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Nutritional Assessment in Hemodialysis Patient Haneen Nabeel Molla M.Sc. Clinical Dietitian King Khalid University Hospital.

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Presentation on theme: "Nutritional Assessment in Hemodialysis Patient Haneen Nabeel Molla M.Sc. Clinical Dietitian King Khalid University Hospital."— Presentation transcript:

1 Nutritional Assessment in Hemodialysis Patient Haneen Nabeel Molla M.Sc. Clinical Dietitian King Khalid University Hospital

2 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

3 StageDescriptionGlomerular Filtration Rate (GFR)* 1Kidney damage (e.g., protein in the urine) with normal GFR 90 or above 2Kidney damage with mild decrease in GFR 60 to 89 3Moderate decrease in GFR30 to 59 4Severe reduction in GFR15 to 29 5Kidney failureLess than 15 Stages of Kidney Disease

4 Inability to excrete waste products, maintain fluid and electrolyte balance and produce hormones. End Stage Renal Disease ( ESRD ) :

5 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?

6 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?

7 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

8 Prevent nutrients deficiencies Control edema and serum electrolytes Provide an attractive healthy diet The Goals of the Nutritional Management in Dialysis

9 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

10 adjusted body weight (AIBW) = (Actual weight – IBW) x IBW women x 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

11 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

12 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

13 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

14 Protein is found in 2 types of foods: Protein Animal sourcesPlant sources poultry, meat, eggs, seafood, milk and cheese nuts, seeds, legumes, soy and tofu

15 Some 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 Protein

16 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

17 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

18 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

19 High-Potassium Fruit Apricot, raw (2 medium) dried (5 halves) Avocado (¼ whole) Banana (½ whole) Cantaloupe Dates (5 whole) Dried fruits Figs, dried Grapefruit Juice Honeydew Kiwi (1 medium) (>200 mg / portion) The portion size is ½ cup Mango(1 medium) Nectarine(1 medium) Orange(1 medium) Orange Juice Papaya (½ whole) Pomegranate (1 whole) Pomegranate Juice Prunes Prune Juice Raisins

20 High-Potassium Vegetables Artichoke Baked Beans Squash Beets, fresh then boiled Black Beans Broccoli, cooked Brussels Sprouts Chinese Cabbage Carrots, raw Lentils Dried Beans and Peas (>200 mg / portion) The portion size is ½ cup Legumes Mushrooms, canned Okra Parsnips Potatoes, white and sweet Pumpkin Rutabagas Spinach, cooked Tomatoes/Tomato products Vegetable Juices

21 Other High Potassium Foods Bran/Bran products Chocolate (1.5-2 ounces) Granola Milk, all types (1 cup) Molasses (1 Tablespoon) Yogurt (>200 mg / portion) The portion size is ½ cup

22 Low-Potassium Fruit Apple (1 medium) Apple Juice Applesauce Blackberries Blueberries Cherries Cranberries Fruit Cocktail Grapefruit (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)

23 Low-Potassium Vegetables Asparagus (6 spears) Beans, green or wax Cabbage, green and red Carrots, cooked Cauliflower Celery (1 stalk) Corn, fresh (½ ear) frozen (½ cup) Cucumber Eggplant Mixed Vegetables Mushrooms, fresh (<200 mg/ portion) The portion size is ½ cup Watercress Yellow Squash Zucchini Squash Onions Parsley Peas, green Peppers Radish Kale Lettuce

24 Other Foods Low Potassium Cake: angel, yellow Coffee: limit to 8 ounces ( 1 cup ) Pies without chocolate or high potassium fruit Cookies without nuts or chocolate Tea: limit to 16 ounces (2 cups ) ( <200 mg/ portion) The portion size is ½ cup Rice Noodles Pasta Bread and bread products: (Not Whole Grains)

25 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

26 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

27 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

28 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

29 High Phosphorus Food Vegetables dried beans and peas: baked beans black beans chick peas kidney beans lentils northern beans split peas soy beans Other foods bran cereals brewers yeast nuts caramels seeds Beverages Ale, Beer drinks made with milk chocolate drinks Cocoa, dark colas

30 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

31 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 g/day Sodium

32 SEASONINGSHigh Sodium Sauces Salted Snacks MEATSPROCESSED FOODS Table salt Seasoning salt Garlic salt Onion salt Celery salt Barbecue Steak Soy Teriyaki Oyster Crackers Potato chips Corn chips Pretzels Tortilla chips Nuts Popcorn Sunflower seeds Hot Dogs Cold cuts, Pastrami Sausage Corned beef Spam Frozen prepared foods Commercial mixes Buttermilk Cheese Soups Tomato products Vegetable juices Canned vegetables Canned raviolis Chili Macaroni & Cheese Spaghetti Fast foods Pickles Olives Sodium

33 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

34 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 ml Fluids

35 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

36 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

37 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

38 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

39 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

40 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

41 Thank you

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