Nutrition is a critical component in the care of patients with ESRD. Recent studies reveal that around 50% of all patients diagnosed with ESRD and undergoing maintenance dialysis are malnourished.
Malnutrition and the disease process
Malnutrition among ESRD patients is caused by a number of factors, particularly increased nutritional needs and improperly met nutritional requirements. Kidney failure results in metabolic abnormalities such as impaired glucose tolerance, altered lipid and amino acid metabolism, uremia, metabolic acidosis, increased leptin and cytokine activity, and carnitine depletion.
Most ESRD patients also have concomitant diseases, particularly sepsis, inflammation and cardiovascular disease, that further add up to their nutritional requirements. Moreover, the disease process results in symptoms, such as anorexia and gastrointestinal disturbances, which lead to decreased food intake.
Socioeconomic and psychosocial factors also contribute in malnutrition of ESRD patients. Depression, loneliness, lack of knowledge, ignorance, and alcohol or drug abuse can take toll on a patient’s nutritional state. These psychosocial factors can set in at any stage of the disease process. Some patients may have difficulty complying with recommended dietary changes due to economic issues.
Malnutrition is associated with muscle wasting, poor wound healing, increased risk of infection, and increased mortality. Moreover, the risk of mortality doubles in patients with poor nutritional status at initiation of maintenance dialysis. Low serum albumin levels, considered as indicator of an ESRD patient’s nutritional status, are often associated with increased risk of mortality.
Achieving nutritional goals
Nutritional assessment and evaluation is critical in helping ESRD patients cope up with the disease process. While it is the role of the in-house nutritionist to ensure that patients get proper nutrition, collaboration among the healthcare team members – nephrologists, dialysis nurses, dialysis technicians, social worker and nutritionist – is critical in achieving the nutritional goal of each patient.
Each patient requires a carefully planned diet that is based on his or her nutritional state, disease process, and level of activity. Primarily, the goal of dietary adjustment is to keep the build-up wastes in the body in between dialysis sessions to a minimum while meeting the nutritional needs of ESRD patients. The nephrologists and
Levels of calories, protein, potassium, sodium, fluid, phosphorus, calcium, and vitamins may vary depending on the needs of the patient. Balancing these nutritional components can help improve the patient’s well-being and have better outcomes. Compared to patients on hemodialysis, patients on CAPD or daily dialysis have fewer dietary restrictions and fluid limits.
Helping patients achieve better nutrition status
Patients undergoing in-center HD undergo regular dietary and nutritional counseling. Dialysis nurses and technicians can reinforce dietary instructions provided by the nutritionist through the following measures:
– At every session, talk with your patient about their eating patterns. Tell the dietitian or charge nurse any reported changes in taste, appetite, gastrointestinal symptoms (nausea or vomiting, diarrhea, heartburn and bloating, constipation, feeling of fullness after ingesting very little food), or problems maintaining desired blood sugar levels.
– Discuss with the social worker and dietitian if a patient is unable to meet recommended dietary intake due to dialysis treatment times or economic problems.
– In case a patient consistently arrives below dry weight, notify the charge nurse and dietitian. Low energy level or any unplanned weight loss may signal problems with nutrition.
– For patients with diabetes, inform the dietitian if there is trouble maintaining blood sugar levels.
– Encourage patient compliance in the prescribed sodium and fluid limits. Discuss with the dietitian and nephrologists if the patient gains a lot of fluid during off-days.
– Discuss with the patient the prescribed meal plan. Reassure patients that they can still enjoy foods that they love as long as they are within the recommended nutritional plan.
– Remind patients to take their prescribed nutritional supplements, particularly binders.
Malnutrition in ESRD is a preventable disease complication. Patient education and a collaborative approach can help patients overcome this prevalent problem. Each healthcare team member play a role in achieving better nutrition status for patients.