Search This Blog

MCI Dementia CKD diet.


2024apr14.     Mild cognitive impairment (MCI)   Many people struggle with their memory or thinking from time to time. This can easily happen when a person is feeling tired, unwell or stressed. It can happen more often as they get older.    However, if problems with thinking continue for more than a few months, it could be a sign that they have MCI.    MCI involves problems with one or more thinking skills. For example:

  • memory or learning – difficulties remembering recent events or learning new things 
  • reasoning – struggling  to make decisions or work through everyday problems 
  • attention – finding it more challenging to focus on a task or filter out distractions
  • language – having difficulties finding the right word in conversation    Sluring or stumbling with pronunciation.  Not remembering a name in an easy circumstance.
  • loss of interest or motivation – less interest in usual activities or hobbies. 

People with MCI often have difficulties remembering things as well as they once did. Others describe more of a ‘brain fog’ where they feel unable to think clearly.        Having MCI is not the same as having dementia. A person with MCI has milder symptoms, which means they are still able to do most everyday tasks without support.     MCI can be caused by lots of different health problems, whereas dementia is always caused by a disease that damages the brain.    Dementia is progressive, which means it always gets worse over time. This isn’t always the case for MCI.        For many people it’s not possible to know what’s causing their MCI, although it may become clearer over time.    A person can develop MCI at any age. However, the risk increases greatly with older age. About 1 in 4 people in their early 80s has MCI.    Sometimes MCI is caused by a health condition that can get better with time and treatment. These include:

  • sleep disorders – for example, not being able to sleep (insomnia) or not breathing easily while asleep (sleep apnoea)
  • side effects of medicines that cause confusion or drowsiness
  • having low blood pressure
  • mental health problems, such as depression, anxiety or long-term stress
  • functional cognitive disorder 
  • sight or hearing loss
  • infections, including the after-effects of COVID or other viruses 
  • severe constipation
  • regularly drinking too much alcohol
  • high or low levels of vitamins, minerals, hormones, or sugars in the body.
  • The effects of these may be worse if the person is also frail, tired, or in pain.

About 4 in 10 people with MCI will get better. However, there’s no guarantee that their recovery will be permanent. Many people who get better from MCI have similar problems again later.         Although getting older is the biggest risk factor for MCI, evidence shows there may be things a person can do to reduce their long-term risk, with the right support.    These changes mainly involve keeping the body healthy and preventing damage to the brain. They include:

  • being physically active
  • eating healthily
  • not smoking
  • drinking less alcohol
  • staying mentally and socially active
  • looking after other health conditions, such as high blood pressure or diabetes.

It’s best to start from at least midlife, during your 40s and 50s.        Some people with MCI develop useful strategies to cope with their symptoms, which can help to make everyday tasks easier and less frustrating. For example: 

  • Try to do just one thing at a time and remove distractions. If you are trying to concentrate on something, turn off the television or close the window if there is noise coming from outside.
  • Getting into a routine of putting belongings in the same place so they are easy to find – for example, always putting keys on a hook, or keeping a wallet or purse in the same drawer. 
  • Declutter the home as much as possible. Label drawers and cupboard doors to show what is inside.
  • Use a calendar, diary or reminders on a phone or tablet to help remember appointments and important events. Keeping a notebook handy can be very useful.
  • Set an alarm for when a medicine needs to be taken and then tick it off on a daily or weekly checklist once done.
  • If there are lots of medicines to be taken at different times, make an appointment to have a medication review. GP surgeries often have a pharmacist who can help to make medicines easier to manage. 
  • Explore ways to reduce stress, anxiety and depression as this can improve thinking and memory. Be as kind to yourself as you would be to others you care about.
  • Try to get enough sleep, ideally at least seven hours each night. Get help from a health professional for any sleep disorders, such as insomnia or breathing problems.
  • Ask a GP or dementia adviser about memory support groups in the local area. These can help people develop strategies to cope with memory problems and stay independent for longer.  https://www.alzheimers.org.uk/about-dementia/types-dementia/tips-managing-mci-diagnosis

2024mar28      dementia    Want to avoid dementia? Scientists name THREE most effective things you can do to protect 'weak spot' in brain from succumbing to memory-robbing disorder.        Drink less alcohol, stay away from busy roads and stop eating so much sugar.  https://www.dailymail.co.uk/health/article-13244325/cut-risk-dementia-scientists-name.html

2023sep27     plant based diet   Association between plant-based diet and kidney function in adults (2023).        Objective - A plant-based diet has both antioxidant and anti-inflammatory properties. Therefore, it is hypothesized that adherence to a plant-based diet may have a positive effect on kidney function. The study aimed to determine the association between the plant-based diet index (PDI) and chronic kidney disease (CKD).        Methods - This cross-sectional analysis used information from the Ravansar non-communicable diseases (RaNCD) cohort study, which included 9,746 participants between the ages of 35 and 65. By measuring the glomerular filtration rate (eGFR) with the Modification of Diet in the Renal Disease equation, CKD was determined. Using a food frequency questionnaire (FFQ), the PDI was computed based on food intake. To determine odds ratios (ORs), multivariable logistic regression models were utilized.        Results - 1,058 (10.86%) of participants had CKD (eGFR<60 ml/min/1.73 m2), and the mean PDI was 54.22± 6.68. The mean of eGFR in the group with a high PDI score was significantly higher than the group with a low PDI score (fourth quartile: 79.20± 0.36 vs. first quartile: 72.95± 0.31, P<0.001). Adherence to a plant-based diet was more prevalent in those with a higher socioeconomic status (P<0.001). After adjusting for potential confounders, the odds of CKD in the third and fourth quartiles of PDI were 25% (OR: 0.75; 95% CI: 0.62- 0.91) and 39% (OR: 0.61; 95% CI: 0.48- 0.78, P trend<0.001) lower than the first quartile, respectively.        Conclusions - The findings of this study suggest that having a plant-based diet may prevent the prevalent CDK. However, further studies with a cohort design are recommended.        Abbreviation - BMI (Body mass index), HDL-C (High-density lipoprotein cholesterol), LDL-C (Low-density lipoprotein cholesterol), TG (Triglycerides), T-C (Total cholesterol), FBS (Fasting blood sugar), SBP (Systolic blood pressure), DBP (Diastolic blood pressure), Cr (Creatinine), BUN (Blood urea nitrogen), AST (Aspartate transaminase), ALT (Alanine transaminase), ALP (Alkaline phosphatase), GGT (Gamma-glutamyl transferase), PDI (Plant-based diet index), Q (quartile), CK D (Chronic kidney disease), RaNCD (Ravansar non-communicable diseases), eGFR (Estimation glomerular filtration rate), MDRD (Modification of Diet in Renal Disease), FFQ (Food frequency questionnaire)   https://www.jrnjournal.org/article/S1051-2276(23)00152-8/pdf  

Effects of Plant-Based Protein Consumption on Kidney Function and Mineral Bone Disorder Outcomes in Adults With Stage 3-5 Chronic Kidney Disease: A Systematic Review (2023).        Introduction - Plant-based protein is of growing interest for dietary management of chronic kidney disease (CKD) and is hypothesized to preserve kidney function and reduce CKD-mineral bone disorder (MBD) complications, among other benefits. This systematic review aimed to summarize the available clinical trial evidence for the effect of plant-based protein on kidney function and CKD-MBD outcomes in adults with stage 3-5 CKD not on dialysis.         Methods - Searches of Medline, Embase, Agricola, CAB abstracts, Web of Science, Scopus, and hand searching were performed. Clinical trials with ≥8 participants ≥18 years of age with an estimated glomerular filtration rate <60 mL/min/1.73 m2 but not on dialysis were included. Additionally, only clinical trials with ≥1-week interventions with ≥50% dietary protein from plant-based sources and reported at least one outcome for both kidney function and CKD-MBD outcomes were included. Of the 10,962 identified abstracts, 32 met inclusion criteria and were assessed for risk of bias.        Results - Results for kidney function and CKD-MBD outcomes were heterogenous, with most studies having suboptimal methodological quality. In most of the studies (27/32), protein source was altered only secondarily to low-protein diet interventions. Thus, data synthesis and interpretation were focused on a subset of five studies that investigated a change in protein source only (i.e., animal vs. plant). Of this subset, four studies reported no change in kidney function, while one study reported a decrease. Three studies reported no change in serum phosphorus, and one study reported lower serum phosphorus following a vegetarian diet. Further, limited data and inconclusive results were observed for phosphaturic hormones, parathyroid hormone, and fibroblast growth factor-23.        Conclusion - Current clinical trial evidence on plant-based protein interventions for preserving kidney function and preventing CKD-MBD is limited to inform clinical guidelines at this time. This systematic review emphasizes the ongoing need to research the effects of plant-based protein on kidney function and CKD-MBD outcomes.  https://www.jrnjournal.org/article/S1051-2276(23)00064-X/fulltext  

In the ‘Plant-Based’ Era, Patients with Chronic Kidney Disease Should Focus on Eating Healthy (2023).        Abstract - In the era of plant-based diets, it is important for Nephrology providers to know the evidence regarding their healthfulness in patients with chronic kidney disease (CKD). A whole food, plant-based diet, which emphasizes fresh, minimally processed or refined, plant-based foods and limits animal products, has shown benefits for patients with CKD. These include reduced dietary acid load, lower bioavailability of potassium and phosphorus, increased dietary fiber intake, nutritional adequacy, and cardiovascular and mortality benefits. Potential drawbacks include the need for specific knowledge, skills, and cost involved in preparing varied, healthy, and appetizing plant-based meals, leading to lower acceptability and accessibility to certain populations. Liberalization of the standard CKD diet to include healthy, minimally processed foods such as fruits, vegetables, nuts, legumes, and whole grains is likely beneficial, though more research is needed to determine whether a plant-based-only diet is the optimal way to achieve healthier eating in patients with CKD.  https://www.jrnjournal.org/article/S1051-2276(23)00131-0/fulltext  

Patient Perception of Plant Based Diets for Kidney Disease (2022).        Objective - Plant-based diets can delay the progression of chronic kidney disease (CKD) and help manage complications and comorbid conditions such as hypertension, acidosis, diabetes, and cardiovascular disease. The objective of this study was to understand nephrology patients’ familiarity, perception, and use of plant-based diets.        Design & Methods - A survey was shared via the National Kidney Foundation's social media channels. Analysis included 844 responses. Survey items were evaluated with descriptive statistics. Differences across items were determined using chi-square tests.        Results - Most respondents were 61-70 years of age (26.7%, n = 225), female (56.5%, n = 477) and achieved a Bachelor's or advanced degree (49.9%, n = 421). The majority of respondents suffered from nondialysis–dependent CKD (34%) or received a kidney transplant (34%). About half (45%) of respondents were familiar with plant-based diets and most (58%) were aware that plant-based diets can improve CKD. Twenty-two percent reported following some version of a vegetarian diet, and 29% reported “eating less meat”. Respondents were not confident (Mdn = 2, IQR = 2, on a scale of 1-5) in their ability to plan a balanced plant-based meal, and were moderately confident that a plant-based diet could help blood pressure (Mdn = 3, IQR = 2) and slow progression of CKD (Mdn = 3, IGR = 2). Family eating preference, meal planning skills, preference for meat, figuring out what is healthy to eat, food cost, time constraints, and ease of cooking were rated as equal barriers to following a plant-based diet (Mdn = 3). A sample meal plan, individual counseling session with a Registered Dietitian Nutritionist (RDN), handouts, and cooking classes were resources rated most helpful to transition to a plant-based diet (Mdn = 4).        Conclusion - Approximately half of respondents were aware that plant-based diets can be beneficial for CKD. Many patients are following a vegetarian or plant-based eating pattern. More research should be done to see how effective RDNs are in educating and moving patients toward a plant-based eating pattern, as they are an underutilized resource in the CKD population.  https://www.jrnjournal.org/article/S1051-2276(22)00165-0/fulltext  

Nutritional Adequacy of Essential Nutrients in Low Protein Animal-Based and Plant-Based Diets in the United States for Chronic Kidney Disease Patients (2022).        Objectives - The nutritional adequacy of both animal-based and plant-based low protein diets (LPDs) and moderate protein diets that are recommended for patients with chronic kidney disease have not been well examined. We therefore analyzed the nutrient content of three representative LPDs and moderate protein diets (lacto-ovo vegetarian, omnivorous, and vegan) containing foods that are likely to be prescribed for nondialyzed chronic kidney disease or chronic dialysis patients in the United States to determine the nutritional adequacy at different levels of protein intake.        Methods - Theoretical 3-day menus were developed as per current renal dietary guidelines to model each diet at 7 different levels of protein intake (0.5-1.2 g/kilograms body weight/day [g/kg/d]). The diets were analyzed for their content of essential amino acids (EAAs) and other essential nutrients.        Results - At an a priori recognized inadequate dietary protein level of 0.5 g/kg/d, all 3 diets failed to meet the Recommended Dietary Allowances (RDAs) for the following EAAs: histidine, leucine, lysine, and threonine. The omnivorous LPD met both the RDA and Estimated Average Requirement at levels of 0.6 g protein/kg/d or more. The lacto-ovo and vegan diets at 0.6 and 0.8 g protein/kg/d, respectively, were below the RDA for lysine. The amounts of several other vitamins and minerals were not uncommonly reduced below the RDA or Adequate Intake with all 3 LPDs.        Conclusion - In comparison to omnivorous LPDs, both vegan and lacto-ovo LPDs are more likely to be deficient in several EAAs and other essential nutrients. To provide sufficient amounts of all EAA, vegan and lacto-ovo LPDs must be carefully planned to include adequate amounts of appropriate dietary sources. Supplements of some other essential nutrients may be necessary with all three LPDs.  https://www.jrnjournal.org/article/S1051-2276(22)00203-5/fulltext  

2023july18.     Serum URS concentrations are elevated in adults with CKD compared to matched non-CKD adults without differences in gut microbiota composition after consuming the same controlled study diet for 6 days.  https://www.jrnjournal.org/article/S1051-2276(23)00110-3/pdf

2023july14.     When signs of too little kidney function do arise, they may include loss of appetite, vomiting, itching, weakness and flu-like symptoms.    Swelling in the legs and shortness of breath may occur if water builds up in the body.  https://www.davita.com/education/kidney-disease/symptoms/what-is-creatinine?utm_source=SilverpopMailing&utm_medium=email&utm_campaign=Kidney%20Health%20Digest_July2023A%20(1)%20A&utm_content=&spMailingID=48480972&spUserID=MTQ2OTQxMTI1NjY5MQS2&spJobID=2500961081&spReportId=MjUwMDk2MTA4MQS2


2023july04.  

2023july03      dementia     H2o has a medical Dx of R41.3 Memory Difficulty (CHC Clinic), and G31.84 Mild Cognitive Impairment (NEF test score 27 of 30).

However, Harv thinks the interference with his daily life is not severe

2023july01      plant based diet    Based on high-quality evidence, international guidelines support the utilization of low-protein diets as an intervention to reduce CKD progression and mortality risk, although the precise thresholds (if any) for dietary protein intake vary across recommendations. There is also increasing evidence demonstrating that plant-dominant low-protein diets reduce the risk of developing incident CKD, CKD progression, and its related complications including cardiometabolic disease, metabolic acidosis, mineral and bone disorders, and uremic toxin generation. 
https://www.jrnjournal.org/article/S1051-2276(23)00105-X/fulltext?dgcid=raven_jbs_aip_email
 
 Data from the National Institutes of Health sponsored “Transitions of Care in CKD” US Renal Data System Special Study have also shown that, among people living with advanced CKD transitioning to ESKD, there is a high burden of comorbidities, including diabetes (74%), heart failure (59%), depression (33%), and anxiety (10%),10 as well as symptom burden.2, 11, 12     ...specific dietary interventions in conservative and preservative care, including 1) low...protein intake, largely from plant- dominant protein sources, 2) higher fruit and vegetable consumption, 3) increased dietary fiber intake, and 4) maintaining adequate caloric intake.        ...guidelines advise that adults with stages 3-5 NDD- CKD without diabetes who are metabolically stable should consume 1) a low-protein diet of 0.55-0.60 g/kg body weight/day, or 2) a very-low-protein diet of 0.28-0.43 g/kg of bodyweight/day with additional keto acid analogs in order to reduce risk of ESKD and/or death...         Although the Modification of Diet in Renal Disease (MDRD) trial showed marginal reduction in CKD progression with a very-low-protein diet, re-analysis of both achieved and prescribed dietary protein intake showed that low-protein diets significantly reduced eGFR decline. 41-43 Other clinical trials and observational studies have corroborated the benefits of low-protein diets on CKD outcomes36-39 and survival. 44         The safety and efficacy of low-protein diets has also been observed in NDD-CKD patients of older age.35 In a landmark randomized controlled trial of older (>70 years) adults with advanced NDD-CKD (eGFR 5-7 ml/min/1.73m?) without diabetes in Italy who were randomized to a supplemented very-low protein vegan diet (comprised of dietary protein intake of 0.3 g/kg/day and ketoacids, amino acids, and vitamins) vs. dialysis without dietary protein intake restriction, those in the supplemented very-low protein vegan diet arm delayed dialysis by ~11 months, with both groups showing similar mortality rates and the dialysis group demonstrating higher rates of hospitalization.36        While many dietary regimens for CKD are inherently restrictive,8 as well as concerns about the potential risk of protein-energy wasting, 45-47 these data suggest that low-protein diets can be safely administered in NDD-CKD, particularly when implemented under the supervision of specialty-trained kidney dietitians (see " Practical Implementation of Dietary Interventions").23, 28, 48-50        While the 2020 KDOQI guidelines indicate insufficient evidence to recommend a particular type of protein (plant vs. animal), the updated recommendations do support prescribing greater fruit and vegetable intake in patients with stages 1-4 NDD-CKD in order to decrease body weight, blood pressure, and net acid production.23       Given strong evidence supporting the role of low-protein diets in delaying CKD progression, experts in the field have proposed a patient-centered, pragmatic plant-dominant low-protein diet (PLADO) comprised of 1) dietary protein intake of 0.6-0.8 g/kg/day from 50% plant- sources, 2) higher fiber intake of >25 g/day, 3) low-sodium intake of <4 g/day (<3 g/day if edema or HTN are present), and 4) adequate caloric intake of 30-35 kcal/kg/day administered by dietitians trained in NDD-CKD care.$7, 73, 74         Both the ISRNM and KDOOI recommendations underscore the essential role that kidney dietitians play in individualized medical nutritional therapy, as well as routine nutritional assessments. 3,28 A patient-centered approach involves a shared understanding of treatment goals, effective communication to alleviate anxieties around food or food misconceptions, individualized advice, and assistance with implementation of dietetic advice in the face of a large symptom burden. 
Intermmitent Fast
270#= 122.5kg =74-98 with 37-49 plant based calories 3600-4200 = bonkers

2023july02.  use 180# weight loss aim 81.5kg gives 2400-2800 calories 

 







2023jun20. 1. Normal creatinine values may vary among different laboratories, and some patients with serum creatinine levels within the “normal” range may have substantial reduction in kidney function. For example, a 66-year-old man with a serum creatinine level of 1.4 mg/dL (to convert to μmol/L, multiply by 88.4)...        The take-home message is that recognition of CKD is important in order to identify and treat reversible causes of renal disease, slow the progression and avoid the complications of renal disease, and identify patients who may need dialysis or a renal transplant.1        3. The preferred method for quantitative estimation of protein excretion is the spot urine protein to creatinine ratio because it is accurate aore convenient than a 24-hour urine collection.4-7 In patients at risk of proteinuria (eg, patients with diabetes), a spot urine albumin to creatinine ratio is helpful for detecting microalbuminuria, thereby guiding further therapy. Patients with diabetes who have microalbuminuria may be at higher risk of developing diabetic nephropathy. In a patient with a urine protein to creatinine ratio of 1 or more, the risk of progression of CKD is higher. In fact, any patient with an elevated ratio (≥1) should be evaluated for causes of glomerular disease, including diabetes, collagen vascular disease (eg, systemic lupus erythematosus), malignancy (eg, multiple myeloma), infections (eg, human immunodeficiency virus infection, syphilis, hepatitis B and C), and use of medications such as nonsteroidal anti-inflammatory drugs (NSAIDs).8         4. In patients with CKD, it is imperative to slow the rate of disease progression. Nephrotoxic drugs, such as NSAIDs, aminoglycoside antibiotics, and radiocontrast agents, should be used with caution or avoided completely. Systemic blood pressure should be monitored frequently and controlled with a goal blood pressure of less than 130/80 mm Hg. A lower blood pressure may be desirable in patients with proteinuric CKD. A spot urine protein to creatinine ratio should be obtained periodically, with a ratio of 1 or more suggesting a higher risk of CKD progression.    Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) may slow the progression of CKD, especially in patients with proteinuria. In addition to lowering systemic blood pressure, ACEIs and ARBs also lower glomerular capillary blood pressure and protein filtration, which may contribute to their beneficial effect in slowing progression. They may also help reduce angiotensin II-mediated cell proliferation and fibrosis.11 Combination therapy with an ACEI and ARB may have a greater antiproteinuric effect than either drug alone, but patients should be monitored carefully for increases in serum creatinine and potassium levels.11,12 Patients with progressive CKD are at risk of renal osteodystrophy. Phosphorus, calcium, and parathyroid hormone levels should be monitored closely in all patients with stage 3 to 4 CKD. Abnormalities in these values may indicate the need for dietary phosphate restriction, administration of oral phosphate binders, and/or the administration of vitamin D.    Patients with CKD also have an increased risk of cardiovascular complications, including myocardial infarction.13 Aspirin (eg, 81 mg/d) and aggressive lipid-lowering strategies should be used, including 3-hydroxy-3-methylglutaryl (HMG) coenzyme A reductase inhibitors or statins, with a goal low-density lipoprotein cholesterol (LDL-C) level of 100 mg/dL or less (to convert to mmol/L, multiply by 0.0259).     Early referral to a nephrologist should be considered if CKD progresses or if the patient has uncontrolled complications, including nephritic-range proteinuria, uncontrolled blood pressure, uncontrolled secondary hyperparathyroidism, or active urine sediment. Consultation and/or comanagement with a kidney disease care team is advisable for patients with stage 3 CKD (GFR, 30-59 mL/min/1.73 m2). All patients with a GFR of less than 30 mL/min per 1.73 m2 (stages 4-5) should be referred to a nephrologist.9         5. Two important drugs in the treatment of patients with CKD are ACEIs and ARBs. In management of proteinuric kidney diseases, ACEIs or ARBs are used not only to optimize blood pressure control (Joint National Commission VII) but can be titrated up in patients with proteinuria. They are also the drugs of choice to prevent progression of proteinuric CKD.12,14,15, Patients who begin taking or have a dose increase in ACEIs or ARBs may experience an increase in the serum creatinine level. Although an increase of 20% to 30% is acceptable,16 it is important to confirm that the serum creatinine level stabilizes at the higher value and does not continue to increase. Also, an increase in serum potassium levels is sometimes seen in patients who are taking ACEIs or ARBs. A serum potassium level of up to 5.5 mEq/L (to convert to mmol/L, multiply by 1.0) is acceptable as long as it is stable and as long as the patient is aware of the need for dietary potassium restriction and will not be exposed to additional medications, such as spironolactone, that may exacerbate hyperkalemia. Follow-up serum creatinine and potassium levels should be ordered within 1 week. In patients with an increase in creatinine level of more than 20% to 30% or in those with uncontrollable hyperkalemia, the ACEI or ARB should be discontinued or titrated to a lower dose. Frequent monitoring is necessary. Furthermore, diuretics that work with reduced GFR, such as furosemide or metolazone, are useful agents in the treatment of hypertension and hyperkalemia in CKD. However, it is important to note that volume depletion may make a patient more susceptible to an ACEI- or ARB-induced increase in the serum creatinine level.        6. {Regular 8-week blood donation and iron supplement discontinued with CKD Dx.}       9. From an epidemiologic standpoint, secondary hypertension is relatively uncommon. Of patients who are diagnosed as having hypertension in a primary care clinic, 95% have primary or essential hypertension, and only 5% have a secondary cause.35 In a study at a hypertension clinic, secondary hypertension accounted for only 9% of all patients seen.36 Severe or difficult-to-control hypertension, hypertension that suddenly develops or suddenly worsens, or hypertension that is associated with other clinical findings may indicate secondary hypertension.37,38         Conclusion. Renal disease is commonly encountered by primary care physicians. Early recognition, evaluation, and appropriate treatment and/or referral are necessary to moderate the substantial morbidity and mortality that are often associated with diseases of the kidney.
2023may16. Why do they put phenylalanine in soda?
Along with other substances, Phenylalanine contributes to the formation of an important neurotransmitter (a brain chemical which transmits nerve impulses). This neurotransmitter enhances mental alertness and memory and improves mood.
 (Google2023may16T9am)

2023may02T6pm. Hi Mr. Otto,
Here is the ICD codes for chronic kidney disease
N18.32 - ICD-10 Code for Chronic kidney disease, stage 3b - Billable (icd10coded.com)
Article - Billing and Coding: Erythropoiesis Stimulating Agents (A57628) (cms.gov)
April Kelton MS, RD, LD/N, CDCES, CLC
 AdventHealth DeLand
Registered Dietitian – Diabetes/Nutrition Clinic
701 West Plymouth Ave
DeLand, FL 32720
Phone 386-943-3162
Fax 386-943-4696
Email: April.kelton@adventhealth.com
International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM)
https://www.cdc.gov › nchs › icd › icd-10-cm
ICD-10-CM Code N18.32 Chronic kidney disease, stage 3b Billable Code
N18.32 is a valid billable ICD-10 diagnosis code for Chronic kidney disease, stage 3b. It is found in the 2023 version of the ICD-10 Clinical Modification (CM) and can be used in all HIPAA-covered transactions from Oct 01, 2022 - Sep 30, 2023. https://icd10coded.com/cm/N18.32/

2023may01   Alzheimer’s   She worried she would soon be an empty shell, drooling and unkempt, a burden to the people she loved. ...fell into deep despair, confounded by the prescription given to her by an empathetic doctor: “Live with joy!” She had nightmares about going insane. But, eventually, she began to push back against the darkness.
Chopp has mild cognitive impairment, a condition that involves subtle changes in thinking and memory and that, in most cases, leads to Alzheimer’s dementia, a fatal neurodegenerative disease that affects more than 6.7 million Americans.
Now, changes are coming in how the disease is diagnosed and treated, and patients with mild cognitive impairment are at the center of the efforts. Lacking a cure, scientists are trying desperately to delay the worst phase of the illness.
...drugs are designed to slow the disease, not just treat symptoms, for people with lifestyle changes can help keep people in the early stage longer mild cognitive impairment, known as MCI, and early dementia from Alzheimer’s.
...lifestyle changes can help keep people in the early stage longer...    
In 2019, when Chopp was diagnosed, she was distraught about a neurologist’s prediction: She wouldn’t be able to button her clothes or feed herself within two years. And she was irritated when some friends, hearing about her illness, started talking more loudly, as though she could not understand what they were saying.
The term “mild cognitive impairment” became popular in 1999 ... The patients’ memories were slipping, but they were still able to drive, pay their bills and, in many cases, work. When the paper described these patients, Petersen said, “doctors said, ‘Yes, that makes sense. I see people in my practice like that, and I don’t know what to do with them.’ ”     The Alzheimer’s Association says that millions of older Americans may have MCI but cautions the data is not firm. Many will develop dementia, though the rate of decline varies widely, experts say.     Besides Alzheimer’s, other causes of MCI include depression, anxiety, medications and stroke. Doctors say it is important to find the cause to determine the next steps.
Chopp’s doctor asked her to take a few memory tests, and was concerned enough to refer her for more testing. Months later, an anxious Chopp and her husband headed to an appointment with a specialist for the diagnosis.
One of those studies was a groundbreaking 2015 one from Finland, called the FINGER trial. It found that using multiple strategies involving exercise, diet, and intellectual and social stimulation could maintain or improve cognitive functioning in older people who did not have symptoms but were at risk for developing Alzheimer’s.
Still, the illness is taking a toll. Chopp no longer drives at night. She often forgets what is on tap for the weekend. Sometimes, she puts ice cream in the pantry and salad in the freezer. And then there are the moments of pure panic.  https://www.washingtonpost.com/health/2023/04/24/alzheimers-early-symptoms-treatment/?utm_campaign=wp_news_alert_revere_trending_now&utm_medium=email&utm_source=alert&location=alert

2022sep via Google search   chronic kidney disease irritability (Google2022sep08R5pm)

Underlined highlights by Harv.  Can renal failure cause agitation?  A common symptom of kidney failure is delirium . This is a mental state that's marked by confusion and restlessness. It develops because the toxins that are accumulating are affecting the brain.

[Harv is taking the “mental clarity” daily pill.]  Can chronic kidney disease cause altered mental status?

Chronic manifestations of altered mental status. Causes of chronic alterations of mental status in CKD patients typically include stroke, cognitive impairment and dementia. These disorders are manifestations of chronic CNS [central nervous system] injury and as such they share several pathophysiological mechanisms.Nov 3, 2016.

Does kidney disease cause personality changes?  Decreased renal function due to chronic kidney disease (CKD) is associated with anxiety and cognitive decline. Although these mental disorders are often obvious in late stage renal disease patients, they might be unnoticeable or are neglected in early stages of the CKD development.Jan 9, 2020

Can kidney problems affect your mood?  Some of the feelings you may be experiencing could be:  Anger can fuel additional strain on relationships both professional and personal. Low mood - Lack of energy and nausea are common symptoms of kidney failure and this in itself can fuel low mood.Jul 2, 2019

How does kidney disease affect mental health?  Neuropsychiatric conditions including depression, anxiety disorders, and cognitive impairment are prevalent in patients with chronic kidney disease (CKD). These conditions often make worse the quality of life and also lead to longer hospitalizations and higher mortality.Aug 16, 2019

How do kidney failure patients feel?  A severe decrease in kidney function can lead to a buildup of toxins and impurities in the blood. This can cause people to feel tired, weak and can make it hard to concentrate. Another complication of kidney disease is anemia, which can cause weakness and fatigue. You're having trouble sleeping.Dec 17, 2020

How does chronic kidney disease affect the brain?  Nervous system complications range in severity from fatigue to dementia, seizure, and coma. There is a higher incidence of dementia in renal failure patients than in other people [19]. A diverse range of cognitive and memory problems have been observed in patients with AKI [acute kidney injury] who are undergoing hemodialysis.Dec 31, 2018

Does kidney disease cause anger issues?  Dealing with an illness like chronic kidney disease (CKD) can bring up many emotions, anger being one of them. Many people feel it is unfair they became ill and are mad about it.

Can kidney disease give you anxiety?  People with chronic kidney disease may be at a higher risk of experiencing anxiety. Research estimates as many as 12-52% of people with end stage kidney disease have anxiety disorder at some point.Sep 8, 2021

What are the 3 early warning signs of kidney disease?  Generally, earlier stages are known as 1 to 3. And as kidney disease progresses, you may notice the following symptoms. Nausea and vomiting, muscle cramps, loss of appetite, swelling via feet and ankles, dry, itchy skin, shortness of breath, trouble sleeping, urinating either too much or too little.Sep 3, 2021

What emotion is related to the kidneys?  Fear is the emotion of the kidneys and the bladder, organs associated with the water element. It is a normal adaptive emotion, but can become chronic when ignored. Kidney issues often arise when we are dealing with fear, such as a change in life direction or unstable living conditions.    The odds of having reduced cognitive ability were increased by 23% among individuals with chronic kidney disease, Dr. Kurella-Tamura's group observed. More advanced stages of kidney disease were associated with even higher risk of poor mental functioning.    Many chronic kidney disease patients have anemia, which aside from making you feel tired, can also make you feel cold. Anemia is the result of kidney disease patients not producing as much heat in their bodies due to fewer red blood cells which carry oxygen through the body.    Individuals with chronic kidney disease (CKD), especially older adults, are at more risk of experiencing cognitive impairment, possibly leading to mild cognitive impairment (MCI) and/or dementia.

Does CKD cause brain fog?  People with kidney disease sometimes describe themselves as feeling like they have “brain fog”—a nice-ish way of saying they are muddled in their thinking, have trouble concentrating, and keep forgetting things. These symptoms can have several kidney disease-related causes.Feb 18, 2020

Does kidney function affect memory?  Baseline kidney function was associated with declines in semantic memory, episodic memory, and working memory but not visuospatial abilities or perceptual speed.

Does high creatinine cause anxiety?  Conversely, creatinine levels (biomarkers) appeared predictive for negative emotional adaptations: high creatinine levels were found to be positively associated with high stress levels as well as psychological distress.Dec 14, 2021    [COA reopened-center 9-5 activities “takeover” of dining-activities caused in-fighting and a complaint environment which reduced fulfillment of Harv’s quality retirement and personal cooperative character expression needs — discussion of many topics, speculation, facts evaluation, insight into COA informal organization, …]    The GFR is the best overall indicator of the level of kidney function (NKF grades S, C, and R). The GFR should be estimated using a prediction equation that takes into account the serum creatinine level and some or all of these variables: age, sex, race, and body size.Sep 15, 2004    Around 90 percent of people who have this condition are unaware they have it. 2 out of 5 adults who have CKD don't know they have severe chronic kidney disease. People with CKD can live for years without knowing, as it doesn't always have the most clearly defined symptoms.Mar 25, 2021    Complete and irreversible kidney failure is sometimes called end-stage renal disease, or ESRD. If your kidneys stop working completely, your body fills with extra water and waste products. This condition is called uremia. Your hands or feet may swell.    Blood sugar, or glucose, is the main sugar found in your blood. It comes from the food you eat, and is your body's main source of energy. Your blood carries glucose to all of your body's cells to use for energy. Diabetes is a disease in which your blood sugar levels are too high.Jun 15, 2017    A fasting blood sugar level of 99 mg/dL or lower is normal, 100 to 125 mg/dL indicates you have pre-diabetes, and 126 mg/dL or higher indicates you have diabetes.  Harv thinks A1c is a longer term indicator.    Ginger is a kidney friendly seasoning. Extracts of Ginger have been shown to reduce nephropathy in rat studies. Research shows Ginger reduces the results of diabetes complications such as Kidney Disease, so it can be used as precautionary medicine to delay kidney disease.Feb 5, 2020

Nephropathy medications. In the early stages of diabetic nephropathy, your treatment plan may include medications to manage the following: Blood pressure control. Medications called angiotensin-converting enzyme (ACE) inhibitors and angiotensin 2 receptor blockers (ARBs) are used to treat high blood pressure.Oct 19, 2021

These studies demonstrate that diabetic nephropathy can be reversed [stopped deterioration] by a relatively simple dietary intervention. Whether reduced glucose metabolism mediates the protective effects of the ketogenic diet remains to be determined.Apr 20, 2020

On a keto diet, you restrict carbohydrates and protein, which means you consume a diet high in fat. Insufficient carbohydrates or protein means you don't have much glucose for fuel. Your body utilizes that back-up fuel, converting the fat you eat and body fat into ketones. You're literally burning fat for fuel!  https://maxliving.com › healthy-articles › the-keto-diet

The keto diet could cause low blood pressure, kidney stones, constipation, nutrient deficiencies and an increased risk of heart disease. Strict diets like keto could also cause social isolation or disordered eating. Keto is not safe for those with any conditions involving their pancreas, liver, thyroid or gallbladder.Jun 20, 2019

2019nov23.  Geriatric assessment.  When Lorraine Griggs' 86-year-old father was diagnosed with prostate cancer, he was treated with 35 rounds of radiation, though he had a long list of other serious medical issues, including diabetes, kidney disease and high blood pressure. The treatment left him frailer, Griggs recalls.    A few years later, when his prostate cancer reoccurred, Griggs' father received a different kind of cancer care. Before his doctor devised a treatment plan, she ordered what's known as a geriatric assessment. It included a complete physical and medical history, an evaluation by a physical therapist, a psychological assessment and a cognitive exam. The doctor also asked her father about his social activities, which included driving to lunch with friends and grocery shopping with some assistance.    "When the doctor saw how physically active and mentally sharp my father was at 89 years of age, but that he had several chronic, serious medical problems, including end stage kidney disease, she didn't advise him to have aggressive treatment like the first time around," says Griggs, who lives in Rochester, N.Y.    Instead, his oncologist placed her dad on one pill a day that just slowed down his cancer. Griggs' father was able to enjoy his activities for another three years until he died at the age of 92.    Geriatric assessment is an approach that clinicians use to evaluate their elderly patients' overall health status and to help them choose treatment appropriate to their age and condition. The assessment includes questionnaires and tests to gauge the patients' physical, mental and functional capacity, taking into account their social lives, daily activities {below} and goals.   https://www.npr.org/sections/health-shots/2019/11/23/714300273/a-cancer-care-approach-tailored-to-the-elderly-may-give-better-results

What are Harv’s goals? (the object of a person's ambition (desire and determination to achieve success {actualization: joy not sad, love not hate, freeing not fearing}) or effort; an aim or desired result. OAD). Goal #1 free to choose daily sequence and intensity of actuals’ tasks. This bases on self joy/love tasks. Daily St.Cloud retirement tasks (1) night sleep, (2) sort/ingest pills, (3) nap sleep, (4) Cici pizza meal/pills, (5) peaceful drives, (6) Disney walk {or day nap}, (7) McD decaf/snack/pills, (1) night sleep. Periodic tasks are (8) hair cuts, (9) showers, (10) gym exercise, (11) laundry, (12) as-set maintenance/shopping, (13) socialization.