A practical approach to the nutritional management of chronic kidney disease patients in Cape Town, South Africa

Background: The multi-racial and multi-ethnic population of South Africa has significant variation in their nutritional habits with many black South Africans undergoing a nutritional transition to Western type diets. In this review, we describe our practical approaches to the dietary and nutritional management of chronic kidney disease (CKD) patients in Cape Town, South Africa. Discussion: Due to poverty and socio-economic constraints, significant challenges still exist with regard to achieving the nutritional needs and adequate dietary counselling of many CKD patients (pre-dialysis and dialysis) in South Africa. Inadequate workforce to meet the educational and counselling needs of patients, inability of many patients to effectively come to terms with changing body and metabolic needs due to ongoing kidney disease, issues of adherence to fluid and food restrictions as well as adherence to medications and in some cases the inability to obtain adequate daily food supplies make up some of these challenges. A multi-disciplinary approach (dietitians, nurses and nephrologists) of regularly reminding and educating patients on dietary (especially low protein diets) and nutritional needs is practiced. The South African Renal exchange list consisting of groups of food items with the same nutritional content has been developed as a practical tool to be used by dietitians to convert individualized nutritional prescriptions into meal plan to meet the nutritional needs of patients in South Africa. The list is currently utilized in counselling CKD patients and provides varied options for food items within the same group (exchangeable) as well as offering ease for the description of suitable meal portions (sizes) to our patients. Summary: Regular and continuous education of CKD patients by a multi-disciplinary team in South Africa enables our patients to meet their nutritional goals and retard CKD progression. The South African renal exchange list has proved to be a very useful tool in meeting this need

Additional file 3: Table S3. of A practical approach to the nutritional management of chronic kidney disease patients in Cape Town, South Africa

Standard portion sizes of South African fruits by potassium content. (DOCX 15 kb

Additional file 2: Table S2. of A practical approach to the nutritional management of chronic kidney disease patients in Cape Town, South Africa

Common South African vegetables and standardized portions according to potassium content. (DOCX 17 kb

Limb fracture during recovery from general anaesthesia : an often tragic complication of equine anaesthesia

A 10-year-old thoroughbred mare was presented for lameness of the left hindlimb as a result of an apical fracture of the lateral proximal sesamoid bone. The mare was ultimately euthanased after suffering catastrophic fractures of the 3rd and 4th metatarsal bones of the contra-lateral hindlimb during an uncoordinated attempt to rise during recovery from general anaesthesia after undergoing arthroscopic surgery. The case report focuses mostly on horse anaesthesia-related mortality, anaesthetic procedure in the horse, possible causes of fractures in horses during recovery and ways in which rate of occurrence of these fractures can be minimised