["3. Monitoring and Evaluation 1. Nutrition Assessment and Anthropometric Measurement. 2. Dietary Interviews (Assess Protein and Calories Intake). 3. Biomarkers. 4. Create community with healthy environment.","1. Nutrition Assessment & Anthropometric measurement \uf075 Nutrition Assessment and diet counseling : Routinely, by Dietitian KDOQI, 2020 \uf075 Nutrition Assessment and diet counseling : Every 3-6 months (at stage \u2265 3b) TOOLS Clinical Practice Recommendation of Nutritional Management in Adult Kidney Patients, 2018 7 \u2013 POINTS SGA \/ NAF \/ NT 2013 Methods Assess CKD Stage DXA (Opinion) Body composition (Gold standard) 1-5D Body Weight \/ BMI (Opinion) - Every 6 months 1-3 - History of Wt. Skinfold Thickness (Opinion) - Every 3 months changes Body fat 4-5D - Serial of Wt. - Edema - Ascites - Polycystic organs 1-5D Gait-speed or handgrip strength Performance (functional status) 1-5D Recommended J. Clin. Med. 2020, 9, 3644 KDOQI, 2020","2. Dietary Interviews \u2022 First year of intervention : 3 times per year is optimal \u2022 3 days food record (2C) \/ 24-hour food recall (2D) \/ FFQ (2D) KDOQI CLINICAL PRACTICE GUIDELINE FOR NUTRITION IN CKD: 2020 UPDATE Inadequate Energy Intake Over Protein Intake \u27a2 With adequate protein \u2022 Confirm with nPCR (2D), if possible Increase energy \u2022 Non-Protein starches. Reduce protein intake \u2022 Good fat. \u2022 Repeat diet counseling. \u27a2 Excessive protein restriction \u2022 Assess knowledge, beliefs, attitudes, behavior, access Increase Energy and Protein \u2022 Repeat diet counseling. If have to food, depression, cognitive function. \u2022 For VLPD + KAs: if assess that Pt. can not follow VLPD, risk of Malnutrition, stop LPD. discuss with physician to consider LPD.","3. Biomarkers Urine : nPCR (g protein\/kg\/day) (2D) Able to measure body Wt. [(UUN + (0.031 x BW in kg)) x 6.25] \uf0b8 Wt. Unable to measure body Wt. [(UUN + 4) x 6.25] \uf0b8 Wt. nPNA: normalized protein catabolic rate (g protein\/kg\/day) UUN = 24- hour urinary urea nitrogen (g N\/day) Serum Kidney\u2019s function \/ Albumin \/ Prealbumin \/ CBC E\u2019lyte \/ P \/ Ca \/ others comorbidity (BS, Lipid profile)","4. Create Community with Healthy Environment \u2022 Group sharing (patient to patient + dietitian). \u2022 Counseling patient together with family and caregiver. \u2022 Assess medical use, knowledge, beliefs, attitudes, access to food, depression, cognitive function of patient together with family and caregiver. \u2022 Learning activities (Interactive presentations, Food exchange explanation with real food, Cooking class, Creative menu for LPDs and VLPDs). \u2022 Advice low protein products that help improve adherence and compliance with LPDs and VLPDs plus KAs (food delivery, low protein rice).","Contraindications to a Low Protein Diet Absolute \u2022 Protein energy wasting (PEW) \u2022 Hypercatabolic state (acute or chronic) \u2022 Anorexia and eating disorders \u2022 End of life care management Relative \u2022 Poor attitude to dietary modifications \u2022 Psychiatric \/ psychological disorders \u2022 Logistic barriers (economic, cultural, lack of support) \u2022 Poorly controlled diabetes \u2022 Chronic steroid treatment \u2022 Intestinal diseases including chewing disorders \u2022 Short life-expectancy J. Clin. Med. 2020, 9, 3644","Flow chart for prescription low protein diet J. Clin. Med. 2020, 9, 3644","Conclusion \u2022 Protein restriction can help preserve eGFR, delay dialysis initiation, and reduce renal death. \u2022 Low protein diet is not recommended in patients who are at risk of PEW. \u2022 Nutrition intervention and prescription should be personalized. \u2022 Integrative and multidisciplinary approaches is the best way to help achieve low protein diet and improve patient QoL. \u2022 Nutrition Monitoring and Evaluation is the key to verify the adherence to low protein diet and to prevent PEW.","Above all, love each other deeply, because love covers over a multitude of sins. 1 Peter 4:8 \u201c \u0e40 \u0e2b \u0e19\u0e37 \u0e2d \u0e2a\u0e48\u0e34 \u0e07 \u0e2d\u0e37\u0e48 \u0e19 \u0e43 \u0e14 \u0e08 \u0e07 \u0e23\u0e31 \u0e01 \u0e01\u0e31 \u0e19 \u0e2d \u0e22\u0e48 \u0e32 \u0e07 \u0e25\u0e36 \u0e01 \u0e0b\u0e36\u0e49 \u0e07 \u0e40 \u0e1e \u0e23 \u0e32 \u0e30 \u0e04 \u0e27 \u0e32 \u0e21 \u0e23\u0e31 \u0e01 \u0e25 \u0e1a \u0e04 \u0e27 \u0e32 \u0e21 \u0e1c\u0e34 \u0e14 \u0e1a \u0e32 \u0e1b \u0e21 \u0e32 \u0e01 \u0e21 \u0e32 \u0e22 \u0e44 \u0e14\u0e49 \u0e42 \u0e14 \u0e22 \u0e01 \u0e32 \u0e23 \u0e43 \u0e2b\u0e49 \u0e2d \u0e20\u0e31 \u0e22 \u201d 1 \u0e40\u0e1b\u0e42\u0e15\u0e23 4:8 Thank you for your attention : )"]
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