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Anatomy and physiology of Kidney

The kidneys are organswith several functions. They are seen in many types of animals, including
vertebratesand some invertebrates. They are an essential part of the urinary system and also
serve homeostaticfunctions such as the regulation of electrolytes, maintenance of acid-base balance,
and regulation of blood pressure. They serve the body as a natural filter of the blood, and remove
wastes which are diverted to the urinary bladder. In producing urine, the kidneys excrete wastes such
as urea and ammonium; the kidneys also are responsible for the re absorption of water, glucose,
and amino acids. The kidneys also produce hormones including calcitriol, renin, and erythropoietin.
Located at the rear of the abdominal cavity in the retroperitoneum, the kidneys receive blood from the
paired renal arteries, and drain into the paired renal veins. Each kidney excretes urine into a ureter,
itself a paired structure that empties into the urinary bladder.

1. Renal pyramid • 2. Interlobular artery • 3. Renal artery • 4. Renal vein 5. Renal hilum • 6. Renal pelvis • 7. Ureter • 8. Minor calyx • 9. Renal
capsule • 10. Inferior renal capsule • 11. Superior renal capsule • 12. Interlobular vein • 13. Nephron • 14. Minor calyx • 15. Major calyx • 16. Renal
papilla • 17. Renal column

1.Renal pyramids (or malpighian pyramids) are cone-shaped tissues of the kidney. The renal
medulla is made up of 7 to 18 of these conical subdivisions (usually 7 in humans). The broad base of
each pyramid faces the renal cortex, and its apex, or papilla, points internally. The pyramids appear
striped because they are formed by straight parallel segments of nephrons.
2.Interlobular arteries(or cortical radiate arteries, or cortical radial arteries), are given off at right
angles from the side of the arcuate arteries looking toward the cortical substance, and pass directly
outward between the medullary rays to reach the fibrous tunic, where they end in the capillary network
of this part.
3.Renal arteries normally arise off the side of the abdominal aorta, immediately below the superior
mesenteric artery, and supply the kidneys with blood. Each is directed across the crus of the diaphragm,
so as to form nearly a right angle with the aorta.
The renal arteries carry a large portion of total blood flow to the kidneys. Up to a third of total cardiac
output can pass through the renal arteries to be filtered by the kidneys.
4.Renal veins are veins that drain the kidney. They connect the kidney to the inferior vena cava.
It is usually singular to each kidney, except in the condition "multiple renal veins".
It also divides into 2 divisions upon entering the kidney:
• the anterior branch which receives blood from the anterior portion of the kidney and,
• the posterior branch which receives blood from the posterior portion.
5.Renal hilum(Latin hilum renale) or renal pedicle of the kidney is the recessed central fissure. The
medial border of the kidney is concave in the center and convex toward either extremity; it is directed
forward and a little downward. Its central part presents a deep longitudinal fissure, bounded by
prominent overhanging anterior and posterior lips. This fissure is named the hilum, and transmits the
vessels, nerves, and ureter. From anterior to posterior, the renal vein exits, the renal artery enters, and
the renal pelvis exits the kidney.
6.Renal pelvis is the funnel-like dilated proximal part of the ureter in the kidney.
In humans, the renal pelvis is the point of convergence of two or three major calyces. Each renal
papilla is surrounded by a branch of the renal pelvis called a calyx.
The major function of the renal pelvis is to act as a funnel for urine flowing to the ureter.
7.Ureters are muscular tubes that propel urine from the kidneys to the urinary bladder. In the adult, the
ureters are usually 25–30 cm (10–12 in) long and ~3-4 mm in diameter.
8.minor calyx, in the kidney, surrounds the apex of the malpighian pyramids. Urine formed in
the kidney passes through a papilla at the apex into the minor calyx then into the major calyx.
9,10,11.Renal capsule is a tough fibrous layer surrounding the kidney and covered in a thick layer
of perinephric adipose tissue. It provides some protection from trauma and damage.
12.Venae stellatae join to form the interlobular veins, which pass inward between the rays, receive
branches from the plexuses around the convoluted tubules, and, having arrived at the bases of the renal
pyramids, join with the venae rectae.
13.Nephron (from Greek νεφρός - nephros, meaning "kidney") is the basic structural and functional
unit of the kidney. Its chief function is to regulate the concentration of water and soluble substances
like sodium salts by filtering the blood, reabsorbing what is needed and excreting the rest as urine. A
nephron eliminates wastes from the body, regulates blood volume and blood pressure, controls levels
of electrolytes and metabolites, and regulates blood pH. Its functions are vital to life and are regulated
by the endocrine system by hormones such as antidiuretic hormone, aldosterone, and parathyroid
hormone.[1] In humans, a normal kidney contains 800,000 to 1.5 million nephrons.
14.Major calyx, in the kidney, surrounds the apex of the malpighian pyramids. Urine formed in
the kidney passes through a papilla at the apex into a minor calyxthen into major calyx before passing
through the renal pelvis into the ureter.
Peristalsis of the smooth muscle originating in pace-maker cells originating in the walls of the calyces
propels urine through the pelvis and ureters to the bladder.
15.Renal papilla is the location where the medullary pyramids empty urine into the minor calyx.
Histologically it is marked by medullary collecting ducts converging to form a duct of Bellini to
channel the fluid. Transitional epithelium begins to be seen.
16.Renal column (or Bertin column, or column of Bertin) is a medullary extension of the renal
cortex in between the renal pyramids. It allows the cortex to be better anchored.

ESSENTISL FLUID AND ELECTROLYTES

Fluid and Electrolyte Balance


The kidneys are essential for regulating the volume and composition of bodily fluids. This page
outlines key regulatory systems involving the kidneys for controlling volume, sodium and potassium
concentrations, and the pH of bodily fluids.
A most critical concept for you to understand is how water and sodium regulation are integrated to
defend the body against all possible disturbances in the volume and osmolarity of bodily fluids. Simple
examples of such disturbances include dehydration, blood loss, salt ingestion, and plain water
ingestion.
Water balance
Water balance is achieved in the body by ensuring that the amount of water consumed in food and
drink (and generated by metabolism) equals the amount of water excreted. The consumption side is
regulated by behavioral mechanisms, including thirst and salt cravings. While almost a liter of water
per day is lost through the skin, lungs, and feces, the kidneys are the major site of regulated excretion
of water.
One way the the kidneys can directly control the volume of bodily fluids is by the amount of water
excreted in the urine. Either the kidneys can conserve water by producing urine that is concentrated
relative to plasma, or they can rid the body of excess water by producing urine that is dilute relative to
plasma.
Direct control of water excretion in the kidneys is exercised by vasopressin, or anti-diuretic hormone
(ADH), a peptide hormone secreted by the hypothalamus. ADH causes the insertion of water channels
into the membranes of cells lining the collecting ducts, allowing water reabsorption to occur. Without
ADH, little water is reabsorbed in the collecting ducts and dilute urine is excreted.
ADH secretion is influenced by several factors (note that anything that stimulates ADH secretion also
stimulates thirst):
1. By special receptors in the hypothalamus that are sensitive to increasing plasma osmolarity (when
the plasma gets too concentrated). These stimulate ADH secretion.
2. By stretch receptors in the atria of the heart, which are activated by a larger than normal volume of
blood returning to the heart from the veins. These inhibit ADH secretion, because the body wants to
rid itself of the excess fluid volume.
3. By stretch receptors in the aorta and carotid arteries, which are stimulated when blood pressure falls.
These stimulate ADH secretion, because the body wants to maintain enough volume to generate the
blood pressure necessary to deliver blood to the tissues.
Sodium balance
In addition to regulating total volume, the osmolarity (the amount of solute per unit volume) of bodily
fluids is also tightly regulated. Extreme variation in osmolarity causes cells to shrink or swell,
damaging or destroying cellular structure and disrupting normal cellular function.
Regulation of osmolarity is achieved by balancing the intake and excretion of sodium with that of
water. (Sodium is by far the major solute in extracellular fluids, so it effectively determines the
osmolarity of extracellular fluids.)
An important concept is that regulation of osmolarity must be integrated with regulation of volume,
because changes in water volume alone have diluting or concentrating effects on the bodily fluids. For
example, when you become dehydrated you lose proportionately more water than solute (sodium), so
the osmolarity of your bodily fluids increases. In this situation the body must conserve water but not
sodium, thus stemming the rise in osmolarity. If you lose a large amount of blood from trauma or
surgery, however, your loses of sodium and water are proportionate to the composition of bodily fluids.
In this situation the body should conserve both water and sodium.
As noted above, ADH plays a role in lowering osmolarity (reducing sodium concentration) by
increasing water reabsorption in the kidneys, thus helping to dilute bodily fluids. To prevent osmolarity
from decreasing below normal, the kidneys also have a regulated mechanism for reabsorbing sodium in
the distal nephron. This mechanism is controlled by aldosterone, a steroid hormone produced by the
adrenal cortex. Aldosterone secretion is controlled two ways:
1.The adrenal cortex directly senses plasma osmolarity. When the osmolarity increases above normal,
aldosterone secretion is inhibited. The lack of aldosterone causes less sodium to be reabsorbed in the
distal tubule. Remember that in this setting ADH secretion will increase to conserve water, thus
complementing the effect of low aldosterone levels to decrease the osmolarity of bodily fluids. The net
effect on urine excretion is a decrease in the amount of urine excreted, with an increase in the
osmolarity of the urine.
2. The kidneys sense low blood pressure (which results in lower filtration rates and lower flow through
the tubule). This triggers a complex response to raise blood pressure and conserve volume. Specialized
cells (juxtaglomerular cells) in the afferent and efferent arterioles produce renin, a peptide hormone
that initiates a hormonal cascade that ultimately produces angiotensin II. Angiotensin II stimulates the
adrenal cortex to produce aldosterone.
*Note that in this setting, where the body is attempting to conserve volume, ADH secretion is also
stimulated and water reabsorption increases. Because aldosterone is also acting to increase sodium
reabsorption, the net effect is retention of fluid that is roughly the same osmolarity as bodily fluids. The
net effect on urine excretion is a decrease in the amount of urine excreted, with lower osmolarity than
in the previous example.

Dialysis
In medicine,dialysis (from Greek "dialusis", meaning dissolution, "dia", meaning through, and "lysis",
meaning loosening) is primarily used to provide an artificial replacement for lost kidney functionn
people with renal failure. Dialysis may be used for those with an acute disturbance in kidney function
(acute kidney injury, previously acute renal failure) or for those with progressive but chronically
worsening kidney function–a state known as chronic kidney disease stage 5 (previously chronic renal
failure or end-stage kidney disease). The latter form may develop over months or years, but in contrast
to acute kidney injury is not usually reversible, and dialysis is regarded as a "holding measure" until
a renal transplant can be performed, or sometimes as the only supportive measure in those for whom a
transplant would be inappropriate.[
The kidneys have important roles in maintaining health. When healthy, the kidneys maintain the body's
internal equilibrium of water and minerals (sodium, potassium, chloride, calcium, phosphorus,
magnesium, sulfate). Those acidic metabolism end products that the body cannot get rid of via
respiration are also excreted through the kidneys. The kidneys also function as a part of the endocrine
system producing erythropoietin and calcitriol. Erythropoetin is involved in the production of red blood
cells and calcitriol plays a role in bone formation. Dialysis is an imperfect treatment to replace kidney
function because it does not correct the endocrine functions of the kidney. Dialysis treatments replace
some of these functions through diffusion (waste removal) and ultrafiltration (fluid removal)
TYPES OF DIALYSIS
There are two primary and two secondary types of dialysis: hemodialysis, peritoneal
dialysis, hemofiltration, hemodiafiltration, and intestinal dialysis.

Hemodialysis
In hemodialysis, the patient's blood is pumped through the blood compartment of a dialyzer, exposing
it to a partially permeable membrane. The dialyzer is composed of thousands of tiny synthetic hollow
fibers. The fiber wall acts as the semipermeable membrane. Blood flows through the fibers, dialysis
solution flows around the outside the fibers, and water and wastes move between these two
solutions.The cleansed blood is then returned via the circuit back to the body. Ultrafiltration occurs by
increasing the hydrostatic pressure across the dialyzer membrane. This usually is done by applying a
negative pressure to the dialysate compartment of the dialyzer. This pressure gradient causes water and
dissolved solutes to move from blood to dialysate, and allows the removal of several litres of excess
fluid during a typical 3 to 5 hour treatment. In the US, hemodialysis treatments are typically given in a
dialysis center three times per week (due in the US to Medicare reimbursement rules); however, as of
2007 over 2,500 people in the US are dialyzing at home more frequently for various treatment
lengths. Studies have demonstrated the clinical benefits of dialyzing 5 to 7 times a week, for 6 to 8
hours. This type of hemodialysis is usually called "nocturnal daily hemodialysis", which a study has
shown a significant improvement in both small and large molecular weight clearance and decrease the
requirement of taking phosphate binders.These frequent long treatments are often done at home while
sleeping, but home dialysis is a flexible modality and schedules can be changed day to day, week to
week. In general, studies have shown that both increased treatment length and frequency are clinically
beneficial.
Peritoneal dialysis
In peritoneal dialysis, a sterile solution containing glucose is run through a tube into the peritoneal
cavity, the abdominal body cavity around the intestine, where the peritoneal membrane acts as a
semipermeable membrane.The peritoneal membrane or peritoneum is a layer of tissue containing blood
vessels that lines and surrounds the peritoneal, or abdominal, cavity and the internal abdominal organs
(stomach, spleen, liver, and intestines). The dialysate is left there for a period of time to absorb waste
products, and then it is drained out through the tube and discarded. This cycle or "exchange" is
normally repeated 4-5 times during the day, (sometimes more often overnight with an automated
system). Each time the dialysate fills and empties from the abdomen is called one exchange. A dwell
time means that the time of dialysate stay in patient's abdominal cavity - wastes, chemicals and extra
fluid move from patient's blood to the dialysate across the peritoneum. A drain process is the process
after the dwell time, the dialysate full with waste products and extra fluid is drained out of patient's
blood.Ultrafiltration occurs via osmosis; the dialysis solution used contains a high concentration of
glucose, and the resulting osmotic pressure causes fluid to move from the blood into the dialysate. As a
result, more fluid is drained than was instilled. Peritoneal dialysis is less efficient than hemodialysis,
but because it is carried out for a longer period of time the net effect in terms of removal of waste
products and of salt and water are similar to hemodialysis. Peritoneal dialysis is carried out at home by
the patient. Although support is helpful, it is not essential. It does free patients from the routine of
having to go to a dialysis clinic on a fixed schedule multiple times per week, and it can be done while
travelling with a minimum of specialized equipment.

Hemodiafiltration
Hemodialfiltration is a combination of hemodialysis and hemofiltration. In theory, this technique offers
the advantages of both hemodialysis and hemofiltration.

Intestinal dialysis
In intestinal dialysis, the diet is supplemented with soluble fibres such as acacia fibre, which is digested
by bacteria in the colon. This bacterial growth increases the amount of nitrogen that is eliminated in
fecal waste.An alternative approach utilizes the ingestion of 1 to 1.5 liters of non-absorbable solutions
of polyethylene glycol or mannitol every fourth hour.
HEMODIALYSIS MACHINES

The Fresenius 2008 Kidney Dialysis


Machine series were designed for
flexibility. They all Equipped with
advanced therapy options;
ultrafiltration, fixed proportioning,
heat disinfecting, variable dialysate
flow, and including automatic blood
pressure monitoring as well as
computer documentation capabilities.
The Fresenius 2008 Kidney Dialysis
Machine, Easy to operate touch
membrane control panel with
improved visual displays and

advancetherapy options in the E model is retrofittable to the C and the D machines and the panel of the
H system is retrofittable to the C, D, and the E model machines.

The Prismaflex (TM) Machine is the newest generation of technology


for CRRT (Kidney Dialysis) offered by Gambro.

With the Prismaflex (TM) System, Gambro enhance prescription flexibility by


offering a platform with increased therapy options and features.
This is the information about the main differences between the current
technology and the Prismaflex (TM) :
The Prismaflex (TM) has the combination of vivid colors and clear graphics
on a large 12 inch touch screen.
The safety system of Prismaflex (TM) is proactive, offering many helpful
features, such as automatic bar code identification of the set and customized
default safe values.
Principle involve hemodialysis
Dialysis works on the principles of the diffusion of solutes and ultrafiltration of fluid across a semi-
permeable membrane. Diffusion describes a property of substances in water. Substances in water tend
to move from an area of high concentration to an area of low concentration. Blood flows by one side of
a semi-permeable membrane, and a dialysate, or special dialysis fluid, flows by the opposite side. A
semipermeable membrane is a thin layer of material that contains various sized holes, or pores. Smaller
solutes and fluid pass through the membrane, but the membrane blocks the passage of larger substances
(for example, red blood cells, large proteins).
The two main types of dialysis, hemodialysis and Peritoneal dialysis, remove wastes and excess water
from the blood in different ways. Hemodialysis removes wastes and water by circulating blood outside
the body through an external filter, called a dialyzer, that contains a semipermeable membrane. The
blood flows in one direction and the dialysate flows in the opposite. The counter-current flow of
the blood and dialysate maximizes the concentration gradient of solutes between the blood and
dialysate, which helps to remove more urea and creatinine from the blood. The concentrations of
solutes (for example potassium,phosphorus, and urea) are undesirably high in the blood, but low or
absent in the dialysis solution and constant replacement of the dialysate ensures that the concentration
of undesired solutes is kept low on this side of the membrane. The dialysis solution has levels of
minerals like potassium and calcium that are similar to their natural concentration in healthy blood. For
another solute, bicarbonate, dialysis solution level is set at a slightly higher level than in normal blood,
to encourage diffusion of bicarbonate into the blood, to act as a pH buffer to neutralize the metabolic
acidosis that is often present in these patients. The levels of the components of dialysate are typically
prescribed by a nephrologist according to the needs of the individual patient.
In peritoneal dialysis, wastes and water are removed from the blood inside the body using
the peritoneal membrane of the peritoneum as a natural semipermeable membrane. Wastes and excess
water move from the blood, across the peritoneal membrane, and into a special dialysis solution, called
dialysate, in the abdominal cavity which has a composition similar to the fluid portion of blood.

Side effects and complications of Hemodialysis


Hemodialysis often involves fluid removal (through ultrafiltration), because most patients with renal
failure pass little or no urine. Side effects caused by removing too much fluid and/or removing fluid too
rapidly include low blood pressure, fatigue, chest pains, leg-cramps, nausea and headaches. These
symptoms can occur during the treatment and can persist post treatment; they are sometimes
collectively referred to as the dialysis hangover or dialysis washout. The severity of these symptoms is
usually proportionate to the amount and speed of fluid removal. However, the impact of a given
amount or rate of fluid removal can vary greatly from person to person and day to day. These side
effects can be avoided and/or their severity lessened by limiting fluid intake between treatments or
increasing the dose of dialysis e.g. dialyzing more often or longer per treatment than the standard three
times a week, 3–4 hours per treatment schedule.
Since hemodialysis requires access to the circulatory system, patients undergoing hemodialysis may
expose their circulatory system to microbes, which can lead to sepsis, an infection affecting the heart
valves (endocarditis) or an infection affecting the bones (osteomyelitis). The risk of infection varies
depending on the type of access used. Bleeding may also occur, again the risk varies depending on the
type of access used. Infections can be minimized by strictly adhering to infection control best practices.
Heparin is the most commonly used anticoagulant in hemodialysis, as it is generally well tolerated and
can be quickly reversed with protamine sulfate. Heparin allergy can infrequently be a problem and can
cause a low platelet count. In such patients, alternative anticoagulants can be used. In patients at high
risk of bleeding, dialysis can be done without anticoagulation.
First Use Syndrome is a rare but severe anaphylactic reaction to the artificial kidney. Its symptoms
include sneezing, wheezing, shortness of breath, back pain, chest pain, or sudden death. It can be
caused by residual sterilant in the artificial kidney or the material of the membrane itself. In recent
years, the incidence of First Use Syndrome has decreased, due to an increased use of gamma
irradiation, steam sterilization, or electron-beam radiation instead of chemical sterilants, and the
development of new semipermeable membranes of higher biocompatibility. New methods of
processing previously acceptable components of dialysis must always been considered. For example, in
2008, a series of first-use type or reactions, including deaths occurred due to heparin contaminated
during the manufacturing process with oversulfatedchondroitin sulfate.
Longterm complications of hemodialysis include amyloidosis, neuropathy and various forms of heart
disease. Increasing the frequency and length of treatments have been shown to improve fluid overload
and enlargement of the heart that is commonly seen in such patients.
Listed below are specific complications associated with different types of hemodialysis access.

Nursing care for hemodialysis patient


Adapt from nephrology nursing practice recommendations developed by Canadian Association of
Nephrology and Technology (CANNT) based on best available evidence and clinical practice
guidelines, a nephrology nurse should perform.
Hemodialysis Vascular Access: Assess the fistula/graft and arm before, after each dialysis or every
shift: the access flow, complications Assess the complication of central venous catheter: the tip
placement, exit site, complications document and notify appropriate health care provider regarding any
concerns. educates the patient with appropriate cleaning of fistula/graft and exit site; with recognizing
and reporting signs and symptoms of infection and complication.
Hemodialysis adequacy: Assesses patient constantly for signs and symptoms of inadequate dialysis.
Assesses possible causes of inadequate dialysis. Educations patients the importance of receiving
adequate dialysis.
Hemodialysis treatment and complications: Performs head to toe physical assessment before, during
and after hemodialysis regarding complications and access’s security. Confirm and deliver dialysis
prescription after review most update lab results. Address any concerns of the patient and educate
patient when recognizing the learning gap.
Medication management and infection control practice: Collaborate with the patient to develop a
medication regimen. Follow infection control guidelines as per unit protocol.
Eat Right to Feel Right on Hemodialysis

How does food affect my hemodialysis?


Food gives you energy and helps your body repair itself. Food is broken down in your stomach and
intestines. Your blood picks up nutrients from the digested food and carries them to all your body cells.
These cells take nutrients from your blood and put waste products back into the bloodstream. When
your kidneys were healthy, they worked around the clock to remove wastes from your blood. The
wastes left your body when you urinated. Other wastes are removed in bowel movements.
Now that your kidneys have stopped working, hemodialysis removes wastes from your blood. But
between dialysis sessions, wastes can build up in your blood and make you sick. You can reduce the
amount of wastes by watching what you eat and drink. A good meal plan can improve your dialysis and
your health.

Your clinic has a dietitian to help you plan meals. A dietitian specializes in food and nutrition. A
dietitian with special training in care for kidney health is called a renal dietitian.

What do I need to know about fluids?


You already know you need to watch how much you drink. Any food that is liquid at room temperature
also contains water. These foods include soup, Jell-O, and ice cream. Many fruits and vegetables
contain lots of water, too. They include melons, grapes, apples, oranges, tomatoes, lettuce, and celery.
All these foods add to your fluid intake.
Fluid can build up between dialysis sessions, causing swelling and weight gain. The extra fluid affects
your blood pressure and can make your heart work harder. You could have serious heart trouble from
overloading your system with fluid.

Control Your thirst


The best way to reduce fluid intake is to reduce thirst caused by the salt you eat. Avoid salty foods like
chips and pretzels. Choose low-sodium products.
You can keep your fluids down by drinking from smaller cups or glasses. Freeze juice in an ice cube
tray and eat it like a popsicle. (Remember to count the popsicle in your fluid allowance!) The dietitian
will be able to give you other tips for managing your thirst.
Your dry weight is your weight after a dialysis session when all of the extra fluid in your body has been
removed. If you let too much fluid build up between sessions, it is harder to get down to your proper
dry weight. Your dry weight may change over a period of 3 to 6 weeks. Talk with your doctor regularly
about what your dry weight should be.
My dry weight should be _____________.

What do I need to know about potassium?


Potassium is a mineral found in many foods, especially milk, fruits, and vegetables. It affects how
steadily your heart beats. Healthy kidneys keep the right amount of potassium in the blood to keep the
heart beating at a steady pace. Potassium levels can rise between dialysis sessions and affect your
heartbeat. Eating too much potassium can be very dangerous to your heart. It may even cause death.

To control potassium levels in your blood, avoid foods like avocados, bananas, kiwis, and dried fruit,
which are very high in potassium. Also, eat smaller portions of other high-potassium foods. For
example, eat half a pear instead of a whole pear. Eat only very small portions of oranges and melons

Talk With a Dietitian


Make a food plan that reduces the potassium in your diet. Start by noting the high-potassium foods
(below) that you now eat. A dietitian can help you add other foods to the list.
High-Potassium Foods:
apricots kiwi fruit potatoes
avocados lima beans prune juice
bananas melons prunes
beets milk raisins
Brussels sprouts nectarines sardines
cantaloupe orange juice spinach
clams oranges tomatoes
dates peanuts winter squash
figs pears (fresh) yogurt

What do I need to know about phosphorus?


Phosphorus is a mineral found in many foods. If you have too much phosphorus in your blood, it pulls
calcium from your bones. Losing calcium will make your bones weak and likely to break. Also, too
much phosphorus may make your skin itch. Foods like milk and cheese, dried beans, peas, colas, nuts,
and peanut butter are high in phosphorus. Usually, people on dialysis are limited to 1/2 cup of milk per
day. The renal dietitian will give you more specific information regarding phosphorus.
You probably will need to take a phosphate binder like Renagel, PhosLo, Tums, or calcium carbonate
to control the phosphorus in your blood between dialysis sessions. These medications act like sponges
to soak up, or bind, phosphorus while it is in the stomach. Because it is bound, the phosphorus does not
get into the blood. Instead, it is passed out of the body in the stool.

What do I need to know about protein?


Before you were on dialysis, your doctor may have told you to follow a low-protein diet. Being on
dialysis changes this. Most people on dialysis are encouraged to eat as much high-quality protein as
they can. Protein helps you keep muscle and repair tissue. The better nourished you are, the healthier
you will be. You will also have greater resistance to infection and recover from surgery more quickly.
Your body breaks protein down into a waste product called urea. If urea builds up in your blood, it’s a
sign you have become very sick. Eating mostly high-quality proteins is important because they produce
less waste than others. High-quality proteins come from meat, fish, poultry, and eggs (especially egg
whites).

What do I need to know about sodium?


Sodium is found in salt and other foods. Most canned foods and frozen dinners contain large amounts
of sodium. Too much sodium makes you thirsty. But if you drink more fluid, your heart has to work
harder to pump the fluid through your body. Over time, this can cause high blood pressure and
congestive heart failure.
Try to eat fresh foods that are naturally low in sodium Look for products labeled low sodium.
Do not use salt substitutes because they contain potassium. Talk with a dietitian about spices you can
use to flavor your food. The dietitian can help you find spice blends without sodium or potassium.

What do I need to know about calories?


Calories provide energy for your body. If your doctor recommends it, you may need to cut down on the
calories you eat. A dietitian can help you plan ways to cut calories in the best possible way.
Some people on dialysis need to gain weight. You may need to find ways to add calories to your diet.
Vegetable oils—like olive oil, canola oil, and safflower oil—are good sources of calories. Use them
generously on breads, rice, and noodles.
Butter and margarines are rich in calories. But these fatty foods can also clog your arteries. Use them
less often. Soft margarine that comes in a tub is better than stick margarine. Vegetable oils are the
healthiest way to add fat to your diet if you need to gain weight.
Hard candy, sugar, honey, jam, and jelly provide calories and energy without clogging arteries or
adding other things that your body does not need. If you have diabetes, be very careful about eating
sweets. A dietitian’s guidance is very important for people with diabetes.

Should I take vitamins and minerals?


Vitamins and minerals may be missing from your diet because you have to avoid so many foods. Your
doctor may prescribe a vitamin and mineral supplement like Nephrocaps.
Warning: Do not take vitamin supplements that you can buy off the store shelf. They may contain
vitamins or minerals that are harmful to you.

Resources:
http://kidney.niddk.nih.gov/kudiseases/pubs/eatright/index.htm
ARELLANO UNIVERSITY
COLLEGE OF NURSING
2600 Legarda Street,Sampaloc,Manila

REQUIREMENT
in
RELATED LEARNING
EXPERIENCE
HEMODIALYSIS UNIT

SUBMITTED BY:
CRUZ, Jennina Mae V.
IV-BSN-14
GROUP54A

SUBMITTED TO:
Ms. Melindaneva S. Biteng RN,MAN