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    Diet in ESRD/ Hemodialysis


    Diet in ESRD/ Hemodialysis Empty Diet in ESRD/ Hemodialysis

    Post  nancelle on Sat 27 Jun 2009, 12:42 pm

    Dyad 1 : Nancelle Dumlao/ Rodel Perez

    Diet in ESRD and Hemodialysis Patients

    The long forgotten salt factor and the benefits of using a 5-g-salt-restricted diet in all ESRD patients
    By : Stanley Shaldon and Joerg Vienken

    This is a review of the significance of reviving the routine diet management of limited salt intake to 5g per day for ESRD patients undergoing hemodialysis using several studies undertaken by several authors. Two of the latest studies were published in 2004 entitled Dialysis Outcomes Quality Initiatives Guidelines on the problem of cardiovascular disease in ESRD patients (K/DOQI) and the other one published in 2006 by the same learned body (K/DOQI) using 60 references on the use of a salt-restricted diet in the management of ESRD patients undergoing hemodialysis. This revival of this long abandoned treatment policy may be traced from an empirical observation published over 40 years ago on salt restriction to 5g/day on ESRD patients with severe hypertension (Comty and Shaldon, 1964). The findings then was that it took several months to control blood pressure without taking medications for hypertension. The lag phenomenon was independent of the initial decrease in blood pressure related to decreasing extracellular volume and getting an arbitrarily defined dry body weight This means that the delay in the reduction in mean arterial pressure happened several months after stabilizing both the exchangeable sodium and body weight. This lag phenomenon was due to the reduction in peripheral resistance which may be related to the reduction of non-osmotically active sodium that may be attached in the lining of intimal surface of blood vessels( which contains proteoglycans and glycosaminoglycans (Shaldon, 2006; Titze, 2004) . This sodium store takes months to normalize on a 5-g salt intake.

    The results of these studies indicate that for ESRD patient on hemodialysis, the survival rate increases not much because of the technical aspects of the therapy but due largely to the adherence on the 5g daily salt intake in the diet. Local high sodium concentration stimulate the release of the gene that is responsible for inducing inflammatory cytokine cycle, MAPK38 (mitogen-activated protein kinase) which result to ADMA (asymmetric dimethyl arginine)-induced increase in peripheral resistance (this is due to reduction in nitric oxide synthesis). The low-salt dietary intake will reverse this whole process and at the same time reverse the production of inflammatory cytokines leading to reduction in blood pressure.
    These findings are further reinforced by another randomized study (Cook, et al, 2007) of prehypertensive’ normals (ages of 35 to 55) who were monitored for 10 years with compliance estimated by monthly 24-h urinary sodium determinations. The application of this salt-restricted diet resulted to positive outcome of 25% reduction in cardiovascular morbidity and mortality for the group of patients taking 5g/day salt in their diet as compared to those with a normal unrestricted salt intake in their diet.

    This may seem such a simple resolution to a problem such as hypertension but it could mean improved and prolonged survival for ESRD patients undergoing lifetime hemodialysis. However, it is my observation that even this simple management is being overlooked by the patients themselves perhaps due to the fact that many are not cognizant of how to measure and monitor their salt intake on a daily basis. Moreover, people do not relish eating bland foods and are easily tempted to use liberal amount of seasoning and salt in their diet. As observed by the authors, nowadays, there is a tendency to increase salt intake due to the worldwide acceptance of processed foods and instant cooking which contributes to the difficulty of controlling salt in the diet.


    1. Kidney Disease Outcomes Quality Initiative (K/DOQI). Clinical practice guidelines on hypertension and antihypertensive agents in chronic kidney disease. Guideline 6: dietary and other therapeutic lifestyle changes in adults. Am J Kidney Dis (2004) 43(Suppl_1):s116.
    2. Kidney Disease Outcomes Quality Initiative (K/DOQI10. Clinical practice guidelines for hemodialysis adequacy update 2006. Guideline 5: on control of volume and blood pressure. Am J Kidney Dis (2006) 48(Suppl 1):s33.
    3. Comty C, Rottka H, Shaldon S. Blood pressure control in patients with end stage renal disease treated by intermittent haemdialysis. Proc Eur Dial Transplant Assoc (1964) 1:209–213.
    4. Shaldon S. Editorial: an explanation for the lag phenomenon in drug-free control of hypertension by dietary salt restriction in patients with chronic kidney disease on hemodialysis. Clin Nephrol (2006) 66:1–2.[ISI][Medline]
    5. Titze J, Shakibaie M, Schaffihuber M, et al. Glycosaminoglycan polymerization may enable osmotically inactive Na+ storage in the skin. Am J Physiol Heart Circ Physiol (2004) 287:H203–H208.[Abstract/Free Full Text]
    6. Ritz E. Where does some of the ingested sodium chloride hide without exerting osmotic pressure? J Am Soc Nephrol (2006) 17:3–11.[Free Full Text]
    7. Cook N, Cutler JA, Obarzanek E, et al. Long term effects of sodium reduction on cardiovascular disease outcomes: observational follow up of the trials of hypertension prevention (TOPH). BMJ (2007) 334:885.[Abstract/Free Full Text]


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    Diet in ESRD/ Hemodialysis Empty by guomanman and chenya

    Post  guomanman on Sat 27 Jun 2009, 3:19 pm

    Dyad 6 guomanman and chenya

    The Hemodialysis Diet Versus The Peritoneal Dialysis Diet
    By Maria Karalis, MBA, RD, LD

    Nutrition is an important part of your dialysis treatment plan whether you are on hemodialysis (HD) or peritoneal dialysis (PD). To give forth your best in all aspects of your lifestyle, you need to make an effort to maintain yourself by eating enough of the right kinds of foods or less restricted foods.

    If you are thinking about changing modalities or need to make an informed decision about which modality to begin, there are a lot of issues to consider. One thing to consider is what your diet will be like on HD versus PD. This article will give you a very brief overview of the differences in these diets.


    Protein is needed to keep tissues healthy and replace old or damaged tissues. People on PD are advised to follow a diet higher in protein than those on HD because protein is lost through the peritoneal membrane with every dialysis exchange. Some proteins are also lost during HD, but not to the same degree as PD.

    Protein is also important as an aid for the body in preventing infection. Since the potential for infection is always present with PD, it is important to maintain a protein-rich diet. During infection, people on PD are advised to eat 1 1/2 times more meat and meat substitutes than usual.

    There are two kinds of protein. High quality (animal) comes from milk, meat, chicken, fish and eggs, and contains all the needed ingredients for tissue growth. Low quality (plant) comes from vegetables, breads, cereals, and lacks some ingredients that tissues need to grow. You need both proteins. Your renal dietitian will decide your protein needs.

    In order for your body to use proteins for growth and repair, sufficient calories are needed. Calories are necessary for energy and for maintaining your body weight. Just as fuel gives power to cars, calories fuel your body and give you energy. If you are underweight, you may have to eat high-calorie foods. This is more of an issue with HD patients.

    People on PD tend to gain weight over time from absorption of calories from the dextrose in the dialysate (some people absorb as much as 500-700 calories each day from their dialysate). To minimize unwanted weight gain, decrease calorie intake. This should be done by reducing concentrated sweets and fats. Exercise is also important in maintaining your body weight. As always, check with your doctor before starting any exercise program.


    Potassium is a mineral vital for regulating your heart. People on PD do not usually require a potassium restriction since they are receiving dialysis every day. In fact, some are usually advised to increase their potassium through diet or oral medication.

    Most people on HD need to limit their intake of high potassium foods since potassium builds up in between dialysis treatments. Some foods high in potassium include bananas, tomatoes, oranges, exotic fruits and potatoes.


    As kidneys fail, they lose their ability to balance calcium and phosphorus. Phosphorus combines with calcium to keep teeth and bones strong. Unlike potassium, phosphorus is not removed well by HD or PD. High phosphorus levels can eventually lead to calcium and phosphorus deposits in the heart, skin, joints and blood vessels. As such, phosphorus must be controlled through diet and phosphate binders for HD and PD. Phosphorus is found in almost all foods but is especially high in dairy products, cheese, dried beans, liver, nuts and chocolate.


    The amount of sodium allowed in HD and PD is the same. Sodium is limited to control thirst and keep blood pressure under control. For both HD and PD, food can be cooked with a small amount of salt, but no additional salt should be added to foods at the table.

    On PD, sudden weight gain from fluids, elevated blood pressure or excessive thirst, may signal the need to cut back on sodium and/or fluid intake. Additionally in PD, excess water weight requires stronger, or higher, dialysate concentrations and consequently more calories are absorbed. This can eventually lead to an increased body weight.


    Healthy kidneys maintain fluid balance and prevent swelling in feet, ankles, legs, hands or face. When the kidneys lose their ability to get rid of extra fluid, excess water can raise blood pressure, cause strain on the heart and make it hard to breathe.

    Fluid gain and fluid intake work the same for those on either modality. PD operates by putting 1-2 liters of fluid solution in the peritoneal membrane every few hours, depending on the dialysis. At the end of the exchange, the fluid is withdrawn. If more fluid is released than was put in, you will need to drink a little more. If less fluid is released than was put in, you will need to drink a little less.

    One of the goals during HD is fluid removal. Less fluid gain between treatments results in better-tolerated treatments and is easier on the heart. Higher fluid gains can lead to cramping during dialysis and possibly longer treatment times (some people need extra treatment if all water weight is not removed). The goal for fluid gain should be no more than 1-2 pounds per day between treatments.

    The fluid allowance for HD is determined by the amount of urine produced in a 24-hour period. Most people are limited to 700-1000 ml of fluid per day plus urine output. For example, if you urinate 500 cc, your total daily fluid allowance would be 1200 cc (500 + 700). Fluid allowances vary from person to person. Other considerations include how much the remaining kidney function is left and the person’s body size.

    Hemodialysis Peritoneal Dialysis

    Protein Based on needs Based on needs; protein needs higher than HD

    Calories Based on needs Based on needs; focus is on less sweets/fats to

    prevent unwanted weight gain from dextrose

    in dialysate

    Potassium Limited Not usually limited

    Phosphorus Limited Limited

    Sodium Limited Limited

    Fluid Limited Limited but can be more liberal than HD


    The table above provides a summary of the differences in PD and HD diets. For more specific and individualized advice about your diet, please consult with your physician and Registered Dietitian.



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    Diet in ESRD/ Hemodialysis Empty Dietary habits by YuanShuHui & YangChunHua

    Post  YangChunHua on Sun 28 Jun 2009, 5:01 pm

    Dietary habits focused on phosphate intake in hemodialysis patients with hyperphosphatemia

    †U. O. Nefrologia e Dialisi, A.O. Pistoia, Italy
    Available online 13 October 2004.

    To evaluate the dietary habits of hemodialysis patients with hyperphosphatemia and the effects of a dietetic intervention focused on limiting dietary phosphate load.
    Design:Cross-sectional dietary evaluation and prospective intervention study.
    Subjects:Forty-three stable adult hemodialysis patients, 20 of whom had phosphorus serum levels >5.5 mg/dL.
    Intervention:Analysis of dietary composition and of the effects of individual dietetic counseling in an attempt to reduce phosphorus intake while preserving the same protein intake.
    Main outcome measures
    Differences in nutrient intake between normophosphatemic and hyperphosphatemic patients, and changes in dietary phosphorus and phosphorus-protein ratio, serum phosphate, and calcium-phosphate product after dietetic intervention.
    Results:No major differences in nutrient intake were detected between hyperphosphatemia and normophosphatemia patients, apart from a lower phosphorus-protein ratio (13.1 ± 1.7 versus 14.1 ± 2.1 mg/g, P < .05) in the former. After dietetic intervention in the hyperphosphatemia patients, phosphate and calcium intake decreased significantly (by 100 mg on average), whereas dietary protein did not change. A further decrease of the dietary phosphate-protein ratio (12.5 ± 1.8 mg/g, P < .05) also occurred. Serum phosphate showed a trend to decrease in the intervention group, whereas the serum calcium-phosphate product decreased significantly (from 66.8 ± 13.1 to 61.0 ± 13.8 mg2/dL2, P < .05).
    Conclusions:In compliant and motivated patients, individual dietetic counseling may be useful in reducing phosphate load and in limiting the phosphate burden related to an adequate protein intake, with a potentially favorable impact on calcium-phosphate retention. A phosphate-controlled diet has a role in an integrated therapeutic approach to hyperphosphatemia and positive calcium-phosphorus balance in hemodialysis patients.

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    Diet in ESRD/ Hemodialysis Empty Re: Diet in ESRD/ Hemodialysis

    Post  gillegarda/joanalynbalino on Sun 28 Jun 2009, 11:27 pm

    RESPONSE: DIET- Hemodialysis
    By: D2: Gil Legarda and Joanalyn Balino

    Nutrition and Outcome on Renal Replacement Therapy of Patients with Chronic Renal Failure Treated by a Supplemented Very Low Protein Diet

    This research study by Aparicio et al was to identify the efficacy of nutrition such as supplementation of very low protein diet on renal replacement therapy of patients with chronic renal failure. This research study will help advance CRF patients it is to to alleviate uremic symptoms also other manifestations and to slow the progression of Chronic Renal Failure. The potential harmful effects of protein restriction on nutritional status and clinical outcome of patients with CRF have raised concern. There were 239 patients treated for more than 3 months and were considered to be eligible for this study. Many of these patients were included in previously published studies from the department about the metabolic effects of SVLPD. This study was held in Service de Néphrologie, Hôpital Pellegrin, Bordeaux, France. The clinical outcomes was evaluated the date of completion of the study with a functioning graft or on Renal Replacement Therapy. A questionnaire was sent to the transplant unit and the dialysis centers in France. Using the ANOVA the comparisons between groups were carried out and the Fischer exact test as applicable. Comparisons between two periods were made using paired t test for same patients. All clinical outcomes of the patients was evaluated at the end of the treatment by SVLDP and one year after if applicable, and at the end of follow-up. The analyses in survival were performed with the Kaplan-meier method. The Cox proportional hazard method was used to analyze the factors influencing survival. Two-tailed tests were performed in all analyses. The limitation of this report is only focusing on advance chronic renal failure not to other renal diseases and only concern for protein restrictions not to other some nutrients for better guidance for hemodialysis patients what to take and what is not.

    As a result of this study it shows that interstitial nephritis, glumerulonephritis, autosomal dominant polycystic kidney disease and chronic rejection were the most common causes of Chronic Renal Failure, while nephrosclerosis and diabtes represented only ten and seven point four percent respectively. The low prevalence of diabetes is similar to other in print data from French patients. Rena function was not different in CRF patients of different etiologies but proteinuria was more severe in patients with chronic glumerulonephritis and diabetes. In Patients with chronic rejection the nutritional status was poorer.

    SVLPD was proposed between 1985 to 1998 to all adult patients with andvanced Chronic Renal Failure but those patients with severe comorbid conditions that might superimpose as hypercatabolic state were excluded. It shows that low protein diet in patients with advanced CHF carefully selected, motivated and followed had no deleterious influence on their nutritional status in the predialysus phase of chronic renal failure. Reduction in serum urea levels showed the correlation of several metabolic disorders alleviated uremic symptoms and in this manner delayed the onset of end-stage renal failure treatment until GFR levels lower than those currently recommended were attained.

    Aparicio M. et. al. (2000). Nutrition and Outcome on Renal Replacement Therapy of Patients with Chronic Renal Failure Treated by a Supplemented Very Low Protein Diet. Journal of the American Society of Nephrology Vol. 11, pages 701-716.. Retrieved June 28, 2009 from http://jasn.asnjournals.org/cgi/reprint/11/4/708?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&searchid=1&FIRSTINDEX=0&minscore=5000&resourcetype=HWCIT

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    Post  alkhaloidz on Mon 29 Jun 2009, 12:23 am



    Fast food consumption has increased dramatically in the general population over the last 25 years. However, little is known about the prevalence and nutritional implications of fast food consumption among hemodialysis patients. Using a cross-sectional study design, this study obtained data on fast food consumption and nutrient intake (from four separate 24-hour dietary recalls) and nutritional parameters (from chart abstraction) for 194 randomly selected patients from 44 hemodialysis facilities in northeast Ohio.

    Eighty-one subjects (42%) reported consuming at least one fast food meal or snack in four days. Subjects who consumed more fast food had higher kilocalorie, carbohydrate, total fat, saturated fat, and sodium intakes. For example, kilocalorie per kilogram intake per day increased from 18.9 to 26.1 with higher frequencies of fast food consumption (p=.003). Subjects who consumed more fast food also had higher serum phosphorus levels and interdialytic weight gains.

    Fast food is generally consumed by hemodialysis patients and is linked with a higher intake of kilocalories, carbohydrates, fats, and sodium and adverse changes in phosphorus and fluid balance. Further work is needed to understand the long-term benefits and risks of fast food consumption among hemodialysis patients. Nurse researchers can further enhance this study by researching on the proper amount of kilocalories, carbohydrates, fats, sodium, phosphorous and fluid intake in order to lessen the worst effects to hemodialysis patients.


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    Diet in ESRD/ Hemodialysis Empty Re: Diet in ESRD/ Hemodialysis

    Post  yachen on Mon 29 Jun 2009, 6:35 am

    Dyad 6 guomanman and chenya

    The hemodialysis diet
    What is a hemodialysis diet?
    The hemodialysis diet is an eating plan tailored to patients who are in stage 5 of chronic kidney disease (CKD), also known as end stage renal disease (ESRD). These patients have very little or no kidney function and must undergo dialysis to clean their blood of waste and excess fluids.

    Hemodialysis is one type of dialysis. The procedure is done several times a week, usually for 3 to 4 hours at a time. The hemodialysis diet is designed to reduce the amount of fluid and waste that builds up between hemodialysis treatments so that you can feel your best.

    What can I eat?
    In addition to enjoying a variety of nutritious foods, the hemodialysis diet will introduce a higher amount of protein into your eating plan. The exact amount will be determined by your dietitian. You will be encouraged to get protein from high quality sources such as lean meat, poultry, fish and egg whites. These high protein foods provide all the essential amino acids your body needs.

    What can’t I eat?
    The hemodialysis diet will restrict foods that contain high amounts of sodium, phosphorus and potassium. Your dietitian will provide you with a diet guide and food lists that indicate which foods are allowed and which ones you should avoid or limit. You will also limit your fluid intake.

    Why do I have to eat this way?
    Your dietitian and doctor will strongly recommend you follow the hemodialysis diet, so your dialysis treatments will be effective and you can feel your best. You will also reduce the risk of other health complications associated with kidney disease and dialysis.

    How does the hemodialysis diet help?
    Potassium builds up in the blood between dialysis treatments. The amount of potassium that accumulates is determined by the amounts and types of foods eaten, as well as how much kidney function remains. Too much potassium is very dangerous. It can cause muscle weakness and make your heart stop beating. Potassium is easily removed by dialysis. Certain fruits, vegetables, dairy products and other foods that are very high in potassium will need to be restricted on your hemodialysis diet.

    Phosphorus is difficult for hemodialysis to filter from the blood. This mineral can build to high levels in the bloodstream and cause complications to your health, such as weak bones, heart problems, joint pain, or skin ulcers. By limiting foods that contain phosphorus, you lessen the risk of developing other health problems. In addition to a low phosphorus diet, your doctor may prescribe a medicine called a phosphorus binder to help keep phosphorus levels normal.

    Sodium causes your body to hold onto more fluid and raises your blood pressure. You may feel uncomfortable and short of breath if you consume too much sodium and fluid. When excess fluid is removed during dialysis, you can get muscle cramps and feel dizzy and weak during or after treatment. Eating less sodium and drinking less fluid can help you feel comfortable before and after your dialysis sessions.

    Your hemodialysis diet will also include a balance of nutrients to help keep your body healthy and strong, while allowing the amount of potassium, phosphorus and sodium your body can safely handle.

    What about fluid intake?
    You will be given specific instructions on the amount of fluid you can have. Fluid intake is not limited to what you can drink; fluid is also ‘hidden’ in some foods you eat. Being aware of the fluid in foods such as gelatin, ice, sherbet, watermelon, sauces, gravies and other high liquid foods is important. Your dietitian will give you guidelines to help you monitor your fluid intake.

    Too much fluid gain between hemodialysis sessions can cause discomfort. You may experience swelling, shortness of breath or high blood pressure. Fluid gain can also make your hemodialysis session uncomfortable due to muscle cramping and drops in blood pressure during dialysis. Following your recommended fluid intake is an important part of feeling better before and after a dialysis session.

    How long do I have to follow the hemodialysis diet?
    You will need to follow the hemodialysis diet as long as you need hemodialysis. Your dietitian may make some changes to the diet in order to adjust to your current condition and activity levels.
    byron webb romero
    byron webb romero

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    Diet in ESRD/ Hemodialysis Empty Re: Diet in ESRD/ Hemodialysis

    Post  byron webb romero on Mon 06 Jul 2009, 9:41 pm

    DYAD THREE (3)
    Byron Webb A. Romero
    Von Deneb H. Vitto
    Raymond C. Ursal

    Nutrition is of basic importance for patients who are on hemodialysis (HD) and an effort to maintain eating enough of the right kinds of foods and avoid those that which can aggravate the condition or predispose to a complication (Karalis, 2005). For intake of protein, patients on HD must increase their protein as it is needed to maintain healthy tissues and replace old or damaged tissues. It is also of importance in aiding the body for preventing infection. While there are two kinds of protein, high quality and low quality, patients on HD need both. The former comes from milk, meat, chicken, fish and eggs which contain all the essentials for tissue growth. Low quality, or those that come from plants include vegetables, breads, and cereals. A dietician however will have to decide for the appropriate diet for patients on HD. For potassium, a limitation on intake must be observed by patients on HD as it builds up in between dialysis treatments. Foods to limit include bananas, tomatoes, oranges, as well as exotic fruits and potatoes. As the ability to balance calcium and phosphorus is lost or diminished with kidney failure, phosphorus intake must be controlled as eventually high levels of phosphorus can lead to calcium and phosphorus deposits in the heart, skin, joints, and blood vessels. In terms of sodium intake, it should also be limited so as to control thirst and maintain a controlled blood pressure. Condiments should be avoided as they contain higher amounts of sodium. Fluid removal is one of the main goals of HD. Lesser fluid gained between and during treatments results in better-tolerated treatments and less work for the heart. Fluid gain can lead to cramping during dialysis and can result to longer treatment times. Goal for fluid gain should not be more than 1-2 pounds per day between treatments. Fluid allowance for hemodialysis patients is determined by the amount or urine produced in a 24-hour period. Most people however are limited to 700-1000mL of fluid per day plus urine output. Fluid allowances vary from person to person, and that other considerations include how much the remaining kidney function is left and the person’s body size.

    As diet is an important aspect of care for patients on HD, our role as nurses is to promote a healthy behavior towards diet among our patients. We must also work collaboratively with other members of the health care team so as to deliver safe and quality care to our patients. It is also our role to conduct health teachings involving the patients and their families. We must continually utilize evidence-based researches on nutrition for patients on hemodialysis to make ourselves up-to-date and maintain currency of practice.

    Karalis, M. (2005). Hemodialysis Diet versus Peritoneal Dialysis Diet. American Association of Kidney Patients. January 2005, 20 (4). Retrieved July 6, 2009 from http://www.aakp.org/aakp-library/hemodialysis-diet-versus-peritoneal-diet/.


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