WHAT IS END STAGE RENAL FAILURE???

End stage renal failure is a complete or almost complete renal failure. Those who had ESRF will depend on dialysis for a lifetime unless they undergo kidney transplantation.

WHAT ARE THE RISK FACTOR OF DEVELOPING ESRF??

Risk factors for ESRF include:

•   Diabetes
•  Diabetes is the biggest risk factor in developing ESRF. In diabetes, body doesn’t use glucose (sugar) very well thus, that glucose will remain in the blood and become harmful to the body. 
Nearly one –third of people who develop ESRF have diabetes.

•  High blood pressure (hypertension)
• High blood pressure is the second leading cause of kidney failure. This condition can affect kidney function where it can cause damage to small blood vessels at the kidney thus preventing kidney from filtering the waste product in the blood.

•   History of glomerular disease
•  This is third leading cause of glomerular disease. Glomerular disease will damage glomeruli which function to filter blood in the kidney.

•   Drug use
•  Extensive use of over the counter pain medicine or abuse of illegal drugs can lead to kidney 
  failure.
  
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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 =)

PHOSPHORUS AND KIDNEY DISEASE

What is phosphorus?
- phosphorus is a minerals which help to keep bones strong and healthy.

What is the relationship between phosphorus and kidney disease?
- decline in kidney function lead to a rise in phosphate blood level which causing itchy skin, painful joints and loss of calcium from bone. Thus, those who have kidney disease have to limit amount of high and moderate phosphate- containing food.

Below are some guidelines for kidney patient in choosing phosphate food in their diet.

PHOSPHORUS GUIDELINE FOR CHOOSING FOOD
Instead of these higher phosphorus food	… you can eat these lower phosphorus food
Dairy and dairy-substitutes
8 ounces milk	8 ounces non-dairy creamer or 4 ounces milk
½ cup ice cream	½ cup sherbet (sorbet) or 1 popsicle
½ cup custard or pudding made with milk	½ cup pudding or custard made with non-dairy creamer
Malted milk	Tea, hot apple cider
Brown rice	White rice, barley
Biscuits: store-bought, mixes and refrigerated	Biscuits: homemade (use baking powder substitute below**)
Muffins: all store-bought, mixes, and homemade bran and oat bran flavours	Muffins: homemade, made with white flour (use baking powder substitute below**)
Meat and other proteins
Carp, crayfish, beef liver, chicken liver, fish roe, organ meats, oysters, sardines	Unseasoned beef, chicken, pork, turkey, veal, fish, eggs
Fruit and vegetables
Lima or pinto beans	Mixed vegetables or green beans
Dried fruits, prunes, prune juice	Fresh or canned fruits such as apples, pears, berries, grapes, watermelon, pineapple
Beverages
Cola soft drinks	Non-cola soft drinks (ginger ale, lemon/lime flavoured soda, root beer)
Iced tea with phosphate additives	Homemade iced tea
Cocoa, hot chocolate	Tea, hot apple cider
Snacks and miscellaneous items
Peanuts	Unsalted popcorns
Nuts, peanut butter, sesame or sunflower seeds; avoid pumpkin seeds	Unsalted popcorn, unsalted pretzels, unsalted corn chips
Chocolate bars	Hard candy, fruit flavoured candy or jelly beans

**Since baking powder is high in phosphorus, try this low phosphorus alternative: use ¼ tsp baking soda + ½ tsp cream of tartar instead of 1 tsp baking powder

do consume variety of vegetables!

list of high phosphorus food

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PERITONEAL DIALYSIS

This types of dialysis has recently became choices among kidney patient over hemodialysis as this method allowed the blood to be filtered while the patient can carry out their own activities without needed to be stick at the dialysis machine over hours.

In peritoneal dialysis, blood is filtered inside the body after the abdomen is filled with a special cleaning solution. It means that blood is cleaned by using lining of abdominal area as a filter. This method allowed blood to be filtered while patient carry out their everyday activities.
Before first peritoneal dialysis session, doctor will create access to abdominal area by making small surgical cut, most often at the side of belly button. A plastic tube called a catheter is inserted into the stomach and nearby organ. This is called peritoneal cavity.

     HOW PERITONEAL DIALYSIS WORKS??

In peritoneal dialysis, peritoneum (natural lining of abdomen) acts as dialysis membrane. Small operation is needed to insert a catheter into the abdomen. The wastes and extra fluid are removed from the body into the lower bag when the dialysis solution is drained off. The fresh dialysis solution from the top bag is drained in into the peritoneal cavity. This is called an ‘exchange’- fresh fluid replacing old.

•    The draining and filling process, called an exchange take about 30 to 40 minutes. Patient will need 4 exchanges per day.
•       There are two main types of peritoneal dialysis:

a) Continuous Ambulatory Peritoneal Dialysis (CAPD).

This type of dialysis is done without a machine. Dialysis solution is placed into the catheter and patient can go for their everyday activities or sleep. It is done four or five times a day.

b) Continuous Cycler-assisted Peritoneal Dialysis (CCPD).

This type of dialysis uses a machine called a cycler to fill and drain the solution from the stomach, usually done while sleeping.

POTENTIAL PROBLEM THAT MAY ARISE DURING CAPD

•     Peritonitis- inflammation of peritonitis
•     Weight gain
•     Due to the use of dextrose solution and fluid overload in the body because of imbalance in and out fluid.
•     Dehydration
•      Due to drinking too little, causing too concentrated dextrose solution

HAEMODIALYSIS

Before we go in depth about hemodialysis, let we first explain to you what it is actually called dialysis. Dialysis is a life- saving treatment which is needed to replace over the kidney function when the kidney is unable to carry out it function anymore. Dialysis uses special machine to filter harmful wastes, salt and excess fluid from the blood. 

There are two types of kidney dialysis; Hemodialysis and Peritoneal dialysis. However, in this part we will only cover about hemodialysis.

 In hemodialysis, blood is filtered using dialyzer and dialysis machine. Before first session, doctor will create vascular access which is creating an entrance to into one of the blood vessels to connect to the dialysis machine.
 Vascular access can be done by:

•       Connecting an artery to a vein to create a larger blood vessel area, called a fistula

picture of graft

•          Joining (grafting) an artery and vein together using a soft plastic tube
•        Inserting a thin plastic tube into a large vein in the neck or groin area of the leg; this type of access is temporary. 

Access can be temporary or permanent dependent on individual condition. It is recommended to create the access weeks or months before using it so that it has enough time to heal properly.

HOW HEMODIALYSIS WORK??

Blood from the body (contains toxins and excess water) is pumped through a dialyser. then, a blood thinner called heparin is introduced into the blood to avoid clotting. The blood then passed into the dialysis fluid where it is filtered to remove the waste and excess water. The cleansed blood is then returned to the body while the waste is pumped away out of the dialyser

•  Patients have to attend the renal unit regularly 3 times a week, every week for haemodialysis.
•  It takes 3 to 5 hours each visit depends on how much toxic waste the individual patient makes. The bigger the patient, the more amount of toxic waste to be removed.

POTENTIAL PROBLEM THAT MAY ARISE DURING HEMODIALYSIS

•          Low blood pressure
•      Blood pressure fall due to rapid removing of fluid and salt. This can cause feelings of light- headed, sweaty and sick.

•   Nausea
• Occurs due to changes in blood in blood pressure during and after treatment

•    Cramp
•  Leg cramp may occur due to rapid removal of fluid during dialysis

•    Headache
•  Occasionally occurs at the end of dialysis due to changes in fluid and waste product level in the body

SYMPTOMS OF CHRONIC KIDNEY DISEASE

What is the commonly symptoms occur to chronic kidney disease patient??? Mostly, people will not notice any severe symptoms until their kidney is advanced. However, usually people with chronic kidney disease will have these symptoms:

•     Feel tired and less energy

  

•       Have problem in concentrating

 

  

•        Have poor appetite

 

  

•     Have problem with sleeping

       

  

•        Having muscle cramping at night 

    

  

•       Swollen feets and ankles (edema)

•       Have puffiness around eyes, especially in the morning

•       Having dry and itchy skin

       

  

•       Urinate more frequently, especially at night.

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LOW PROTEIN CEREAL FOR CRF PATIENTS

Good day, we meet again with the list of cereal foods that suitable for the consumption of chronic kidney failure patients.  All of the food listed below are low in protein, have a look!

FOOD	SERVING SIZE	WT (g)	CALORIE (kcal)	PROTEIN (g)	CHO (g)
Soh-hun	1 cup	31	103	0	25.7
Sago	1 tbsp	11	37	0	9.3
Marie biscuit	1 pcs	7	32	0.5	5.7
Cream cracker	1 pcs	9	40	0.8	6.8
Lo-see-fun	1 cup	141	177	0.8	42.5
Putu mayam	1 pcs	50	95	1.4	19
White bread	1 slice	19	48	1.8	9.8
Rice	1 cup	128	167	2.9	38.5
Kuih teow	1 cup	108	150	3.2	34.3
Mee	1 cup	109	225	4.9	49.4
Mee-hoon	1 cup	53	184	5.9	40.2