Bone Mineral Disease
There were no new practice points made for managing Bone Mineral Disorders of CKD. Instead readers are referred back to the 2017 KDIGO guidelines.
The highlight take away for us dietitians is that this 2017 statement for phosphorus is still in effect:
4.1.8. In patients with CKD G3a–G5D, we suggest limiting dietary phosphate intake in the treatment of hyperphosphatemia alone or in combination with other treatments (2D). It is reasonable to consider phosphate source (e.g., animal, vegetable, additives) in making dietary recommendations (Not Graded).
What are the recommendations for gout?
Practice Point 3.14.4: Nonpharmacological interventions which may help prevent gout include limiting alcohol, meats, and high-fructose corn syrup intake
The recommendations made by the KDIGO group for gout prevention include limiting:
- Alcohol intake – More than 30 units per week of alcohol is associated with more gout than less than 20 units per week
- Purine intakes – Consuming more than 850mg per day was associated with higher odds of gout
- Fructose ingestion of 1g/kg body was associated with increases in urine acid. While the guidelines state carbonated drink, in the fine print, it stipulates that diet drinks were not associated with gout.
Low fat dairy, high-fibre, plant-based diets were associated with a lower risk of gout.
Take Aways
Well, at least we don’t have to learn anything new with regards to phosphorus this go around! But I am hoping that when trials such as a the HiLo and Phosphate start to report out, we might get better direction around ideal phosphorus limits, especially for those living on dialysis.
With regards to the treatment for gout – again, I don’t think there is anything too new for us dietitians here. I don’t tend to do a lot of gout counselling in my clinical practice, so I am not sure how often it will come up for me. Do you see many patients for treatment of gout in your kidney clinics?
