Nutrition and Renal Disease
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Nutrition and Renal Disease
Dialysis changes dietary needs. Patients undergoing typical hemodialysis, involving about three treatments per week, follow diets that are restricted in protein, sodium, potassium, phosphorus, and fluid. Patients on continuous ambulatory peritoneal dialysis, involving several dialysate exchanges per day, can be more liberal in protein, sodium, potassium, and fluid intake.
Sodium: Sodium intake must be modified to prevent hypertension, congestive heart failure, and pulmonary edema. Limiting intake will help avoid thirst and maintain acceptable fluid balance. Restrictions range from 1,000-3,000 milligrams per day with hemodialysis and 2,000-4,000 milligrams per day for peritoneal dialysis. Major salt sources are described below.
Fluid: Fluid consumption should be controlled to avoid congestive heart failure, pulmonary edema, hypertension, and swelling of the legs and feet. Fluid allowances are 1,000-1,5000 milliliters per day and are based on urine output and type of dialysis.
Protein: Protein requirements range from 1.1-1.5 grams per kilogram, depending on the type of dialysis used and the patientís nutritional status. It is important to ensure sufficient protein to maintain visceral protein stores, but to avoid excesses that could lead the accumulation of nitrogenous waste products in the blood (uremia).
Phosphorus: Kidney failure causes high levels of phosphorus to build up in the blood and disrupts calcium/phosphorus balance. Elevated phosphorus levels can lead to metastatic calcification (soft tissue calcification), secondary hyperparathyroidism, and renal osteodystrophy. Recommended intakes usually range from 800-1,000 milligrams per day with hemodialysis and less than 1,200 milligrams per day with periotoneal dialysis.
Potassium: Potassium restrictions depend on serum potassium levels, the type of dialysis, medications, and residual renal function. Patients on hemodialysis are usually restricted to 2,000-3,000 milligrams per day to prevent hyperkalemia between treatments. Patients on peritoneal dialysis may follow a more liberal dietary potassium intake, as potassium is lost in the dialysate solution during daily exchanges.
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