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Objectives

Participant will be able to describe the importance ofnutrition 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

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Dietary challenge Anorexia

Taste challenge

Reduce food intake

The main focus on dietary management is on protein,sodium, potassium phosphate, water and adequate nonprotein.

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.

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Nutritional requirement during

various stages of renal faillureNutrient Acute renal faillure End-state renal disrase

perdialysis

Haemodialysis Peritoneal dialysis

Energy 30-50 kcal/kg of body

weight

35 kcal/kg ideal body

weight

35 kcal/kg ideal body

weight

35 kcal/kg ideal body

weight

Protein 0.6-0.8g/kg based on

kidney fuction

0.6-0.8g/kg

>60%* HBV

1.0-1.2g/kg ideal weight

>60%* HBV

Diabetic may need 1.2-1.5g/kg

1.2-1.5g/kg for ideal body

weight >60%* HBV

Sodium 1-2g/day, depends on B/P

oedema replace diuretic

phase

Usual 2-4g/day 2-3g/day

Or

no added salt

3-4g/day

Or

No added salt

Phosphorus Maint serum level 10-20mg/g protein 12-15 mg/g protein 12-15mg/g protein

Potassium 5.0 mEq/L replace loss in

diauretic phase

Not restricted unless

serum potassium is

elevated and urine output

1ltr/day

2-3g/day (individualise) 2-3g/day (individualise)

Fluid Output+600cc Unrestricted balance fluid

intake with urine output

to avoid oedema

Output+1000cc Output+1000cc

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Potassium content of vegetables in 100gmLOW

0-100 mg

Medium

101-200mg

High

201mg and above8Fenugreek leaves Cabbage Amaranth

Lettuce Carrots Coriainder leaves

Beetroot Onion-small Drumpstick leave

Radish pink Radishwhite Spinach

Bottle gourd Bitter gourd Colocasia

Broad beans Brinjal Potato

Cucumber Cauliflower Sweet potato

Kno l khol (ganth gobhi) French beans Tapioca

Green mango Ladies finger Yam

Peas Onion stalks Drumstick

Ridge gourd Plantain flower Green papaya

Snake gourd Green plantain

Chow chow pumpkin

Tamarind leaves Green tomato

Kurry leaves Parwar

Mint (ararot)

Giant chillies

Double boiling and draining excess water reduce potassium content

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Potassium content of fruits

mg/100gmFruits low in potassium Fruits high in potassium

Orange..9 Mango ..205

Pineapple37 Amla.225

Papaya..69 Plums..247

Apple75 Sapota.269

Banana..88 Lemon..270

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Daily supplements of proteins of HBV to provide EAA

Veg Non -veg

Milk 200ml, Egg 1 pc

Paneer 30gm Chiken/meat 30gm

Milk 100ml

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Liberally permitted

Sugar fat

Jiggery (cane/date) Butter

honey Ghee (clarified butter oil)

Sherbets

Jally

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Phosphorus10High Phosphorus Foods Dairy products

Beans & Nuts Processed meats

Chocolate

Pancakes, waffles,biscuits, cakes

Sardines

Whole wheat, brancereals

Lower Phosphorus Foods

Fresh meat products

Homemade baked goods

Nondairy creamer

Unenriched rice milk

Cream cheese

White flour products

Rice cakes

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