Nutrition considerations while on dialysis
The National Kidney and Transplant Institute revealed that one Filipino develops chronic renal failure every hour. End Stage Renal Disease (ESRD) or End Stage Kidney Disease occurs when the two bean-shaped organs located below the ribs could no longer filter wastes and remove extra fluid in the form of urine.
There are five stages of kidney disease and this is determined by a blood test. The Glomerular Filtration Rate (GFR) measures the volume of blood the kidneys can filter in one minute. Decreased GFR means a decline in kidney function.
A normal kidney function (Stage 1) has a GFR of 90ml/min or above. Mild loss of kidney function (Stage 2) is 60 to 89ml/min GFR. Stage 3 is divided into two sub-categories: Mild to moderate (Stage 3a) is 45 to 59ml/min of GFR while moderate to severe (Stage 3b) has a GFR of 30 to 44min/ml. Severe loss of kidney function (Stage 4) has a GFR of 15 to 29 min/ml. When GRF hits less than 15ml/min, this is considered as kidney failure (Stage 5).
Treatment for kidney failure includes dialysis or kidney transplant. Organ transplantation is a rigorous process that takes some time, from finding an organ donor to matching, undergoing surgery, post-surgery management, and recovery.
Before transplantation, a patient will have to undergo dialysis. Hemodialysis is the most common type of dialysis. It is a process of artificially removing wastes and extra fluids from the blood while restoring electrolyte levels through an artificial kidney machine. Potassium, sodium, chloride, calcium, magnesium, and bicarbonate are electrolytes in the body. These chemicals play a role in keeping the blood pressure, hydration level, and blood pH balanced. They also contribute to nerve and muscle function.
Patients undergoing hemodialysis have a high risk of getting malnutrition, specifically protein energy malnutrition (PEM). Early detection and intervention are crucial to preventing complications. Malnutrition occurs as a result of inadequate nutrient intake, increased protein breakdown, and protein losses during dialysis. This results to fatigue, poor wound healing, and a compromised immune system that leads to increased risk of infection and poor rehabilitation.
Unlike other kidney patients who are recommended low protein intake, patients on hemodialysis require a higher protein allowance of about 1.2g protein per kilogram of body weight. Half of the protein requirement must come from high biologic value protein like soy, egg, fish, and lean meat. Dairy is also a good source of protein but is usually avoided by individuals who have food sensitivities, leaky gut, and have chronic inflammation. Other sources of protein should come from vegetables, whole grains, nuts, and seeds. A registered nutritionist dietitian is the only health care professional who can help a patient determine the amount of optimal protein food sources to be consumed on a daily basis.
Patients must also be conscious about their potassium, sodium, calcium, magnesium, phosphorus, and iron levels. These are all greatly affected by food intake. The blood values may fluctuate and are often monitored by the physician.
Iron deficiency anemia is a common concern among patients on hemodialysis. While lean animal sources are great sources of heme iron, plant foods like green leafy vegetables, legumes, soy, cashews, white and oyster mushrooms are also abundant in non-heme iron. These are best eaten with vitamin C-rich food like guava, citrus fruits, melon, pineapple, potato, broccoli, tomatoes and peppers. Vitamin C enhances the absorption of non-heme iron.
The electrolyte potassium is a mineral that regulates heartbeat, muscle and nerve function. Its level in the blood is also crucial. Intake of potassium containing food may be regulated depending on the blood test results. Here are some food items that are high in potassium: cauliflower, celery, mushroom, malunggay, squash, calamansi, leafy vegetables, guava, kamatsili, jackfruit or langka, orange, strawberry, santol, melon, guyabano, banana, cashew, lanzones, dried fruits like raisins and prunes, balimbing, butong pakwan, coconut milk, coconut, avocado, peanut butter, oatmeal, chocolates, cakes, pastries, molasses, and ketchup. Patients may be prescribed medications to lower potassium levels. Canned fruit has lower potassium content. Remember to rinse off excess syrup to prevent spikes in blood sugar or glucose level.
Phosphorus is a mineral that plays a role in cellular repair, metabolism of carbohydrates, fat, and protein. Elevated phosphorus levels could be a risk factor for heart disease and inflammation. Patients may also be prescribed a phosphate binder taken with meals to decrease phophorus level. Phophorus-rich food items are: Cola and chocolate beverages, all bran, whole-grain cereals, buttermilk, cocoa, parmesan cheese, processed cheese, milk and yogurt, nuts, beans and bean products, internal organs of meat.
Looking at these list of foods and restrictions may dampen the spirits of a patient undergoing dialysis. But with proper guidance from a dietitian on the many other food options to choose from and tips on meal preparations in collaboration with the renal doctor’s drug prescription and dialysis treatment, a patient on dialysis can successfully nourish his or her body and prevent complications to achieve a better quality of life.