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Nutrition: Whatcanieat?
Nutrition: Whatcanieat?
HD
What can I eat ?
Mona Tawfik
Lecturer of internal Medicine
Nephrology Unit
MNDU
CASE PRESENTATION-1
A 63-year-old male patient who has ESRD secondary to diabetes.
He has been on dialysis for three years. Prior to his multiple
hospitalizations. He was an active person, had a good appetite and
was viewed as a “non-compliant” patient as his phosphorus was
always out of control and he usually forgot to take his binders.
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Uremic malnutrition
Protein–energy malnutrition
Malnutrition–inflammation atherosclerosis
syndrome
Malnutrition–inflammation complex syndrome
Inflammatory wasting
o Gender
o Age
o Systemic disease
(K/DOQI) 2000
3 day recall Recommendations for
Nutritional Management
7 day recall
Diet Assessment
Calories
Protein
Carbohydrates
Fat/Cholesterol
Sodium
Potassium
Phosphorus
Fluid
Vitamins
Minerals
BMI
EBPG,2007
USRDS DIALYSIS, MORBIDITY AND MORTALITY
WAVE II STUDY (DMMS).
P<0.01
DOPPS study
The investigators concluded that in haemodialysis
patients malnutrition, as indicated by low values
obtained with the SGA, was associated with higher
mortality risk
Kidney Int 2002; 62: 2238–2245
EBPG2007
MAC (MID-ARM
CIRCUMFERENCE)
However
Albumin is affected by non-nutritional
factors
Infection
Inflammation
Co-morbidities
Fluid overload
Inadequate dialysis
Blood loss
Metabolic acidosis
J Bras Nefrol 2015;37(2):198-205
SERUM PREALBUMIN
Include
General physical appearance
Oral , skin health & Signs of
vitamin deficiency
Handgrip strength (Heimburger
et al 2000)
Subjective visual assessment of
subcutaneous tissue and muscle
mass (Enia1993)
Kidney International (2008) 73, 391–398
As there is no single IDEAL ‘gold
standard’ measure of nutritional
state
DIAGNOSIS OF PEW IN HD
ISRNM Kidney Int. 2008;73:391-98
1
CASE STUDY: DIETETIC HISTORY
Before hospitalization; the patient was following the
clinic’s standard HD diet (80gm protein, 2gm sodium,
2gm potassium, <900mg phosphorus and 1000mL fluid
restriction).
Recommended Recieved
Changes in DW over
past 4 months
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Nephrologist
Nurse
pharmacist
Social Worker
patient's best
friend
renal specialist
dietitian
psychotherapist
NEPHROLOGIST FROM OPC TO DIALYSIS UNIT
Removal of :
Amino acids (about 10 to 12 g per HD)
Some peptides
low amounts of protein (< 1 to 3 g per dialysis, including
blood loss)
Small quantities of glucose (about 12 to 25 g per dialysis if
glucose-free dialysate is used)
Dietitians
are qualified
professionals and
experts in the
application of
science in
nutrition and
metabolism.
.
NUTRITIONAL CARE ……
HD DIETS AIMS TO
Limit the build up of waste product
(urea, phosphate, K, Na & salt)
Calculated based on
Current weight,
Age and gender
Physical activity and metabolic stress
30-35 kcal/kg/d 1B
o 0.75 g/kg IBW/day for patients with stage 4-5 CKD not on dialysis
• 82 grams
1.2 (protein per kg • ½ cup milk
BW)×68 (BW) • 2 eggs or 4
= egg whites
81.6 gm of protein • 5-6 oz meat
• 3 vegetables
50-70% of HBV • 8 servings of
grains
TIPS FOR COOKING
SODIUM
In CKD& HD:-
May result in :-
High blood pressure,
Fluid retention/swelling (edema)
Excessive thirst
CHF
SODIUM CONTENT OF BREAKFAST
TIPS FOR SALT REDUCTION
Excess fluid :
Calcium phosphate
Disodium phosphate
Trisodium triphosphate
Monosodium phosphate
Sodium tripolyphosphate
Tetrasodium pyrophosphate
Potassium tripolyphosphate
PHOSPHORUS ADDITIVES
POTASSIUM
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