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.

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

GEJALA-GEJALA KEGAGALAN BUAH PINGGANG KRONIK

Apakah gejala- gejala yang biasa dialami oleh mereka yang menghidap kegagalan buah pinggang tahap kronik??? Kebiasaannya, gejala- gejala yang teruk tidak akan kelihatan sehinggalah buah pinggang mereka sudah berada di tahap yang  kritikal. Gejala- gejala yang biasa dialami termasuk:

•      Terasa penat dan tidak bertenaga

     

•       Tidak dapat menumpukan perhatian dengan sepenuhnya

     

•       Kurang selera makan

      

•      Kurang tidur

       

•       Mengalami kekejangan otot pada waktu malam

          

•    Bengkak kaki dan buku lali

    

•     Bengkak di sekeliling mata, terutama pada waktu pagi

•    Kulit kering dan gatal

     

•   Kerap membuang air kecil, terutama pada waktu malam 

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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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