MNT FOR END STAGE RENAL FAILURE (ESRD) PATEINT

Doctors usually advise the ESRD patients to watch their diet, this should reduce, that should avoid, this shouldn’t take.  Then, what else is left? What should they eat?

Here, I will list out the recommendation micro and macronutrients needed for ESRD patients.  Of course, I will also provide the list of food choices that ESRD patients are save to consume.  Let’s find out what are they.

First, we need to determine which type of dialysis the patient undergoing.  Basically there are two types of dialysis: hemodialysis and continuous ambulatory peritoneal dialysis (CAPD).  The energy and nutrients requirement for both of these are different.

HEMODIALYSIS

NUTRIENTS	RECOMMENDATION	RATIONALE
Calories	35 kcal/kg body weight (<60 y/o) 30-35 kcal/kg (>60 y/o)	Energy expenditure of the hemodialysis patients are the same as those healthy individuals.  However, the energy intake should be adjusted according to the physical activity.
Protein	50% HBV   1.2 g/kg BW 1.3 g/kg BW (severe malnourish/acute illness)	Intake of less than 1.2 g/kg BW per day might lead to negative nitrogen balance.
Carbohydrate	50-60% of total calories	Less than 50% of energy intake from CHO will cause elevation in proportion of protein and fat. For diabetic patients, complex CHO and dietary fiber are recommended.
Fats	25-35% of total calories <7% total calories of SFA 10% of total calories of PUFA 20% of total calories of MUFA <200 mg/day of cholesterol	Patients are at high risk of CVD.
Sodium	2-3 g/day	High sodium intake will increase thirst in patients.
Fluids	750-1000 ml/day
Potassium	2-3 g/day	Hyperkalemia will cause cardiac arrhythmias.
Phosphate	800-1000 mg/day	Hyperphosphatemia will cause elevation of PTH and results in bone disease.
Calcium	<1500 mg/day	Avoid: Dairy products and soybean products
Iron	200 mg/day	In hemodialysis, blood loss increases through dialysers, therefore, there is a need to take supplementation to maintain adequate iron stores.

SAMPLE OF ONE DAY MENU

MEAL TIME	FOOD	AMOUNT
Breakfast	Plain tosai Yellow dhall gravy Tea/coffee + sugar	1 pcs ½ cup 1 tbsp
Morning tea	Kuih apam gula hangus Tea/coffee + sugar	1 pcs 1 tbsp
Lunch	Cooked rice Fried ikan kembong coated with corn flour Cabbage stir-fried Watermelon	150 g 80 g ½ cup 1 slice
Afternoon snack	Tea +sugar Fried popia	200 ml 2 pieces
Dinner	Fried mee Chinese style + chicken pieces + mustard leaves (cut & soaked) Barley water + sugar Lai	80 g 1 tbsp 1 no

CAPD

NUTRIENTS	RECOMMENDATION	RATIONALE
Calories	35 kcal/kg body weight (<60 y/o) 30-35 kcal/kg (>60 y/o) *Includes calories from dialysate due to glucose absorption.	Approximately 60-70% of dialysate fluid glucose may be absorbed. Small and frequent meals are recommended due to early satiety in patients.
Protein	50% HBV   1.2 g/kg BW 1.3 g/kg BW (severe malnourish/acute illness)	Intake of less than 1.3 g/kg BW per day might lead to negative nitrogen balance.
Carbohydrate	50-60% of total calories	Less than 50% of energy intake from CHO will cause elevation in proportion of protein and fat. For diabetic patients, complex CHO and dietary fiber are recommended.
Fats	25-35% of total calories <7% total calories of SFA 10% of total calories of PUFA 20% of total calories of MUFA <200 mg/day of cholesterol	Patients are at high risk of CVD.
Sodium	2-4 g/day	High sodium intake will increase thirst in patients.
Fluids	Up to 1500 ml/day	Ultrafiltration normally can remove 2-2.5kg fluid per day.
Potassium	3-4  g/day	Hypokalemia may occur due to continuous removal of potassium in dialysate.
Phosphate	800-1000 mg/day	Hyperphosphatemia will cause elevation of PTH and results in bone disease.
Calcium	<2000 mg/day	Avoid: Dairy products and soybean products
Iron	200 mg/day	In hemodialysis, blood loss increases through dialysers, therefore, there is a need to take supplementation to maintain adequate iron stores.

SAMPLE ONE DAY MENU

MEAL TIME	FOOD	AMOUNT
Breakfast	Fried meehoon + fried egg Tea/coffee + sugar	½ cup 1 tbsp
Lunch	Cooked rice Roasted pandan chicken Old cucumber soup Apple	100 g
Afternoon snack	Tea +sugar Kuih lapis	1tbsp 1 pieces
Dinner	Cooked rice Fish, fried in chilli Fried petola + fuchok + su-un Papaya	100 g 1 slice