By CHESHIRE QUE, RND , RN, RD
An estimated 850 million people worldwide suffer from kidney diseases. Chronic kidney disease (CKD) is currently ranked sixth as the fastest growing cause of death—claiming a minimum of 2.4 million deaths per year. Diabetes, cardiovascular disease, obesity, and infections such as malaria, tuberculosis, hepatitis, and HIV are all risk factors for chronic kidney disease.
Malnutrition is common among individuals with CKD. To raise awareness on the numerous issues patients encounter, a panel of experts came together to compare and contrast nutritional and dietary needs of patients undergoing predialysis and postdialysis, during the 64th annual convention of the Nutritionist Dietitians’ Association of the Philippines held recently at the Conrad Hotel, Manila.
Dr. Patricia Myers, MD, a nephrologist from Parkview Regional Medical Center, Dr. Esther Fay Myers, RDN, PhD, adjunct faculty in North Dakota State University, and Virgith Buena, RND, RDN, chairperson of Professional Regulation Commission – Board of Nutrition and Dietetics, shared their expertise and addressed seven important issues during the panel discussion, which shed light and gave hope to CKD patients.
Can I eat while undergoing dialysis?
Buena gave an overview of how patients on dialysis eat in the Philippine setting. There is a misconception that it is all right to eat as much as you like (sort of like having a fiesta). After all, the dialysis will help remove everything. “Dialysis does not remove everything, not even all the toxins,” said Buena.
Dr. Patricia Myers emphasized that patients should not eat meals during dialysis as this will cause a drop in blood pressure, also known as hypotension. A light snack is allowed.
Can I eat a lot of high potassium food?
“The idea that they can overload on potassium is crazy,” said Dr. P. Myers. High potassium food includes banana, orange, strawberry, guava, melon, lanzones, langka, or jackfruit, santol, all leafy vegetables, mushroom, cauliflower, malunggay, avocado, coconut milk, coffee, tea, and chocolate.
Buena advises patients to pair low potassium fruits with high potassium vegetables, or vice versa in order to maintain normal potassium level in the blood. There are ways on how to decrease potassium from fresh produce. For instance, potatoes can be sliced thinly and soaked in water several times.
Is weight gain normal for patients on dialysis?
Most patients in the Philippines undergo dialysis two to three times a week. According to Dr. P. Myers, patients begin to lose their intrinsic kidney function after six months of undergoing dialysis as a result of Ischemia to the kidneys. This leads to about 500ml to zero urine output per day. Edema or water retention occurs and contributes to weight gain.
According to Dr. Esther Myers, a weight gain of one kilogram per day on non dialysis days is acceptable. That is approximately two to three kilograms of weight gain in between treatments.
How should supplements and medications be taken?
CKD patients are at risk of nutrition deficiencies. Dr. P. Myers shared that oral iron supplementation is not used in Stage 4 and 5 CKD in the US due to suboptimal absorption, stomach upset, anorexia, nausea, and vomiting. Instead, iron is administered intravenously (IV) one to two times a year, taking into consideration the ferritin level of the patient.
Dr. P. Myers recommends taking phosphate binders with meals or snacks, while iron must be taken together with vitamin C for better absorption during meals. Vitamin D must be taken in its active form. She adds that it is equally important to monitor monthly levels of phosphorus, calcium, vitamin D, and PTH. Increased phosphorus is an indicator of inflammation and increased risk for heart attack and stroke.
If a patient is on oral supplementation, Buena gives the following guidelines on the appropriate timing of taking them.
Calcium phosphate — with meals
Calcium supplement – one hour before or two hours after a meal Vitamin D — taken with calcium for better absorption.
Can dialysis patients travel?
A dialysis patient can travel with proper coordination between the medical teams in current location and destination. This is to ensure continuity of care and treatment during the trip. In fact, cruises that offer dialysis treatments on board are now available.
There are, however, circumstances beyond our control. Some individuals need to go on unplanned trips that are crucial. Buena refers to “disaster planning” during these instances.
The dietitian’s role is vital in helping the patient prevent blood chemistry values from going haywire while keeping the body nourished.
How much protein should a patient have?
Protein intake may be restricted for patients who have CKD but not on dialysis. Patients may be prescribed ketoanalogues like Ketosteril to supply amino acids to the body. According to Dr. Alison Steiber, chief science officer of the Academy of Nutrition and Dietetics, USA, research have shown that the use of ketoanalogues is effective in maintaining nutritional status and delays the onset of dialysis treatment for two years and up.
Patients on dialysis need a higher protein intake but must not consume more than what the body requires.
How should vegans and vegetarians manage their diet?
Buena tackled common issues among vegans and vegetarians with CKD. Vitamin B12 deficiency is common as this is obtained from animal sources. Therefore, vitamin B12 injections are necessary.
Dr. E. Myers recommends intake of soy-based protein, which helps decrease inflammation and phosphorus while providing high biologic value protein.
When it comes to managing chronic kidney disease, the role of a registered nutritionist dietitian is vital in helping the patient live a quality life.