nutritional assessment in hemodialysis patient haneen nabeel molla m.sc. clinical dietitian king...
TRANSCRIPT
Nutritional Assessment in Hemodialysis
Patient
Haneen Nabeel Molla M.Sc.
Clinical Dietitian King Khalid University Hospital
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
Stage
Description Glomerular Filtration Rate (GFR)*
1 Kidney damage (e.g., protein inthe urine) with normal GFR
90 or above
2 Kidney damage with milddecrease in GFR
60 to 89
3 Moderate decrease in GFR 30 to 59
4 Severe reduction in GFR 15 to 29
5 Kidney failure Less than 15
Stages of Kidney Disease
Inability to excrete waste products , maintain fluid and electrolyte balance and produce hormones.
End Stage Renal Disease ( ESRD ) :
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 Needed?
Symptoms such as nausea, vomiting, swelling and fatigue.
A high level of wastes in their blood that may be toxic to their body.
When is Dialysis Needed?
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
Nutrition and Hemodialysis
Prevent nutrients deficiencies Control edema and serum electrolytes Provide an attractive healthy diet
The Goals of the Nutritional Management in Dialysis
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 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
Anthropometric Measurement
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
Will keep the patients from losing weight.
The amount of calories recommended will depend on the individual needs.
Getting the Right Amount of Calories
Energy 35 kcal/kg of body weight for <60 years; 30 to 35 kcal/kg of body weight for >60 years
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.
Getting the Right Amount of Protein
Protein is found in 2 types of foods:
Protein
Animal sources Plant sources
poultry , meat , eggs, seafood , milk and cheese
nuts, seeds , legumes, soy and tofu
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
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.
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.
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
Potassium
High-Potassium Fruit
Apricot, raw (2 medium)dried (5 halves)
Avocado (¼ whole)Banana (½ whole)CantaloupeDates (5 whole)Dried fruitsFigs, driedGrapefruit JuiceHoneydewKiwi (1 medium)
(>200 mg / portion) The portion size is ½
cup
Mango(1 medium)Nectarine(1 medium)Orange(1 medium)Orange JuicePapaya (½ whole)Pomegranate (1 whole)Pomegranate JuicePrunesPrune JuiceRaisins
High-Potassium Vegetables
ArtichokeBaked BeansSquashBeets, fresh then boiledBlack BeansBroccoli, cookedBrussels SproutsChinese CabbageCarrots, rawLentilsDried Beans and Peas
(>200 mg / portion) The portion size
is ½ cup
LegumesMushrooms, cannedOkraParsnipsPotatoes, white and sweetPumpkinRutabagasSpinach, cookedTomatoes/Tomato productsVegetable Juices
Other High Potassium Foods
Bran/Bran productsChocolate (1.5-2 ounces)GranolaMilk, all types (1 cup)Molasses (1 Tablespoon)Yogurt
(>200 mg / portion) The portion size
is ½ cup
Low-Potassium Fruit
Apple (1 medium)Apple JuiceApplesauceBlackberriesBlueberriesCherriesCranberriesFruit CocktailGrapefruit (½ whole)
(<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)
Low-Potassium Vegetables
Asparagus (6 spears)Beans, green or waxCabbage, green and redCarrots, cookedCauliflowerCelery (1 stalk)Corn, fresh (½ ear) frozen (½ cup)CucumberEggplantMixed VegetablesMushrooms, fresh
(<200 mg/ portion) The portion size is ½ cup
WatercressYellow SquashZucchini SquashOnionsParsleyPeas, greenPeppersRadishKaleLettuce
Other Foods Low Potassium
Cake: angel, yellowCoffee: limit to 8 ounces ( 1
cup )Pies without chocolate or
high potassium fruitCookies without nuts or
chocolateTea: limit to 16 ounces (2
cups )
( <200 mg/ portion) The portion size is ½ cup
RiceNoodlesPastaBread and bread products:
(Not Whole Grains)
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.
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.
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
Phosphorus
High Phosphorus Food
Protein Carp, sardines, beef
liver, chicken liver ,organ meats, oysters
( >150 mg/portion) The portion size is ½ cup
Dairy Products: Milk, Yogurt ,Pudding,
Custard, Ice cream and Cream soups
High Phosphorus Food
Vegetables dried beans and peas:
baked beansblack beanschick peaskidney beanslentilsnorthern beanssplit peassoy beans
Other foods
bran cerealsbrewer’s yeastnutscaramelsseedsBeveragesAle, Beerdrinks made with milkchocolate drinksCocoa, dark colas
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.
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
Sodium 1 - 3 g/day
Sodium
SEASONINGS
High Sodium Sauces
Salted Snacks
MEATS PROCESSED FOODS
Table saltSeasoning saltGarlic saltOnion saltCelery salt
Barbecue Steak Soy Teriyaki Oyster
CrackersPotato chipsCorn chipsPretzelsTortilla chipsNutsPopcornSunflower seeds
Hot DogsCold cuts, PastramiSausageCorned beefSpam
Frozen prepared foodsCommercial mixesButtermilkCheeseSoupsTomato productsVegetable juicesCanned vegetables Canned raviolisChiliMacaroni & CheeseSpaghettiFast foodsPicklesOlives
Sodium
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 Popsicles Gelatin Gravy and Soups
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
Fluids
Calcium is the mineral that is important for building strong bones.
However, foods that are good sources of calcium are also high in phosphorus.
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.
Calcium
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 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 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.
Diabetic-Renal Diet in Hemodialysis
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.
Conclusion
Thank you