Nutritional assessment in hemodialysis patient
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Nutritional Assessment in Hemodialysis Patient. Haneen Nabeel Molla M.Sc. Clinical Dietitian King Khalid University Hospital. S tages of Kidney Disease. There are five stages of kidney disease . It based on the presence of kidney damage and the glomerular filtration rate (GFR )

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Nutritional Assessment in Hemodialysis Patient

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Nutritional assessment in hemodialysis patient

Nutritional Assessment in HemodialysisPatient

Haneen NabeelMolla M.Sc.

Clinical Dietitian

King Khalid University Hospital


S tages of kidney disease

Stages of Kidney Disease

There are five stages of kidney disease.

It based on the presence of kidney damage and the glomerular filtration rate (GFR)

The treatment is based on the stage of kidney disease.


Stages of kidney disease

Stages of Kidney Disease


End stage renal disease esrd

End Stage Renal Disease ( ESRD ) :

Inability to excrete waste products , maintain fluid and electrolyte balance and produce hormones.


When is dialysis needed

When is Dialysis Needed?

Kidneys no longer remove enough wastes and fluid from the blood

When only 10 to 15 percent of the kidney function left.


When is dialysis needed1

When is Dialysis Needed?

Symptoms such as nausea, vomiting, swelling and fatigue.

Ahigh level of wastes in their blood that may be toxic to their body.


Nutrition and hemodialysis

Nutrition and Hemodialysis

  • Diet is an important part in hemodialysis patient overall care.

  • We will go over some of the important points in the patient diet which include :

    • Getting the right amount of calories and protein

    • Staying at a healthy body weight

    • Important nutrients in the diet

      • Potassium

      • phosphorus

      • sodium and fluids

      • calcium

    • Diabetic – Renal Diet


The goals of the nutritional management in dialysis

The Goals of the Nutritional Management in Dialysis

Prevent nutrients deficiencies

Control edema and serum electrolytes

Provide an attractive healthy diet


Anthropometric measurement

Anthropometric Measurement

  • Weight kg

  • High cm

  • Body mass index (BMI ): Weight

    (Height)2

    • Underweight 16.0 to 18.5

    • Normal (healthy weight) 18.5 to 25

    • Overweight 25 to 30

    • Obese Class I (Moderately obese)30 to 35

    • Obese Class II (Severely obese)35 to 40

    • Obese Class III (Very severely obese) over 40


Anthropometric measurement1

Anthropometric Measurement

adjusted body weight (AIBW)= (Actual weight – IBW)

x 0.32 + IBW women

x 0.38 + IBW men

Ideal body weight (IBW) : (Height)2 x 22.4 men

x 22.1 women

% of IBW: Actual Weight x 100

IBW


G etting the right amount of calories

Getting the Right Amount of Calories

  • To the patients overall health and helps to give them energy to do their normal activities .

  • Calories come from all the foods they eat , and are important because :

    • Give the body energy

    • Help to stay at a healthy body weight

    • Help the body use protein for building muscles

      and tissues.


Getting the right amount of calories

Getting the Right Amount of Calories

  • Energy35 kcal/kg of body weight for <60 years;

    30 to 35 kcal/kg of body weight for >60 years

Will keep the patients from losing weight.

The amount of calories recommended will depend on the individual needs.


Getting the right amount of protein

Getting the Right Amount of Protein

  • In pre-dialysis patients have to be on a low-protein diet.

  • During dialysis patients will need diet with more protein.

  • It is important for overall health and how well they feel.

  • Body needs the right amount of protein for:

    • Building muscles

    • Repairing tissue

    • Fighting infections.


Protein

Protein

  • Protein is found in 2 types of foods:


Protein1

Protein

  • Some of these protein-rich foods may also contain lots of phosphorus, which need to be controlled in their diet.

  • Protein : 1.2- 1.3 g/kg of body weight, >50% HBV protein


Potassium

Potassium

Potassium is an important mineral found in food.

Potassium helps the muscles and heart work properly.

Healthy kidneys helps to keep the right amount of potassium in the body.


Potassium1

Potassium

Too much or too little potassium level in the blood can be dangerous.

With hemodialysis, patients need to limit their intake of high-potassium foods.


Potassium2

Potassium

  • Soaking the vegetables after cutting it and cooking it helps to remove high amount of potassium

  • Potassium: 2 to 3 g/day; or 40mg/kg IBW


High potassium fruit

High-Potassium Fruit

(>200 mg / portion) The portion size is ½ cup

Mango(1 medium)

Nectarine(1 medium)

Orange(1 medium)

Orange Juice

Papaya (½ whole)

Pomegranate (1 whole)

Pomegranate Juice

Prunes

Prune Juice

Raisins

Apricot, raw (2 medium)dried (5 halves)

Avocado (¼ whole)

Banana (½ whole)

Cantaloupe

Dates (5 whole)

Dried fruits

Figs, dried

Grapefruit Juice

Honeydew

Kiwi (1 medium)


High potassium vegetables

High-Potassium Vegetables

(>200 mg / portion) The portion size is ½ cup

Legumes

Mushrooms, canned

Okra

Parsnips

Potatoes, white and sweet

Pumpkin

Rutabagas

Spinach, cooked

Tomatoes/Tomato products

Vegetable Juices

Artichoke

Baked Beans

Squash

Beets, fresh then boiled

Black Beans

Broccoli, cooked

Brussels Sprouts

Chinese Cabbage

Carrots, raw

Lentils

Dried Beans and Peas


Other high potassium foods

Other High Potassium Foods

(>200 mg / portion) The portion size is ½ cup

Bran/Bran products

Chocolate (1.5-2 ounces)

Granola

Milk, all types (1 cup)

Molasses (1 Tablespoon)

Yogurt


Low potassium fruit

Low-Potassium Fruit

(<200 mg/ portion) The portion size is ½ cup

Grapes, Grape Juice

Raspberries

Plums (1 whole)

Tangerine (1 whole)

Strawberries

Pears(1 small) canned (½ cup)

Pineapple, Pineapple Juice

Peaches, (1 small) canned (½ cup)

Watermelon(limit to 1 cup)

Apple (1 medium)

Apple Juice

Applesauce

Blackberries

Blueberries

Cherries

Cranberries

Fruit Cocktail

Grapefruit (½ whole)


Low potassium vegetables

Low-Potassium Vegetables

(<200 mg/ portion) The portion size is ½ cup

Watercress

Yellow Squash

Zucchini Squash

Onions

Parsley

Peas, green

Peppers

Radish

Kale

Lettuce

Asparagus (6 spears)

Beans, green or wax

Cabbage, green and red

Carrots, cooked

Cauliflower

Celery (1 stalk)

Corn, fresh (½ ear) frozen (½ cup)

Cucumber

Eggplant

Mixed Vegetables

Mushrooms, fresh


Other foods low potassium

Other Foods Low Potassium

( <200 mg/ portion) The portion size is ½ cup

Rice

Noodles

Pasta

Bread and bread products: (Not Whole Grains)

Cake: angel, yellow

Coffee: limit to 8 ounces ( 1 cup )

Pies without chocolate or high potassium fruit

Cookies without nuts or chocolate

Tea: limit to 16 ounces (2 cups )


Phosphorus

Phosphorus

Phosphorus is a mineral found in different kind of foods.

Eating foods high in phosphorus will raise the amount of phosphorus in the blood.

When phosphorus builds up in the blood, calcium is pulled from the bones. Over time, the bones will become weak and break easily.

Dialysis cannot remove all of this phosphorus.


Phosphorus1

Phosphorus

  • A high level of phosphorus in the blood may also cause calcium phosphorus crystals to build up in the joints, muscles, skin, blood vessels and heart.

  • These crystals may cause serious problems such as

    • Bone pain

    • Damage to the heart and other organs

    • Poor blood circulation

    • Skin ulcers.


Phosphorus2

Phosphorus

  • To keep blood phosphorus at safe levels, patients will need to limit phosphorus-rich foods, and may need to take some medications.

  • Phosphorus 800 to 1,000 mg/day; or 17mg/kg IBW


High phosphorus food

High Phosphorus Food

( >150 mg/portion)

The portion size is ½ cup

Dairy Products:

Milk, Yogurt ,Pudding, Custard, Ice cream and Cream soups

Protein

  • Carp, sardines, beef liver, chicken liver ,organ meats, oysters


High phosphorus food1

High Phosphorus Food

Other foods

bran cereals

brewer’s yeast

nuts

caramels

seeds

Beverages

Ale, Beer

drinks made with milk

chocolate drinks

Cocoa, dark colas

Vegetables dried

beans and peas:

baked beans

black beans

chick peas

kidney beans

lentils

northern beans

split peas

soy beans


Sodium

Sodium

Sodium is a mineral found naturally in foods. It is found in large amounts in table salt and in foods that have added table salt.

Eating too much sodium can make the patient thirsty and cause the body to hold onto more fluid.


Sodium1

Sodium

  • The extra sodium can cause:

    • Swelling or puffiness around eyes, hands or feet

    • Fluid weight gain

    • Shortness of breath

    • Rise in blood pressure

    • More work for their heart

  • Sodium1 - 3 g/day


Nutritional assessment in hemodialysis patient

Sodium


Fluids

Fluids

  • Fluid is any food or beverage that is liquid at room temperature.

  • Some examples are:

    • Ice

    • Beverages like coffee, tea, sodas, juices and water

    • Frozen desserts such as ice cream, sherbet or PopsiclesGelatin

    • Gravy and Soups


Fluids1

Fluids

  • Signs may noticed with drinking too many fluids

    • A sudden increase in weight along with swelling

    • Shortness of breath

    • A rise in the blood pressure

      Fluid : output + 1000 ml


Calcium

Calcium

Calcium is the mineral that is important for building strong bones.

However, foods that are good sources of calcium are also high in phosphorus.


Calcium1

Calcium

  • To prevent loss of calcium from bones

    • Follow a diet that limits high-phosphorus foods

    • Take phosphate binders.

  • In some cases the physician may prescribe a special form of vitamin D to help keep calcium and phosphorus levels in balance and prevent bone disease.


Diabetic renal diet in hemodialysis

Diabetic-Renal Diet in Hemodialysis

Patient on hemodialysis diet will have restrictions in foods containing high amounts of phosphorus, sodium and potassium.

Diabetic patients who are on hemodialysis will be tightly controlled the Carbohydrate intake in order to manage the blood glucose levels.


Diabetic renal diet in hemodialysis1

Diabetic-Renal Diet in Hemodialysis

High sugar foods and all carbohydrate containing foods, increase blood glucose levels.

The total amount of carbohydrates the patients eat will be balanced with their medication and activity level.

They could use system called carbohydrate counting to keep their carbohydrate intake balanced.


Diabetic renal diet in hemodialysis2

Diabetic-Renal Diet in Hemodialysis

Take low phosphorus and low potassium foods .

Limit milk and dairy intake.

Control blood sugar to help control thirst and fluid gains.

Avoid cooking with salt, salt substitutes, or add salt at the table.


Conclusion

Conclusion

Our goal for hemodialysis patients should be a healthy lifestyle that can be maintained in the long run, rather than a short-term "diet”. It's all about making changes that will last a lifetime--changes that are focused on smart, sensible eating.


Thank you

Thank you


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