1. Protein Management for Hemodialysis Patients Polly Peru

2. Chronic Kidney Disease & Hemodialysis  One in nine American adults is currently suffering from chronic kidney disease. Chronic kidney disease is the eighth leading cause of death in America.  The two main causes of chronic kidney disease are diabetes and high blood pressure, which are responsible for up to two-thirds of the cases. Polycystic Kidney Disease Glomerulonephritis Lupus Malformations in utero  The kidneys perform many vital functions in the body which include:  filter toxins out of the body  regulate blood pressure,  maintain acid-base balance,  stimulate the bone marrow to make red blood cells by producing the hormone erythropoietin (EPO).

3. Treatments are limited to hemodialysis, peritoneal dialysis and kidney transplantation. *None of these are a cure for CKD. Hemodialysis: Renal Replacement Therapy  Treatments 3-5 times/week  2-4 Hours  Side effects 

4. Why Protein Needs are Higher for Dialysis Patients  The renal diet can be very challenging as it requires strict adherence to the restriction of sodium, potassium, phosphorus, fluid and the increase of high-quality protein  Dialysis treatments remove protein waste and amino acids from the blood resulting in higher needs of high quality protein.  The Kidney Disease Outcomes Quality Initiative Clinical Practices Guidelines for nutrition of hemodialysis patient’s recommends the following energy and protein needs:  Energy: 35 Kcal/Kg body weight per day  Protein: 1.2 - 1.3 g/Kg body weight per day

5. Albumin Serum albumin is a widely used biomarker of nutritional status in patients with chronic kidney disease.

6. What is Albumin?  Albumin is the most common protein found in the blood.  Draws extra fluid from swollen tissues back into the blood, where it can then be removed during treatment.  Provides the body with the protein needed to both maintain growth and repair tissues.  Your renal dietitian will calculate your protein intake in grams per day and track your serum albumin level for optimal health. If you are on dialysis and have an albumin level less than 4.0 grams/deciliter your dialysis team will work with you to improve your levels.  Your grams of protein per day are___________.  Your albumin level is_____________.

7. Examples of foods and their protein content to help you plan your protein intake for the day. Meats: Contain 7 g protein/1-oz serving or 21 g/3-oz serving:  Beef (all forms, including ground beef, steaks, and roasts)  Pork (all forms, including ham, loin, chops, ground pork, bacon, and sausage)  Poultry (all forms, including chicken, turkey, quail, duck, goose, and Cornish hen)  Fish (all forms, including finfish, shellfish, shrimp, and canned tuna) Dairy Contain 7–8 grams (g) protein/serving:  1 cup (C) whole, reduced- fat, or skim milk  1 C buttermilk  ¾ C yogurt Cheese:  ¼ C cottage cheese  2 tablespoons (Tbsp) grated Parmesan  1 ounce (oz) feta  1 oz other cheeses

8. Examples of foods and their protein content to help you plan your protein intake for the day. Meat alternates: Contain 6- 7 g protein/serving:  One egg  2 Tbsp peanut butter  ½ C dry beans, peas, and lentils Soy foods:  1 C soy milk  ½ C tofu  ¼ C tempeh Additional dietary sources of protein: About 3–5 g/serving, serving sizes vary:  Breads: white and whole wheat, buns, tortillas, naan and rolls)  Cereals: oatmeal  Grains: grits, flour, and rice  Starchy vegetables: green peas, potatoes, winter squash, and corn  Popcorn  Whole Grain Crackers  Nuts and seeds

9. Nutrition Supplements Use nutrition supplements (beverages, bars, etc) as recommended by your renal dietitian.  Add protein powders to warm or cold liquids such as: hot cereal, coffee, soup, juices and smoothies.

10. Make Wise Protein Food Choices

12. Taste Test Please rate the protein bar samples in the order that you preferred them.  1 = I liked it  2 = It was ok!  3 = I did not like it   _______ Luna Lemon Zest   _______Pure Protein Chocolate Peanut Butter   _______Balance Bar Peanut Butter 

13. Thank You!