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ABSTRACT
Year : 2018  |  Volume : 4  |  Issue : 2  |  Page : 48-49

Nutrition in dialysis patients


Renal Dietitian, Apex Kidney Care, Mumbai, Maharashtra, India

Date of Web Publication6-Dec-2018

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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2395-1540.246993

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How to cite this article:
Jasani RH. Nutrition in dialysis patients. J Renal Nutr Metab 2018;4:48-9

How to cite this URL:
Jasani RH. Nutrition in dialysis patients. J Renal Nutr Metab [serial online] 2018 [cited 2018 Dec 17];4:48-9. Available from: http://www.jrnm.in/text.asp?2018/4/2/48/246993

Dialysis patients usually encounter a number of challenges which include physical, financial, social, psychological and nutritional. The key to a better quality of life on dialysis is regular dialysis therapy and good nutrition regime. Achieving a good nutrition regime can be challenging as there are multiple aspects that need to be addressed. This lecture is aimed at focusing on individualizing the nutrition therapy to achieve better outcomes in dialysis patients.

Medical nutrition therapy (MNT [Table 1]) plays an integral role in the health of patients with chronic kidney disease (CKD) stage 5 (D) Dialysis. The goals of MNT in CKD 5D include:
Table 1: Nutritional requirements of patients on maintenance dialysis

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  1. To meet the nutritional requirements in patients with ESRD
  2. To prevent malnutrition and correct if any
  3. maintain acceptable blood chemistries, blood pressure and fluid status.



  Nutrition Assessment in Dialysis Patients Top


Nutrition assessment is the basis for the nutrition care plan and formulation of goals. Tools of a complete nutrition assessment include:

  • Medical and social history – it includes weight history, past medical and surgical history, primary and secondary diagnoses, religion, conventional eating patterns, etc.
  • Dietary history – it includes food allergies and intolerances, appetite and taste changes, chewing or swallowing problems, alcohol intake, etc.
  • Physical examination – it includes skin turgor, facial puffiness, abdomen
  • Anthropometry and body composition – height, weight, BMI, skinfold thickness, waist circumference, waist to hip ratio
  • Biochemical data – serum albumin, pre-albumin, serum transferrin
  • Estimation of energy, protein and fluid requirements.


No single assessment tool is sensitive and specific enough to be used as a sole indicator of nutritional status. However, in patients with CKD 5D, where correction of malnutrition is the primary goal, a new technique called Subjective Global Assessment (SGA) has proven to be beneficial. SGA is a simple and reliable malnutrition screening tool. This method is based on taking the history and physical examination. The merit of this tool being highly predictive of the outcome, it is estimated to be a potent predictor of patient survival.

Based on the SGA ratings, patients can be placed in various nutritional risk categories, including normal nutrition (well nourished), mild to moderate malnutrition and severe malnutrition. Low or falling SGA scores would be considered a marker for high risk and requires intervention.



 
 
    Tables

  [Table 1]



 

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