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Friday, February 19, 2010
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Nutrition for Renal Disorder Patients
Renal Function
1. Excretion
2. Non excretion
a. Blood pressure regulation
b. Hemopoietic function = produce erythropoietin hormone that regulates erythrocyte production
c. Vitamin D metabolism
3. Metabolic function
DIETARY IN CHRONIC RENAL FAILURE /CHRONIC KIDNEY DISEASE PATIENT
Characteristic of CRF Patients
- High urea, creatinine , uric acid in blood
- Carbohydrate metabolism disturbance: hiperglucagonemia, insulin resistancy
- Decrease production of erythropoietin, cause anemia
- Altered protein metabolism: if protein intake too low will cause malnutrition, in the other hand too many will cause increased urea, uric aicd, creatinine, and ammonia in blood
- Hypercholestrolemia, hypertrygliseridemia that will promote atherosclerosis in renal patients
- Dehydration or hyperhydration, hypo/ hypernatremi, hipercalemi (high K/potassium in blood)
- Decrease water soluble vitamin (B,C), increase non water soluble vitamin (A,D,E,K)
- Hyperphosphatemia (PO4), hypocalcemia (Ca), hypermagnesia (Mg).
We can divide into 2 groups dietary:
1. Non-blood dialysis (for patients that not yet get any dialysis for their treatment)
2. Post-blood- dialysis (for patients that has got dialysis)
Subject Non-blood dialysis Post-blood dialysis
Protein limit protein intake if creatinine clearance <20mL/minutes 0.5-0.6 gram/kg BW (2/3 from animal, 1/3 from plants) We can limit the protein till 0.28 gram/kg BW , but we must add essential amino acids/ketoacids groups supplements Twice from non blood dialysis (NBD)patient Energy <60 y.o: 35 kcal/ kg ideal BW/daily >60 y.o: 30/kcal/kg ideal BW/daily
BW> 120 % ideal BW: energy intake must be decreased
Energy source: Carbohydrate and fat (dont use protein) Equal to NBD
Fat Fat<=30% total energy Saturated fatty acid <10% Cholesterol <=300mg/daily Equal to NBD Polyunsaturated/saturated fatty acid ratio= 1:1 Carbohydrate Source: carbohydrate complex> simple Equal to NBD
Hydration and sodium Intake: 1500mL/daily
Sodium 1-3 gr/daily
Must be adjusted by renal function Intake: 750-1500 mL
Sodium : 750 – 1000 mL
Must be monitored, overload risk
Supplement: B6 5-10 mg/daily
Folic acid 1mg/daily, vit C 100mg/daily
Potassium Max 70 mEq/daily Equal to NBD
Phosphor 8-10 mg/ kg BW/ daily Equal to NBD
Calcium 1400-1600 mg/ daily Equal to NBD
Magnesium 100-300 mg/ daily Equal to NBD
IDEAL Body Weight (BW) use Body Mass Index (BMI)
BMI = {BW in kg / [(Body height in meter) quadrate]}
Ideal BMI = 18.5 – 22.5
So the formula for ideal BW = range 18.5 – 22.5 X (BH in meter)quadrate
For using above table, we must have table food composition, so we can calculate patients dietary intake. Commonly in practical view, physicians often control patients water intake, protein intake, and potassium intake.
Reference:
Summary lecture notes from dr. Dadang A. Primana MSc, Sp.GK, Sp.KO. Department of Medical Nutrition Science , Faculty Medicine of Padjadjaran University
1. Excretion
2. Non excretion
a. Blood pressure regulation
b. Hemopoietic function = produce erythropoietin hormone that regulates erythrocyte production
c. Vitamin D metabolism
3. Metabolic function
DIETARY IN CHRONIC RENAL FAILURE /CHRONIC KIDNEY DISEASE PATIENT
Characteristic of CRF Patients
- High urea, creatinine , uric acid in blood
- Carbohydrate metabolism disturbance: hiperglucagonemia, insulin resistancy
- Decrease production of erythropoietin, cause anemia
- Altered protein metabolism: if protein intake too low will cause malnutrition, in the other hand too many will cause increased urea, uric aicd, creatinine, and ammonia in blood
- Hypercholestrolemia, hypertrygliseridemia that will promote atherosclerosis in renal patients
- Dehydration or hyperhydration, hypo/ hypernatremi, hipercalemi (high K/potassium in blood)
- Decrease water soluble vitamin (B,C), increase non water soluble vitamin (A,D,E,K)
- Hyperphosphatemia (PO4), hypocalcemia (Ca), hypermagnesia (Mg).
We can divide into 2 groups dietary:
1. Non-blood dialysis (for patients that not yet get any dialysis for their treatment)
2. Post-blood- dialysis (for patients that has got dialysis)
Subject Non-blood dialysis Post-blood dialysis
Protein limit protein intake if creatinine clearance <20mL/minutes 0.5-0.6 gram/kg BW (2/3 from animal, 1/3 from plants) We can limit the protein till 0.28 gram/kg BW , but we must add essential amino acids/ketoacids groups supplements Twice from non blood dialysis (NBD)patient Energy <60 y.o: 35 kcal/ kg ideal BW/daily >60 y.o: 30/kcal/kg ideal BW/daily
BW> 120 % ideal BW: energy intake must be decreased
Energy source: Carbohydrate and fat (dont use protein) Equal to NBD
Fat Fat<=30% total energy Saturated fatty acid <10% Cholesterol <=300mg/daily Equal to NBD Polyunsaturated/saturated fatty acid ratio= 1:1 Carbohydrate Source: carbohydrate complex> simple Equal to NBD
Hydration and sodium Intake: 1500mL/daily
Sodium 1-3 gr/daily
Must be adjusted by renal function Intake: 750-1500 mL
Sodium : 750 – 1000 mL
Must be monitored, overload risk
Supplement: B6 5-10 mg/daily
Folic acid 1mg/daily, vit C 100mg/daily
Potassium Max 70 mEq/daily Equal to NBD
Phosphor 8-10 mg/ kg BW/ daily Equal to NBD
Calcium 1400-1600 mg/ daily Equal to NBD
Magnesium 100-300 mg/ daily Equal to NBD
IDEAL Body Weight (BW) use Body Mass Index (BMI)
BMI = {BW in kg / [(Body height in meter) quadrate]}
Ideal BMI = 18.5 – 22.5
So the formula for ideal BW = range 18.5 – 22.5 X (BH in meter)quadrate
For using above table, we must have table food composition, so we can calculate patients dietary intake. Commonly in practical view, physicians often control patients water intake, protein intake, and potassium intake.
Reference:
Summary lecture notes from dr. Dadang A. Primana MSc, Sp.GK, Sp.KO. Department of Medical Nutrition Science , Faculty Medicine of Padjadjaran University
Potassium
Potassium is one of major minerals that very important to human physiologic function.
Potassium role in our body:
- Intracellular major cation
- Cell membrane repolarization
- Neuroautonomic
- Neuromuscular excitability
- Protein metabolism
- Growth hormone releasinh
- pH intacellulare
Potassium equilibrium: 70 kg man -->3500mEq potassium
Intake: 50-100mg (average American)
Output: 50-100mg via sweat, urine, faeces. (from urine 30mEq/L/urine; urine ouput 0.5cc/kgBB/daily)
Hipokalemi
- potassium level in blood <3.5 mEq/L
- clinical manifestation: muscular weakness, unreactive to stimulus, abdominal distention, paralitic ileus, postural hipotension, cardiac disturbance, insulin secretion abnormality
Causes:
- low intake potassium dietary (rarely)
- increasing potassium excretion through kidney or faeces, eg: regular use of certain drugs (strong laxative, diuretics, steroids)
- conditions such as diabetic acidosis, dehydrations, prolonged vomiting, or diarrhea
How to treat hipokalemia
- potassium correction deficit via potassium infusion, dangerous to be given without doctor supervision, if too quickly could make cardiac arrest
- KSR (kalium slow release) tablet, usually given 1 tablet orally daily
- Increasing potassium rich dietary, eg: all fresh food especially fruits and vegetables
Hiperkalemia
- Symptoms: muscular weakness, vomiting , cardiac arrest (if given bolus intraveinaly)
- Causes: doesnt result from overeating foods high in potassium, usually result from overconsumption of potassium salts or supplements and from certain disease or treatments
Potassium in selected foods
Adequate intake: adults 4700 mg/day
- Potato (1 medium baked w/skin , 133 kcal) = 500mg
- Tomato juice (3/4 cup, 31 kcal) = 400mg
- Banana (1 medium raw, 109 kcal) = 450mg
- Squash, acorn (1/2 cup baked, 69 kcal)= 500mg
- Soybeans (1/2 cup cooked, 149 kcal)= 450mg
- Artichoke (1 servings, 60kcal) = 425 mg
- Milk (1 cup reduced fat 2%, 121 kcal)= 375 mg
Reference:
1. Pedoman cairan infus edisi revisi VIII 2003, pt.otsuka indonesia
2. Understanding nutrition 10th ed, thomson wadsworth
Potassium role in our body:
- Intracellular major cation
- Cell membrane repolarization
- Neuroautonomic
- Neuromuscular excitability
- Protein metabolism
- Growth hormone releasinh
- pH intacellulare
Potassium equilibrium: 70 kg man -->3500mEq potassium
Intake: 50-100mg (average American)
Output: 50-100mg via sweat, urine, faeces. (from urine 30mEq/L/urine; urine ouput 0.5cc/kgBB/daily)
Hipokalemi
- potassium level in blood <3.5 mEq/L
- clinical manifestation: muscular weakness, unreactive to stimulus, abdominal distention, paralitic ileus, postural hipotension, cardiac disturbance, insulin secretion abnormality
Causes:
- low intake potassium dietary (rarely)
- increasing potassium excretion through kidney or faeces, eg: regular use of certain drugs (strong laxative, diuretics, steroids)
- conditions such as diabetic acidosis, dehydrations, prolonged vomiting, or diarrhea
How to treat hipokalemia
- potassium correction deficit via potassium infusion, dangerous to be given without doctor supervision, if too quickly could make cardiac arrest
- KSR (kalium slow release) tablet, usually given 1 tablet orally daily
- Increasing potassium rich dietary, eg: all fresh food especially fruits and vegetables
Hiperkalemia
- Symptoms: muscular weakness, vomiting , cardiac arrest (if given bolus intraveinaly)
- Causes: doesnt result from overeating foods high in potassium, usually result from overconsumption of potassium salts or supplements and from certain disease or treatments
Potassium in selected foods
Adequate intake: adults 4700 mg/day
- Potato (1 medium baked w/skin , 133 kcal) = 500mg
- Tomato juice (3/4 cup, 31 kcal) = 400mg
- Banana (1 medium raw, 109 kcal) = 450mg
- Squash, acorn (1/2 cup baked, 69 kcal)= 500mg
- Soybeans (1/2 cup cooked, 149 kcal)= 450mg
- Artichoke (1 servings, 60kcal) = 425 mg
- Milk (1 cup reduced fat 2%, 121 kcal)= 375 mg
Reference:
1. Pedoman cairan infus edisi revisi VIII 2003, pt.otsuka indonesia
2. Understanding nutrition 10th ed, thomson wadsworth
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