MedifocusHealth

Malnutrition is prevalent in end-stage renal disease and is consistently linked to increased mortality, morbidity, and poor quality of life in the dialysis population. Malnutrition in dialysis patients is characterized by insidious loss of protein stores in the body and is present in approximately 20-50% of patients on dialysis. Factors associated with decreased nutritional status include:

• Decrease dietary protein and calorie intake (due to poor appetite, hospitalizations, multiple medications)
• Comorbid illnesses such as diabetes, gastrointestinal disease
• Increased energy expenditure at rest
• Inadequate dialysis
• Loss of nutrients during dialysis
• Hormonal and metabolic changes (including hyperparathyroidism, insulin, and growth hormone resistance)

Studies have suggested that inappropriate food and fluid intake contributes to 60-80% of deaths in persons with end-stage renal disease. It is important to speak with a dietician on a regular basis for guidance and assistance in determining and optimal individualized diet plan - and to adhere to the recommended diet closely.

Some common nutritional guidelines include:

• Eating balanced amounts of foods high in protein such as meat and chicken. Animal protein is better used by your body than the protein found in vegetables and grains.
• Monitoring and restricting the amount of potassium intake. Potassium is a mineral found in salt substitutes, some fruits, vegetables, milk, chocolate, and nuts. Too much or too little potassium can be harmful to your heart.
• Limiting the amount of fluids you drink - especially water. Fluids build up quickly in your body when your kidneys aren't working. Too much fluid makes your tissues swell. It also can cause high blood pressure and heart trouble.
• Minimizing or avoiding salt intake
• Limit foods such as milk, cheese, nuts, dried beans, and soft drinks. These foods contain the mineral phosphorus. Too much phosphorus in your blood causes calcium to be pulled from your bones. Calcium helps keep bones strong and healthy.
• Use of dietary supplements to enhance caloric intake (speak with your nephrologist and dietician for recommendations on appropriate supplements)
• For patients undergoing peritoneal dialysis, it may be necessary to reduce total caloric intake, since the sugar in the dialysate solution may cause weight gain.