MEDICAL NUTRITION THERAPY FOR ACUTE RENAL FAILURE

What is the goal of dietary management for acute renal failure patient??? The recommendation for both micro and macronutrient below which is established for acute renal patient intended to limit further renal injury and also to prevent malnutrition.
Come and have a look about the recommended amount of both micro and macronutrient!

Nutrient	Suggested prescription	Rationale
Energy	30- 35 kcal/kg body weight	Based on nutritional status and stress level of the patient
Protein	Nondialysis patients    :  0.8-1.2 g/kg Hemodialysis patients : 1.2-1.5 g/kg CAPD patients             : 1.2-1.3 g/kg CCPD patients             : 1.2-1.3 g/kg CRRT patients              : 1.5-2.0g/kg	Increase as GFR is back to normal. High biological value protein should be provided for at least 60%
Sodium	1.1-1.3 g/day	Depending on urinary output, blood pressure, edema, dialysis and serum sodium level; replace loss in diuretic phase. Excess sodium can increase fluid retention.
Potassium	2-3 g/day	Depending on urinary output, dialysis and serum potassium level; replace loss in diuretic phase. Excess potassium can result in severe cardiac and neuromuscular complications.
Fluid	24- hours urine output + 500 ml	Based on urinary sodium and total urine output
Phosphorus	Limit as needed	Excess phosphorus may result of decreased renal phosphorus excretion and increased endogenous release of phosphates.  It can also interact with calcium to weaken bones. It has negative effects on the heart tissue, blood vessels, and lungs. May need supplementation with tube feeding and/or with TPN.
Magnesium	Limit as needed	Excess magnesium can affect neuromuscular, cardiovascular and neurologic systems
Calcium	1.0- 1.5 g/day	May require supplementation as needed
Vitamin/ Minerals	Supplement as needed	May need to supplement water soluble and fat soluble vitamin, especially vitamin B & C

This is the recommendation of intake for acute renal failure patient and can be used as a guidance for daily dietary intake. If you can't understand on how this recommendation works, don't worry! Go and meet your dietitian and she/ he will determine how much to take, which food is appropriate for your diet and which to avoid based on your individual needs.
Meet your dietitian now and he/she will help you out on your diet =)

MEDICAL NUTRITION THERAPHY FOR ACUTE RENAL FAILURE

Pengurusan diet untuk pesakit kegagalan buah pinggang akut bertujuan untuk mengelakkan buah pinggang dari mengalami kerosakan yang lebih teruk dan juga untuk memastikan pesakit mendapat nutrisi yang secukupnya. 

Disertakan di sini adalah kuantiti pengambilan mikro dan makronutrient yang disarankan untuk pesakit buah pinggang akut:
 

Nutrien	Preskripsi yang dicadangkan	Rasional
Tenaga	30- 35 kcal/kg berat badan	Berdasarkan kepada status pemakanan dan tahap stress pesakit.
Protein	Pesakit tanpa dialisis   :               0.8-1.2 g/kg Pesakit dengan haemodialisis :    1.2-1.5 g/kg Pesakit dengan CAPD : 1.2-1.3 g/kg Pesakit dengan CCPD : 1.2-1.3 g/kg Pesakit dengan CRRT  : 1.5-2.0g/kg	Pengambilan meningkat apabila GFR (kadar penapisan glomerular) kembali normal. Protein yang tinggi nilai biologi perlu diambil sekurang- kurangnya 60%.
Sodium	2-3 g sehari	Bergantung kepada pengeluaran air kencing, tekanan darah, edema, dialysis dan paras serum sodium; diperlukan untuk menggantikan sodium yang hilang ketika fasa diuretik Sodium yang berlebihan boleh menyebabkan penahanan cecair di dalam badan.
Potassium	2-3 g sehari	Bergantung kepada pengeluaran air kencing, dialysis dan paras serum potassium; diperlukan untuk menggantikan kehilangan potassium ketika fasa diuretik Potassium yang berlebihan boleh mengakibatkan komplikasi pada jantung dan saraf.
Cecair	24- jam pengeluaran air kencing + 500 ml	Berdasarkan sodium dalam air kencing dan jumlah pengeluaran air kencing.
Fosforus	Hadkan seperti yang diperlukan	Lebihan fosforus boleh menyebabkanpenurunan perkumuhan fosforus oleh buah pinggang dan meningkatkan pembebasan fosfat ke dalam sel.  Fosforus juga boleh bertindakbalas dengan kalsium untuk melemahkan tulang. Fosforus mempunyai kesan negative terhadap tisu jantung, salur darah dan peparu.
Magnesium	Hadkan seperti yang diperlukan	Lebihan magnesium boleh memberi kesan kepada sistem saraf, kardiovaskular dan neurologi.
Kalsium	1.0-1.5 g sehari	Mungkin memerlukan makanan tambahan seperti yang diperlukan.
Vitamin/ Mineral	Tambah seperti yang diperlukan	Mungkin memerlukan suplemen untuk vitamin larut lemak dan larut air terutamanya vitamin B & C

 
Ini merupakan saranan pengambilan makanan untuk pesakit kegagalan buah pinggang akut yang boleh dijadikan panduan dalam pemilihan makanan seharian. Sekiranya anda tidak memahami bagaimana untuk mengaplikasikan saranan ini dalam pemakanan seharian, jangan risau! Dietitian- dietitian terlatih sedia untuk membantu anda.Berjumpalah dengan mereka sekarang dan mereka akan membantu anda sebaik yang mungkin untuk memsatikan anda mendapat pengambilan makanan yang secukupnya berdasarkan keadaan kesihatan dan tubuh badan anda.

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