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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

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.

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


    • 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


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 is found in 2 types of foods:


  • 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 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.


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.


  • 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


Prune Juice


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

Avocado (¼ whole)

Banana (½ whole)


Dates (5 whole)

Dried fruits

Figs, dried

Grapefruit Juice


Kiwi (1 medium)

High potassium vegetables
High-Potassium Vegetables

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


Mushrooms, canned



Potatoes, white and sweet



Spinach, cooked

Tomatoes/Tomato products

Vegetable Juices


Baked Beans


Beets, fresh then boiled

Black Beans

Broccoli, cooked

Brussels Sprouts

Chinese Cabbage

Carrots, raw


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)


Milk, all types (1 cup)

Molasses (1 Tablespoon)


Low potassium fruit
Low-Potassium Fruit

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

Grapes, Grape Juice


Plums (1 whole)

Tangerine (1 whole)


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






Fruit Cocktail

Grapefruit (½ whole)

Low potassium vegetables
Low-Potassium Vegetables

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


Yellow Squash

Zucchini Squash



Peas, green





Asparagus (6 spears)

Beans, green or wax

Cabbage, green and red

Carrots, cooked


Celery (1 stalk)

Corn, fresh (½ ear) frozen (½ cup)



Mixed Vegetables

Mushrooms, fresh

Other foods low potassium
Other Foods Low Potassium

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




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 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.


  • 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.


  • 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


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

High phosphorus food1
High Phosphorus Food

Other foods

bran cereals

brewer’s yeast





Ale, Beer

drinks made with milk

chocolate drinks

Cocoa, dark colas

Vegetables dried

beans and peas:

baked beans

black beans

chick peas

kidney beans


northern beans

split peas

soy beans


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.


  • 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


  • 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


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

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


  • 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.


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.