katowice, Poland, 7nstitute of Medical Genetics, University of J02. A 3-year-old girl was referred to genetic mental delay or intellectual disability and at least one congenital malfor counselling because of facial dysmorphism, seizures, and moderate mental mation were established in 10 patients. Patients has typical facial dysmorphy with uplif probes confirmed that the chromosomal material added on chromosome 15 ted earlobes with a central depression visible irrespective of patient’s age. Our observation is unique because the duplication of the Among congenital malformations the most common were heart defects, whole short arm of chromosome 9 without monosomy of another chromo agenesis of corpus callosum and kidney defects. Psychomotor or intellectual some and resulting from a de novo unbalanced translocation was never re development were severely retarded in all cases.

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For instance diabetes insipidus and specific gravity buy cheap glucotrol xl 10 mg line, infants and growing children require proper amounts of fat to diabetes mellitus related to cystic fibrosis purchase generic glucotrol xl on-line support normal growth and development blood sugar jumping up and down buy discount glucotrol xl on-line. If an infant or child is given a low-fat diet for an extended period diabetes signs wiki buy cheap glucotrol xl line, growth and development will not progress normally. Other individuals with high-energy needs are athletes, people who have physically demanding jobs, and those recuperating from illness. When the body has used all of its calories from carbohydrates (this can occur after just twenty minutes of exercise), it initiates fat usage. A professional swimmer must consume large amounts of food energy to meet the demands of swimming long distances, so eating fat-rich foods makes sense. In contrast, if a person who leads a sedentary lifestyle eats the same high-density fat foods, they will intake more fat calories than their body requires within just a few bites. Use caution—consumption of calories over and beyond energy requirements is a contributing factor to obesity. Smell and Taste Fat contains dissolved compounds that contribute to mouth-watering aromas and flavors. What would a meal be without that savory aroma to delight your senses and heighten your preparedness for eating a meal When fatty foods are swallowed the body responds by enabling the processes controlling digestion to retard the movement of food along the digestive tract, thus promoting an overall sense of fullness. Oftentimes before the feeling of fullness arrives, people overindulge in fat-rich foods, finding the 8. To allow your body to experience the satiety effect of the fat before you overindulge, try savoring rich foods. Eating slowly will allow you to both fully enjoy the experience and be sated with a smaller portion. Drink water in between bites or eat a lower fat food before and after a higher fat food. Explain how the structure of each lipid impacts its function as it relates to health and disease. Compare and contrast the structure of the following types of fats: triacylglycerols (monounsaturated, polyunsaturated, omega-3, and omega-6), phospholipids, and sterols. Explain how the fatty acids you consume relate to the fatty-acid composition of your body fat. Lipids are unique organic compounds, each serving key roles and performing specific functions within the body. As we discuss the various types of lipids (triacylglycerols, phospholipids, and sterols) in further detail, we will compare their structures and functions and examine their impact on human health. Triacylglycerols Structure and Functions Triacylglycerols are the main form of lipid found in the body and in the diet. Glycerol is a thick, smooth, syrupy compound that is often used in the food industry. To form a triacylglycerol, a glycerol molecule is joined by three fatty acid chains. Fatty Acids Fatty acids determine if the compound is solid or liquid at room temperature. Fatty acids can differ from one another in3 two important ways—carbon chain length and degree of saturation. It’s All in the Chain Fatty acids have different chain lengths and different compositions. An organic compound that fatty acids with chain lengths between four and twenty-four carbons and most of contains a carboxylic acid them contain an even number of carbon atoms. The term saturation refers to whether or not a fatty acid chain is maximum number of hydrogen filled (or “saturated”) to capacity with hydrogen atoms. If each available carbon atoms with no points of 10 bond holds a hydrogen atom we call this a saturated fatty acid chain. This is referred to as the point of additional hydrogen atoms can 11 unsaturation. A fatty acid that is missing hydrogen atoms with one or When one or more bonds between carbon atoms are a double bond (C=C), that fatty 12 more point of unsaturation. Any fatty acid that has only one double bond is a monounsaturated 13 fatty acid, an example of which is olive oil (75 percent of its fat is monounsaturated). Monounsaturated fats help regulate blood cholesterol levels, thereby reducing the risk for heart disease and stroke. A polyunsaturated fatty 14 acid is a fatty acid with two or more double bonds or two or more points of unsaturation. Both monounsaturated fats and polyunsaturated fats provide nutrition that is essential for normal cell development and healthy skin. Foods that have a high percentage of saturated fatty acids tend to be solid at room temperature. Examples of these are fats found in chocolate (stearic acid, an eighteen-carbon saturated fatty acid is a primary component) and meat. Foods rich in unsaturated fatty acids, such as olive oil (oleic acid, an eighteen-carbon unsaturated fatty acid, is a major component) tend to be liquid at room temperature. Flaxseed oil is rich in alpha-linolenic acid, which is an unsaturated fatty acid and becomes a thin liquid at room temperature. Knowing the connection between chain length, degree of saturation, and the state of the fatty acid (solid or liquid) is important for making food choices. If you decide to limit or redirect your intake of fat products, then choosing unsaturated fat is more beneficial than choosing a saturated fat. This choice is easy enough to make because unsaturated fats tend to be liquid at room temperature (for example, olive oil) whereas saturated fats tend to be solid at room temperature (for example, butter). Conversely, tropical oils are an exception to this rule in that they are liquid at room temperature yet high in saturated fat. Palm oil (often used in food processing) is highly saturated and has been proven to raise blood cholesterol. Shortening, margarine, and commercially prepared products (in general) report to use only vegetable-derived fats in their processing. But even so, much of the fat they use may be in the saturated and trans fat categories. The introduction of a carbon double bond in a carbon chain, as in an unsaturated fatty acid, can result in different structures for the same fatty acid composition. A fatty acid that contains one When the hydrogen atoms are bonded to the same side of the carbon chain, it is point of unsaturation. Naturally occurring fatty acids usually have a cis or more points of unsaturation. Unlike cis fatty acids, most trans fatty acids are not found naturally in foods, but are a result of a process called hydrogenation. Hydrogenation is the process of adding hydrogen to the carbon double bonds, thus making the fatty acid saturated (or less unsaturated, in the case of partial hydrogenation). This is how vegetable oils are converted into semisolid fats for use in the manufacturing process. According to the ongoing Harvard Nurses Health Study, trans fatty acids have been associated with increased risk for coronary heart disease because of the way they negatively impact blood cholesterol levels. Interestingly, some naturally occurring trans fats do not pose the same health risks as their artificially engineered counterparts. These trans fats are found in ruminant animals such as cows, sheep, and goats, resulting in trans fatty acids being present in our meat, milk, and other dairy product supply. Nonessential and Essential Fatty Acids Fatty acids are vital for the normal operation of all body systems. The circulatory system, respiratory system, integumentary system, immune system, brain, and other organs require fatty acids for proper function. However, there are some fatty acids that the body 18 cannot synthesize and these are called essential fatty acids. It is important to note that nonessential fatty acids doesn’t mean unimportant; the classification is based solely on the ability of the body to synthesize the fatty acid. The 3 and 6 refer to the position of the first carbon double bond and the omega refers to the methyl end of the chain. Omega-3 and omega-6 fatty acids are precursors to important compounds called 19 eicosanoids. Eicosanoids are powerful hormones that control many other hormones and important body functions, such as the central nervous system and the immune system.

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Adjustments in fluid balance can be made by altering the quantity or concentration of hypertonic solutions diabetes insipidus occurs when order 10 mg glucotrol xl visa. Patients must measure their own blood pressure and weigh themselves regularly to diabetes symptoms neuropathy buy glucotrol xl 10 mg overnight delivery determine the glucose concentration of dialysate necessary to diabetes mellitus type 2 treatment guidelines discount glucotrol xl 10 mg online maintain fluid balance (2 diabetes prevention network order glucotrol xl, 5, 6). The degree of hypokalemia or hyperkalemia can have a direct effect on cardiac function and should be carefully monitored and adjusted based on biochemical values (1, 2). Hemodialysis: For patients who receive hemodialysis, a potassium intake of 40 mg/kg of standard body weight is recommended; or, the potassium intake can be determined from laboratory values (2, 5, 6). Hemodialysis removes potassium; therefore, monitoring potassium levels and ensuring adequate intake is important (3). Inadequate dialysis, gastrointestinal bleeding, hyperglycemia, infection, and catabolism can cause hyperkalemia, which can lead to life-threatening medical problems (2). Adjustments in potassium intake (either from the diet or from the dialysate bath) can be made to achieve target potassium levels (2). Peritoneal dialysis can increase the risk for hypokalemia, since most commercially available solutions do not contain potassium (3). If needed oral supplementation and/or dietary intake can be adjusted to compensate for low potassium levels. Phosphorus Alterations in calcium, phosphorus, and vitamin D metabolism result in secondary hyperparathyroidism, causing renal osteodystrophy and cardiac and extraskeletal calcification (5, 6, 9). These guidelines provide recommendations for the evaluation of phosphorus, calcium, plasma intact parathyroid hormone, and alkaline phosphorus and for the management and treatment of abnormalities with vitamin D, phosphate binders, and dialysate baths (9). Serum phosphorus levels are difficult to control with diet alone, therefore a phosphate binder may be required (1, 5, 6). Hemodialysis and peritoneal dialysis: Phosphorus requirements should be individualized or limited to10 12 mg/kg of standard body weight or 800-1000 mg when serum phosphorus levels approach the upper limit of normal range (1, 5, 6). A phosphorus restriction is advised when the intact parathyroid hormone level is greater than 70 pg/mL in Manual of Clinical Nutrition Management G-12 Copyright © 2013 Compass Group, Inc. Calcium based, or non-calcium-based, non-aluminum-based phosphate binders are given at mealtimes to bind the phosphate from food. The prescribed amount of phosphate binders should be individualized according to the amount of phosphate present in a meal. However, 100% of additive phosphorus from food enhancers or preservatives is absorbed, and phosphorus is frequently added to many foods that were once considered to be low-phosphorus foods. With an increased calcium-phosphorous product, sevelamer hydrochloride, sevelamer carbonate, or lanthanum carbonate may be more effective and will not contribute to elevated phosphorus and calcium levels. One 800-mg tablet of sevelamer hydrochloride or sevelamer carbonate replaces a calcium acetate tablet (11, 12). Typical starting doses of lanthanum carbonate are 500 to 1, 000 mg with a designated meal. If calcium and phosphorus levels are at the high end of the normal range, a calcium binder may increase these levels to exceed the normal range and contribute to soft-tissue calcification. The goal is for the serum calcium-phosphorus product to be less than 55 mg2/dL2 (5, 6, 10). Aluminum-containing phosphate binders are not recommended due to the risk for aluminum toxicity, which can lead to osteodystrophy, anemia, and encephalopathy (3, 9). The use of vitamin D and other supplements that impact the calcium level should also be considered in the nutrition assessment of calcium needs (1, 5, 6, 9, 13). Hemodialysis and peritoneal dialysis: Calcium intake should be less than 2, 000 mg/day or individualized based on calcium, phosphorus, and parathyroid hormone levels and the use of vitamin D supplementation (2, 5, 6, 9). Intestinal absorption of calcium is impaired in uremia due to the lack of the active form of vitamin D (3). If calcium supplements are needed, they should be taken between meals and not be confused with those supplements used to bind phosphorus. It is important to use an adjusted calcium level in patients with low albumin levels. Magnesium the kidney is the organ primarily responsible for the maintenance of serum magnesium. Excess magnesium mainly accumulates in bone tissue, where it is deleterious to bone metabolism. Symptoms of excess magnesium include muscle weakness, hypotension, electrocardiographic changes, sedation, and confusion. If the patient’s magnesium levels are too high, the level of magnesium in the dialysate can be decreased. Other causes of vitamin deficiencies include impaired food intake as a result of uremia and alterations in the absorption, metabolism, or activity of some vitamins. Studies do not support the routine supplementation of fat-soluble vitamins other than vitamin D for patients consuming well-balanced, adequate diets (5, 9). Medical Nutrition Therapy for Chronic Kidney Disease predisposition for mineral and bone disorders, as well as other conditions that may be affected by insufficient vitamin D (1). Supplements of 1, 25-dihydroxyvitamin D (calcitriol), the active metabolite of vitamin D, can be provided to maintain normal calcium homeostasis and prevent osteomalacia (3). Supplementation with vitamin D analogs, paricalcitol (Zemplar) and doxercalciferol (Hectorol), can be used to treat secondary hyperparathyroidism. The advantage of using the analogs as opposed to calcitriol is the decreased absorption of phosphorus and calcium in the gut (13). Deficiencies of water-soluble vitamins, especially vitamin C, folate, and vitamin B6, may occur secondary to poor appetite, altered metabolism, uremia, removal by dialysis, and a restricted diet (3, 5, 6). Each patient should be evaluated and treated with vitamins according to individual need and after the appropriate assessment of biochemical levels (1, 2, 4-6, 9). Supplementation with folic acid (1 mg/day), vitamin B6 (2 mg/day), and vitamin B12 (3 mcg/day) is suggested for patients who receive hemodialysis or peritoneal dialysis (3, 5, 6). Trace minerals should be supplemented or restricted only after performing the appropriate biochemical assessments (5). Zinc supplementation (15 mg/day) is suggested for patients who receive hemodialysis or peritoneal dialysis (5). Iron status should be routinely evaluated and supplemented based on individual need (5, 6). Intensive treatment of hyperglycemia, while avoiding hypoglycemia, prevents the development of diabetic kidney disease and may slow the progression of established kidney disease (Grade I)(1). The 2002 versions (second editions) of A Healthy Food Guide for People With Chronic Kidney Disease and A Healthy Food Guide for People on Dialysis focus on complementing the patient’s existing diabetes meal planning approaches (eg, constant carbohydrate meal plan, carbohydrate counting meal plan, or exchange meal plan) (2, 6). These publications also recommend strategies that best meet the nutritional needs of the patient and that promote or maintain glucose tolerance. Medical Nutrition Therapy for Chronic Kidney Disease Table G-3: Daily Nutritional Requirements for Adults with Renal Disease Based on Type of Therapy Diagnosis/ Energy Protein Fluid Sodium Potassium Phosphorus Therapy Acute kidney 25-35 0. Diuretic phase: urine volume, Diuretic phase: Replace based serum potassium Include Large volume on urine levels, and need for energy from of fluids may output, edema, dialysis and continuous be needed. In all cases, individual practitioners should use their own clinical judgment and expertise in selecting a method (1, 2, 5, 9). Medical Nutrition Therapy for Chronic Kidney Disease Estimates of Calories Absorbed in Peritoneal Dialysis Energy requirements and nutrient intake calculations for patients who receive peritoneal dialysis should include carbohydrate absorption from the dialysate. The most accurate method of determining the energy load is to measure the grams of glucose in the effluent and compare that with the grams of glucose infused (2). Silver Spring, Md: American Society For Parenteral and Enteral Nutrition; 2012:492-510. Nutrition management of the renal patient depends on the method of treatment as well as on medical and nutritional status. A comparison of treatment methods and primary concerns in each is summarized in the table below. This edition uses an approach that is flexible and encourages self-management training and individualization for both the patient and registered dietitian (1). Foods are divided into groups or “choices” according to nutrient content and are categorized based on the amount of protein, energy, sodium, potassium, and phosphorus content. The following information and tables are reprinted with permission from the Academy of Nutrition and Dietetics, National Renal Diet: Professional Guide (1), Healthy Food Guide for People With Chronic Kidney Disease (2), and Healthy Food Guide for People on Dialysis (3), 2002. The intent of Manual of Clinical Nutrition Management G-17 Copyright © 2013 Compass Group, Inc.

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