Presentation on theme: "Nutritional Assessment in Hemodialysis Patient"— Presentation transcript:
1Nutritional Assessment in Hemodialysis Patient Haneen Nabeel Molla M.Sc.Clinical DietitianKing Khalid University Hospital
2Stages 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.
3Stages of Kidney Disease DescriptionGlomerular Filtration Rate (GFR)*1Kidney damage (e.g., protein inthe urine) with normal GFR90 or above2Kidney damage with milddecrease in GFR60 to 893Moderate decrease in GFR30 to 594Severe reduction in GFR15 to 295Kidney failureLess than 15
4End Stage Renal Disease ( ESRD ) : Inability to excrete waste products , maintain fluid and electrolyte balance and produce hormones.
5When is Dialysis Needed? Kidneys no longer remove enough wastes and fluid from the bloodWhen only 10 to 15 percent of the kidney function left.
6When 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.
7Nutrition 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 proteinStaying at a healthy body weightImportant nutrients in the dietPotassiumphosphorussodium and fluidscalciumDiabetic – Renal Diet
8The Goals of the Nutritional Management in Dialysis Prevent nutrients deficienciesControl edema and serum electrolytesProvide an attractive healthy diet
9Anthropometric Measurement Weight kgHigh cmBody mass index (BMI ): Weight(Height)2Underweight to 18.5Normal (healthy weight) to 25Overweight to 30Obese Class I (Moderately obese) to 35Obese Class II (Severely obese) to 40Obese Class III (Very severely obese) over 40
10Anthropometric Measurement adjusted body weight (AIBW) = (Actual weight – IBW)x IBW womenx IBW menIdeal body weight (IBW) : (Height)2 x menx women% of IBW: Actual Weight x 100IBW
11Getting 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 energyHelp to stay at a healthy body weightHelp the body use protein for building musclesand tissues.
12Getting the Right Amount of Calories Will keep the patients from losing weight.The amount of calories recommended will depend on the individual needs.Energy kcal/kg of body weight for <60 years;30 to 35 kcal/kg of body weight for >60 years
13Getting 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 musclesRepairing tissueFighting infections.
14Protein Protein is found in 2 types of foods: Animal sources Plant sourcespoultry , meat , eggs, seafood , milk and cheesenuts, seeds , legumes, soy and tofu
15ProteinSome of these protein-rich foods may also contain lots of phosphorus, which need to be controlled in their diet.Protein : g/kg of body weight, >50% HBV protein
16Potassium 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.
17PotassiumToo much or too little potassium level in the blood can be dangerous.With hemodialysis, patients need to limit their intake of high-potassium foods.
18PotassiumSoaking the vegetables after cutting it and cooking it helps to remove high amount of potassiumPotassium : 2 to 3 g/day; or 40mg/kg IBW
19(>200 mg / portion) The portion size is ½ cup High-Potassium Fruit(>200 mg / portion) The portion size is ½ cupApricot, raw (2 medium) dried (5 halves)Avocado (¼ whole)Banana (½ whole)CantaloupeDates (5 whole)Dried fruitsFigs, driedGrapefruit JuiceHoneydewKiwi (1 medium)Mango(1 medium)Nectarine(1 medium)Orange(1 medium)Orange JuicePapaya (½ whole)Pomegranate (1 whole)Pomegranate JuicePrunesPrune JuiceRaisins
20High-Potassium Vegetables (>200 mg / portion) The portion size is ½ cupArtichokeBaked BeansSquashBeets, fresh then boiledBlack BeansBroccoli, cookedBrussels SproutsChinese CabbageCarrots, rawLentilsDried Beans and PeasLegumesMushrooms, cannedOkraParsnipsPotatoes, white and sweetPumpkinRutabagasSpinach, cookedTomatoes/Tomato productsVegetable Juices
21Other High Potassium Foods (>200 mg / portion) The portion size is ½ cupBran/Bran productsChocolate (1.5-2 ounces)GranolaMilk, all types (1 cup)Molasses (1 Tablespoon)Yogurt
22(<200 mg/ portion) The portion size is ½ cup Low-Potassium Fruit(<200 mg/ portion) The portion size is ½ cupApple (1 medium) Apple Juice Applesauce Blackberries Blueberries Cherries Cranberries Fruit Cocktail Grapefruit (½ whole)Grapes, Grape JuiceRaspberriesPlums (1 whole)Tangerine (1 whole)StrawberriesPears(1 small) canned (½ cup)Pineapple, Pineapple JuicePeaches, (1 small) canned (½ cup)Watermelon(limit to 1 cup)
23Low-Potassium Vegetables (<200 mg/ portion) The portion size is ½ cupAsparagus (6 spears)Beans, green or waxCabbage, green and redCarrots, cookedCauliflowerCelery (1 stalk)Corn, fresh (½ ear) frozen (½ cup)CucumberEggplantMixed VegetablesMushrooms, freshWatercressYellow SquashZucchini SquashOnionsParsleyPeas, greenPeppersRadishKaleLettuce
24Other Foods Low Potassium ( <200 mg/ portion) The portion size is ½ cupCake: 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 )RiceNoodlesPastaBread and bread products: (Not Whole Grains)
25Phosphorus 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.
26PhosphorusA 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 asBone painDamage to the heart and other organsPoor blood circulationSkin ulcers.
27PhosphorusTo 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
28The portion size is ½ cup High Phosphorus Food( >150 mg/portion)The portion size is ½ cupProteinCarp, sardines, beef liver, chicken liver ,organ meats, oystersDairy Products:Milk, Yogurt ,Pudding, Custard, Ice cream and Cream soups
29High Phosphorus Food Vegetables dried Other foods beans and peas: bran cerealsbrewer’s yeastnutscaramelsseedsBeveragesAle, Beerdrinks made with milkchocolate drinksCocoa, dark colasbaked beansblack beanschick peaskidney beanslentilsnorthern beanssplit peassoy beans
30SodiumSodium 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.
31Sodium The extra sodium can cause: Sodium 1 - 3 g/day Swelling or puffiness around eyes, hands or feetFluid weight gainShortness of breathRise in blood pressureMore work for their heartSodium g/day
32Sodium Table salt Seasoning salt Garlic salt Onion salt Celery salt High Sodium SaucesSalted SnacksMEATSPROCESSED FOODSTable saltSeasoning saltGarlic saltOnion saltCelery saltBarbecueSteakSoyTeriyakiOysterCrackersPotato chipsCorn chipsPretzelsTortilla chipsNutsPopcornSunflower seedsHot DogsCold cuts,PastramiSausageCorned beefSpamFrozen prepared foodsCommercial mixesButtermilkCheeseSoupsTomato productsVegetable juicesCanned vegetablesCanned raviolisChiliMacaroni & CheeseSpaghettiFast foodsPicklesOlives
33FluidsFluid is any food or beverage that is liquid at room temperature.Some examples are:IceBeverages like coffee, tea, sodas, juices and waterFrozen desserts such as ice cream, sherbet or Popsicles GelatinGravy and Soups
34Fluids Signs may noticed with drinking too many fluids A sudden increase in weight along with swellingShortness of breathA rise in the blood pressureFluid : output ml
35CalciumCalcium is the mineral that is important for building strong bones.However, foods that are good sources of calcium are also high in phosphorus.
36Calcium To prevent loss of calcium from bones Follow a diet that limits high-phosphorus foodsTake 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.
37Diabetic-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.
38Diabetic-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.
39Diabetic-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.
40ConclusionOur 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.