Objectives

Participant will be able to describe the importance of

nutrition intervention in patients with ESRD Participant will be able to identify the components of a nutritional assessment Participant will be able to identify the components of the renal diet and the role of the dietitian

Dietary challenge

Anorexia Taste challenge Reduce food intake The main focus on dietary management is on protein, sodium, potassium phosphate, water and adequate non protein. Maintenance peritoneal or haemodialysis is required when the GRF is below 5ml/min Maintain loss of ascorbic acid , folic acid, and water soluble vitamins . During hemodialysis ,amino acid are lost.

Nutritional requirement during various stages of renal faillure

Nutrient Energy Protein Acute renal faillure 30-50 kcal/kg of body weight 0.6-0.8g/kg based on kidney fuction End-state renal disrase perdialysis 35 kcal/kg ideal body weight 0.6-0.8g/kg >60%* HBV Haemodialysis 35 kcal/kg ideal body weight 1.0-1.2g/kg ideal weight >60%* HBV Diabetic may need 1.21.5g/kg 2-3g/day Or no added salt 12-15 mg/g protein 2-3g/day (individualise) Peritoneal dialysis 35 kcal/kg ideal body weight 1.2-1.5g/kg for ideal body weight >60%* HBV

Sodium

Phosphorus Potassium

1-2g/day, depends on B/P oedema replace diuretic phase Maint serum level 5.0 mEq/L replace loss in diauretic phase

Usual 2-4g/day

10-20mg/g protein Not restricted unless serum potassium is elevated and urine output 1ltr/day Unrestricted balance fluid intake with urine output to avoid oedema

3-4g/day Or No added salt 12-15mg/g protein 2-3g/day (individualise)

Fluid

Output+600cc

Output+1000cc

Output+1000cc

Potassium content of vegetables in 100gm

LOW 0-100 mg
8Fenugreek leaves Lettuce Beetroot Radish pink Bottle gourd Broad beans Cucumber Kno l khol (ganth gobhi) Green mango Peas Ridge gourd Snake gourd Chow chow Tamarind leaves Kurry leaves Mint (ararot) Giant chillies

Medium 101-200mg
Cabbage Carrots Onion-small Radish white Bitter gourd Brinjal Cauliflower French beans Ladies finger Onion stalks Plantain flower Green plantain pumpkin Green tomato Parwar

High 201mg and above

Amaranth Coriainder leaves Drumpstick leave Spinach Colocasia Potato Sweet potato Tapioca Yam Drumstick Green papaya

Double boiling and draining excess water reduce potassium content

Potassium content of fruits mg/100gm

Fruits low in potassium Orange..9 Pineapple37 Papaya..69 Apple75 Banana..88 Fruits high in potassium Mango ..205 Amla.225 Plums..247 Sapota.269 Lemon..270

Daily supplements of proteins of HBV to provide EAA

Veg Milk 200ml, Paneer 30gm Milk 100ml Non -veg Egg 1 pc Chiken/meat 30gm

Liberally permitted
Sugar Jiggery (cane/date) honey Sherbets Jally fat Butter Ghee (clarified butter oil)

Phosphorus

10

High Phosphorus Foods Dairy products Beans & Nuts Processed meats Chocolate Pancakes, waffles, biscuits, cakes Sardines Whole wheat, bran cereals

Lower Phosphorus Foods Fresh meat products Homemade baked goods Nondairy creamer Unenriched rice milk Cream cheese White flour products Rice cakes