Monday, June 10, 2013

What’s the deal with the Dialysis Diet?

Renal disease requires a very specific diet pattern.  What happens in kidney failure is that the kidneys are unable to filter the blood so components that are usually excreted just build up in the body.  This can lead to dangerous side effects and without dialysis, death.  Fortunately, through diet, medications and dialysis treatment, patients can manage their disease.  Here are the biggest things to watch out for, the 3 P’s:

Protein - Albumin Goal: ≥4.0
When patients are have renal disease pre-dialysis, they are on a very low protein diet.  All that changes because the process of dialysis increases their needs to 1.2-1.5g/kg, up from 0.6-0.8g/kg.  That is double! Because of this, patients need to be encouraged to eat enough protein, especially from animal sources that are more bio-available compared to vegetarian sources.

Potassium – Goal 3.5-5.5
Potassium is a common component of many fruits and vegetables so what appears to be a healthy diet could be dangerous for a renal patient.  The trouble with potassium is that it affects muscle contractions in blood vessels, including the heart.  A spike can lead to a heart attack, just like that, so it is critical to keep lab values within an acceptable range.  

Phosphorus – Goal 3.0-5.5
Due to the high demand for protein, patients will consume more phosphorus than is ideal, but they take ‘binders’ with every meal to soak up the phosphorus so it is undigested.  One of the major complications associated with uncontrolled Phosphorus is decline in bone health.  High levels stimulate parathyroid hormone (PTH).  In a body with healthy kidneys, this is a signal to excrete the extra phosphorus.  Because it cannot go anywhere, the PTH stays high and causes damage to the bone, leeching out calcium.  In more severe cases, this can lead to calcification of the soft tissue which is painful and if unchecked can result in amputation and death.  

By adhering to a proper diet, using their medications correctly and getting all of their dialysis treatments, all of these values can remain in the healthy ranges.  Dialysis patients may need to work a bit harder, but they can still lead healthy lives. 

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