Question

Thomas Stone is a 55-year old banker who developed chronic kidney disease as a result of hypertension. His condition was discovered several years ago, when routine laboratory tests revealed elevated serum creatinine levels, and persistent albuminuria. Since then, he has been taking antihypertensive medications and restricting dietary sodium, but he reported difficulty following the low-protein diet that was also prescribed. Mr. Stone recently visited his doctor with complaints of low urine output and reduced sensation in his hands and feet. He also reported feeling drowsy at work and mentioned that he was bruising more than usual. The examination revealed a 9-pound weight gain since his last visit and swelling in his ankles and feet. Tests revealed that is GFR had fallen to 10 milliliters per minute. Mr. Stone is 5 feet 8 inches tall and normally weighs 160 pounds. 4. The physician determines that Mr. Stone’s kidney disease has reached the final stage and prescribes hemodialysis. How will dialysis alter Mr. Stone’s diet? Calculate his new protein recommendation, and compare it t the amount of protein recommended before dialysis. What other changes in nutrient intake may be necessary?

Answer 1

After hemodialysis the diet should be high in protein.Eating high quality protein produces less waste so that it makes hemodialysis easier in eliminating the quantity of waste.Limit the intake of sodium,potassium, phosphorus and liquids.

The recommended protein intake before hemodialysis is 0.6-0.8g/kg/day. A low protein diet is recommended because it decreases the work load on glomerular filtration and slowing down the progression to CKD

The recommended protein intake after hemodialysis is 1.2g/kg/day because there is nearly 1-2 g of protein loss due to the dialysate and higher with high flux dialyser.

The other nutrient change recommended is

• Potassium intake has to be limited because high level will affect the hemodialysis session and heart beat even causing death
• Limit phosphorous because high level in blood will pull calcium from bones and finally making bones fragile and break easily.
• Limit sodium because high level in blood will increase thirst
• Calories will not be a restriction, it can be taken generously in the food ( in lean or under weight patients )avoiding frequent use of saturated and trans fats.If over weight calories as to be restricted as per the need.
• Vitamins and minerals has to be taken after the doctors advice because it is list in hemodialysis p.Usually taken in form of tablets.