October 2019 - NephroLife Bulgaria

HEMODIALYSIS – WATER BALANCE AND PROTEINS

Water balance during hemodialysis

Water balance is closely related with the optimal body weight maintenance. Since the amount of urine (diuresis) is reduced up to a complete lack in patients on hemodialysis, a strict self-control of fluid intake is required. Super hydrogenation may provoke intensification of the peripheral edema, ascites (leakage of fluid in the abdominal cavity), hypertension, pulmonary congestion and life-threatening complications such as brain and pulmonary edema.

The basic rule for calculating the quantity of the fluid intake is: fluids (for 24 hors) = diuresis /ml/24 hours + 500 up to 800 ml. The increase in weigh must not overcome 1kg per day. All soups, any yoghurt, sauces, stewed and bottled fruits, fruits, vegetables, etc. that are included in the daily menu must be calculated as liquids.

Dietary recommendations: Table salt consumption to be reduced and other seasonings to be used instead; any food with high content of water to be avoided [soups, sauces, water-melon, ice-creams], any dry air spaces to be avoided, when one feels thirsty, not to drink water but to suck a lemon or a cube of ice.

The role of proteins in hemodialysis

Goal: To maintain all vital metabolic processes in normal levels, to ensure muscle growth and recovery.

Proteins are essential for the diet since the need of them is higher for dialysis patients. Proteins are divided in two basic groups: such with high biological value and such with low biological value. 1.2 gr./kg./24hs is considered to be the optimal protein intake. Half of this quantity should be the so called complete proteins (of higher biological value), that may be found in meat, eggs and milk. That is why appropriate meats, poultry, fish, egg protein or cottage cheese must be consumed at least once a day. It is recommended 100-200 gr. meat to be involved at least once per day during eating. The way of cooking meat may vary depending on the taste preferences of the patient, however for those who have a limited diuresis a dry cooking of meal (excluding sauces) is recommended. Low-value proteins include bread, pasta, fruit and vegetables.

Nausea, vomiting, confusion, itching, bad breath are observed upon excessive protein import. The symptoms of insufficient import are muscle mass decrease, lack of strength, weight loss, difficult wound healing.

POTASSIUM, SODIUM AND PHOSPHORUS BALANCE – HEMODIALYSIS

How important is the balance of potassium, sodium, and phosphorus in the diet of the hemodialysis patients?

The lоw intake of potassium, sodium, and phosphorus is crucial when the case involves feeding patients on hemodialysis.

Potassium

Potassium is involved in the water balance maintaining and in the transmission of nerve impulses and muscles contractions and regulates the blood pressure.

High plasma potassium is a life-threating case of emergency and is an indicator that the patient has made a mistake with his/her diet. Such a state of health is called hyperkalemia and is distinguished by muscle weakness, paralytic symptoms and irregular heart beat, In patients with anuria (complete absence of diuresis) the potassium intake is limited up to 1.5 – 2.0 gr. per day.

Dietary recommendations: the intake of rich in K food is limited – stone fruits, beans, lentils, olives, nuts, vegetable juices, dietary salt, dried fruits. Potatoes and the other vegetables lose most of the potassium when they are pre-cut and soaked in water for 3 hours as well as when they are cooked for 30 minutes. When using canned fruits and vegetables the liquid must be removed beforehand. Fruit juices, dried fruits, and nuts must be avoided.

Sodium

It is crucial to minimize sodium intake and to avoid food additives and fast foods. The use of salt causes fluid retention in the body and is a reason for high blood pressure, cardiac hypertrophy and eventually increases cardio-vascular mortality. Water and potassium control for patients on dialysis is important for the quality of the dialysis treatment and for their survival.

Dietary recommendations: to avoid rich in salt food – canned, marinated, salty and smoked products.

Phosphorus

Since phosphorus can not be fully extracted through dialysis, it is accumulated, thus damaging the bone structure and making bones fragile. The product of potassium and phosphorus values is called the potassium-phosphorus product and its levels should not overcome 4. Otherwise, it is subcutaneously accumulated and causes unpleasant itching.

Dietary recommendation: Foods high in phosphorus must be limited. Limiting the intake of phosphorus may also be done by decreasing the intake of proteins in food. However, this may cause malnutrition of the patient, which is highly undesirable. An efficient way of decreasing the serum phosphorus is the intake of calcium tablets while eating, since at that time the potassium intake is highest and its binding is most efficient.

This mineral may reach high levels in the blood and cause complications such as weak bones, heart problems, joint pain, and skin ulcers.

WHY DOESN’T OUR BLOOD PRESSURE DROP AND WE FEEL BETTER?

A question, commonly asked by our patients is: Why doesn’t our blood pressure drop and we feel better?

The answer lies in the following:

The quality of the dialysis water depends on well-functioning equipment for reverse osmosis and on the use of dry bicarbonate as an important prerequisite for avoiding series of complications. While achieving this quality is somehow associated with a certain increase in the cost of the dialysis, it may lead to some notable savings, far more exceeding the funding. The good water quality contributes to anemia improvement and reduces the patients’ needs of erythropoietin. The use of an ultrapure dialysate helps overcoming the chronic inflammatory response that is associated with the erythropoietin in the dialysis solution in blood and the erythropoietin dose is reduced with almost 30% as meanwhile the hemoglobin values are preserved.

During the last years quite weighty arguments were gathered evidencing that chronic inflammatory reaction plays important role in the genesis of the accelerated atherosclerosis in the dialysis patients and it is one the reasons for the higher morbidity and mortality among them. It has been found that by using dialysis with ultrapure dialysate the progress of the dialysis amyloidosis is notably delayed. Therefore, the use of ultrapure dialysate may lead to saving money from the hospital treatment of the complications as well as to provide better prognosis for the dialysis patients and their quality of life.

The most certain way of getting microorganisms- and endotoxins-free dialysis solution is to use dry bicarbonate and regularly to change the ultrafiltration of the dialysis path.

This is the dialysis that Nephrolife offers to its patients.

Monthly Archives: October, 2019