Role of Medical Nutrition & Management of Dialysis Patient

Updated: Jan 24


Healthy kidneys are essential for a healthy body. Kidneys are responsible for filtering waste products, excess water, and impurities out of the blood. These toxins are stored in the bladder and then removed during urination. The kidneys also regulate pH, salt, and potassium levels in the body. They produce hormones that regulate blood pressure and control the production of red blood cells. The kidneys even activate a form of vitamin D that helps the body absorb calcium.


What is Chronic Kidney Disease?

Causes and Risk Factors Chronic kidney disease refers to a long-term loss of kidney function that can get worse over time. If the extent of damage is high, your kidneys may stop working. This is called kidney failure, or end-stage renal disease (ESRD). If your kidneys fail, you will need dialysis or a kidney transplant in order to live. CKD increases our risk of having heart and blood vessel disease. Out of many the two main causes of CKD are diabetes and high blood pressure.


CAUSES AND RISK FACTORS




The impact of chronic kidney disease on global health

The new analysis suggests that in 2017, the global prevalence of CKD was 9.1% (697.5 million cases). The age-standardized global prevalence of CKD was higher in women and girls (9.5%) than in men and boys (7.3%). Nearly one-third of all cases of CKD were in China (132.3 million) or India (115.1 million), 10 countries had >10 million cases and 79 countries had >1 million cases. Although the all-age global prevalence of CKD increased by29.3% between 1990 and 2017.





How is CKD Treated?

The best treatment of CKD is early detection, when the disease can be slowed or stopped. Early treatment includes diet, exercise, medications, lifestyle changes, and treating risk factors like diabetes and hypertension. However, once kidneys fail, treatment with DIALYSIS or KIDNEY TRANSPLANT is needed.


DIALYSIS comes in two forms: hemodialysis and peritoneal dialysis. Both remove extra fluid & wastes from your blood. In hemodialysis, blood is pumped through a dialysis machine, where it is cleaned and returned to the body where as in peritoneal dialysis, blood is cleaned inside body through the lining of abdomen using a special fluid that is periodically changed.


KIDNEY TRANSPLANT places a healthy kidney into body from a deceased donor or from a living donor. Antirejection and other medications are needed to maintain the transplant.


GFR (Glomerular Filtration Rate) is considered optimal way to measure kidney function, which in conjunction with albuminuria, can help determine the extent of CKD in an individual. The level of GFR and its magnitude of change over time are vital to:

  • the detection of kidney disease

  • understanding its severity (categories)

  • making decisions about diagnosis, prognosis and treatment

  • detection of CKD progression






Prevalence of malnutrition and goals of nutritional intervention

Protein energy malnutrition (protein energy wasting (PEW)) is common (18%-70%) among patients on maintenance hemodialysis (MHD). Hemo study has demonstrated that progressive renal insufficiency is associated with a spontaneous decline in protein intake. In India, protein intake of an average middle class individual is less than 0.7g/kgbw/day. It may be difficult or an Indian patient to switch over from moderately low protein diet to a very high protein diet:

  1. body may not accept such high quantity of protein instantaneously

  2. loss of appetite

  3. it may affect residual renal function

  4. patient can get uremic because of excessively high protein intake and

  5. affordability

Therefore even though patient should be kept on high protein diet, but the target must be achieved gradually over a period of time depending on how much the patient can easily tolerate and digest. Patient should be given high calorie diet to ensure proper utilization of protein.


Management and treatment of Undernutrition with Protein

1. Patients who do not have adequate Dietary Protein Intake(DPI) should first receive dietary counseling and education:

  • Meal plan should be individualized, patient should be motivated to eat enough calories for proper utilization of protein.

  • Appetite assessment tools are a valid and clinically useful measure of estimating nutritional intake.


2. In dialysis patients if DPI remains inadequate oral supplementation should be prescribed.

  • Special Calorie Dense Commercial Formulas provide 2kcal/ml with high protein and low electrolytes.

  • Provide smaller water load than intravenous feeds.

  • Use of Alpha Keto-analogues (optional) may improve protein utilization and reduce degree of catabolism.

  • Standard recommended dose of ketoacid dosage is 6 to 14 g daily. However, high cost of Alpha Keto-analogues deters their use.


3. If oral supplements are not tolerated or effective and protein malnutrition is present tube feeding should be considered to increase protein intake.

  • With tube feeding, overnight enteral supplements can improve nutritional status. Tube feeding provides smaller water load than intravenous feeds, lowers risk of infection than Total Parenteral Nutrition, less expensive, overnight supplementation improves nutritional status.

  • Recommendations for Tube feeding. i. Start with 50-100 ml feeds every 6 hours and gradually increase to 300-400ml per feeding. ii) If continuous feedings are started, then start feeding from 20-50ml/hr, then increase 20ml every 2-8hrs until requirement is reached.


Aims of medical nutrition therapy

Medical Nutrition in hemodialysis is very important in decreasing complications and improving quality life of patients. Nutrition program on patients with chronic renal failure on dialysis plays an important role in the process of treatment.


  1. promote the nutrition to correct patients’ appetite

  2. correct systemic complications composed by the loss of nephrons in progress

  3. reduce of protein catabolism to the lowest level,

  4. Maintain Muscle Mass

  5. relieve or prevent the cardiovascular, cerebrovascular, peripheral vascular diseases formation

  6. prevent increasing fluid and electrolyte disorders

  7. reduce uremic symptoms such as itching, nausea, vomiting, loss of appetite and

  8. ensure optimum nutrition / Prevention of Malnutrition

  9. Improve quality of life of patients

  10. Medical nutrition helps to avoid high-potassium and sodium from the diet to prevent pulmonary edema, hypertension and heart failure.

  11. Keeps the consumption of calcium and phosphorus under control, to prevent renal osteodystrophy




We at Zeon Lifesciences aim for

Good Health for All

With 30+ years of experience in the industry, we are working meticulously to bring the knowledge of nature with innovation and advanced technology in the form of Unique Combinations to our consumers. We believe in fortifying our supplements to match the latest trends and technologies. One of our potential project includes Medical Nutrition Therapy (MNT), it is an integral component to support kidney diseases. MNT for kidney diseases contains various formulas such as Lamino Nephro, Lamino HP, Fresubin HP, Fresubin LP.





References:

Academy of Nutrition and Dietetics

Nutrition Guide for Clinicians

National Institute of Diabetes and Digestive and Kidney Diseases

Journal of Renal Nutrition Vol 26, Issue 1, January 2016, Pages 1-9

National Kidney Foundation

Medical Nutrition Therapy for Hemodialysis Patients

International Research Journal of Pharmacy 2019, 10(4)

Advances in Renal Replacement Therapy, Vol 10, No 3 (July), 2003, 183-193

Guidelines for Maintenance Hemodialysis in India

ESPEN Guidelines on Enteral Nutrition: Adult Renal Failure

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