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October 2004, Volume 34 Number 10 , p 32hn6 - 32hn7


  • Peggy O'Neill RD, MS



  • The menu of nutrition risks

  • What you can do

  • Meeting many challenges

  • Assessing nutritional status


    Healthy kidneys remove water and substrates from the blood to help maintain fluid, electrolyte, acid-base, and calcium-phosphorus balance. They also help eliminate waste and regulate blood pressure (BP). Anyone whose kidney function decreases by 90% or more has end-stage renal disease (ESRD) and inadequate kidney function to maintain these vital roles.

    When a patient with ESRD relies on dialysis to survive, his nutritional status may suffer because of his disease, coexisting conditions, and therapy itself. In this article, I'll explain why certain dietary adjustments are necessary and why tube feeding may be the only way to keep him well nourished.

    The menu of nutrition risks

    The primary nutrition risk for someone on dialysis is protein/calorie malnutrition. Dialysis depletes proteins and amino acids from the blood, and the body will break down muscle tissue if they aren't replaced. The Recommended Dietary Allowance for protein in a healthy person is 0.8 gram/kg/day, but most people on dialysis need 1.2 grams/kg/day.

    Calorie malnutrition increases the risk of immune dysfunction and development of chronic disease. The National Kidney Foundation recommends 35 kcal/kg/day for an adult under age 60 on maintenance dialysis, which is similar to the requirement for a healthy person. If your patient is 60 or older and tends to be sedentary, 30 to 35 kcal/kg/day is adequate. Caloric intake at these levels induces neutral nitrogen balance and adequately maintains body mass.

    Decreased glomerular filtration rate and a decreased ability to concentrate and dilute urine increase your patient's risk of hyperkalemia, phosphatemia, and alterations in sodium and water balance. He may need to restrict consumption ...

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