Post Date December, 03 2023
Hemodialysis treatment is one of the effective alternative treatments for end-stage kidney disease, and nutritional support therapy is of great significance for ensuring the quality of life and prognosis of hemodialysis patients. There are often two extreme errors in nutritional treatment for hemodialysis patients.
On the one hand, it is more common for young patients who start dialysis. As dialysis progresses, toxins in the body are cleared, digestive symptoms and appetite are significantly improved, and diet is not regulated without professional guidance. Improper diet is often prone to high potassium, high phosphorus, hyperuricemia, acidosis, retention of water and uremic toxins, which can lead to cardiovascular complications, loss of residual kidney function and even life-threatening.
On the other hand, for most dialysis patients, especially elderly patients, protein energy malnutrition (PEM) is prevalent.
Firstly, hemodialysis patients should undergo nutritional status analysis with the help of professionals, including dietary surveys, anthropometric measurements, and biochemical analysis. Analyze the patient's nutritional status and causes of malnutrition based on their existing treatment plans and their family and social activities. Thus optimizing the dialysis plan to improve gastrointestinal symptoms, using medication reasonably to avoid appetite disorders caused by drugs, and providing a reasonable individualized nutritional support treatment plan.
1. The total energy requirement of hemodialysis patients is generally 30Kcal/kg/d, and 25Kcal/kg/d may be more suitable for elderly patients and patients with significantly reduced physical activity. For hemodialysis patients with normal nutrition, protein intake of 1.0g/kg/d can generally meet their nutritional needs. It is recommended to use over 50% high-quality protein, including milk, eggs, fish, poultry, lean meat, soybeans, etc.
2. Moderately limit water intake. For patients with residual kidney function and normal urine output, there is no restriction on water intake. Patients can adjust themselves based on whether they have edema symptoms and whether there is weight gain during dialysis. For patients with oliguria and anuria, daily water intake should be strictly limited based on the previous day's urine volume, and the water cup should be marked to develop a planned habit of drinking water in small sips. Eat a light diet and avoid foods with high salt and water content. In addition, when you are slightly thirsty, using a cotton swab to moisten your lips or rinsing your mouth with water is also a small technique for controlling drinking water. Ensure that the weight gain during the dialysis period is controlled within 5% of the body weight according to different dialysis plans, preferably between 2.5 and 3.0kg.
3. Strictly limit sodium intake. Dialysis patients are often accompanied by hypertension. With the reduction of urine volume, water and sodium retention is likely to occur, and sodium intake should be strictly limited. Based on the presence or absence of edema and hypertension, the intake of salt should be controlled at 3-5 g/d. In addition to salt, foods with high sodium content should also be controlled, such as processed foods, alkaline foods, pickled foods, monosodium glutamate, etc. There are also some salt control tips, such as making the most of the inherent flavor of the food (steaming, stewing); The special flavors of scallions, ginger, and garlic can be appropriately utilized; Suitable use of sour, sweet and other seasonings to replace salt; When cooking, do not add all the soy sauce and leave a portion to dip in; Add salt after frying and before eating; Gradually change dietary habits; Reduce dining out.
4. Adjust potassium intake based on blood potassium. Hemodialysis patients are often prone to hyperkalemia as urine volume decreases. Patients with hyperkalemia should avoid foods high in potassium and choose more melons and vegetables. Cut and wash the ingredients first; Green leafy vegetables can be soaked in clean water for more than half an hour, and then blanched in boiling water; Avoid "soaking rice in soup"; It is not advisable to consume high potassium and low sodium salts.
5. Hyperphosphatemia is also the most common complication in dialysis patients and a high-risk factor for cardiovascular complications. However, phosphorus often accompanies high-quality protein, so for patients with hyperphosphatemia, it is only necessary to limit the intake of nuts, miscellaneous beans, fungi, animal organs, grains, dairy products, broth, and cola, and should not blindly limit the intake of high-quality protein due to fear of high phosphorus, leading to malnutrition. For patients who still have high phosphorus levels despite reasonable protein intake, phosphorus binders can be used or some high-quality protein foods can be replaced with low phosphorus protein powder.
6. According to the patient's dietary intake, for patients with insufficient protein intake, protein powder can be directly supplemented. Or provide equivalent α- Ketonic acid can not only utilize urea nitrogen in the body to turn waste into treasure, but also supplement essential amino acids, promote protein synthesis and utilization, and improve nutritional status. For patients with insufficient total calorie intake, oral supplementation with full nutrient enteral nutrition can be used to supplement total energy.
7. Dialysis patients are prone to muscle loss due to their pathological and physiological characteristics, so dialysis patients should maintain appropriate exercise. Especially for resistance activities, such as dumbbells, stretchers, and lower limb resistance activities, to avoid muscle loss.
