DINSHA PATEL COLLEGE OF NURSING

COURSE NAME : DIPLOMA IN GENERAL NURSING &

MIDWIFERY
ACADEMIC YEAR : FIRST YEAR
SUBJECT NAME : COMMUNITY HEALTH NURSING
(NUTRITION)
UNIT : 5th
TUTORIL TITLE : RENAL PATIENT DIET

Prepared by :
Mr. Kailash Nagar
Assistant Professor
 CKD H D
 Clinical studies have shown that renal patients may
have inadequate dietary intakes during early stages

 40 - 70 % of patients with end-stage renal disease are

malnourished

 Protein–energy malnutrition should be avoided in

maintenance hemodialysis because of poor patient
outcome (Evidence III).

 Towtypes of malnutrition I & II has been described

in C K D patients
(ESPEN 2008)
Renal diet minimizes the amount of wastes

A good meal plan choices can:

 Minimize build-up of waste products&
fluid between treatments
 Improve nutritional and functional status
 Conserve muscle mass
 How can we monitor and Follow-up
nutritional status?

BMI = Weight (kg) / (height [m]2)

Severely underweight Less than 16.0

Underweight From 16.0 to 18.5
Normal From 18.5 to 24.9
Overweight From 25 to 29.9
Obese Class I From 30 to 34.9
Obese Class II From 35 to 39.9
Obese Class III Over 40

Haemodialysis patients should maintain a BMI >23.0

 Ideal Body Weight (IBW)
For men = [ (height(cm) – 152.4) x 0.91) ] + 50

For women= [ (height(cm) – 152.4) x 0.91) ] + 45.5

If Actual B W > 30% I B W

use

Adjusted Body Weight (ABW)

For men:Adjusted weight = [( actual weight- IB weight) x 0.38] + IB weight

For women:Adjusted wt = [(actual weight- IB weight) x 0.32 ] + IB weight

Interdialytic W eight Gain (ID W G )
 General recommendation +2 kg

 >5% fluid gains

 Excessive fluid intake

 Weight gain

 <2% fluid gain

 Inadequate fluid and/or food intake

 Weight Loss/Decreased body mass

 Calories
Adequate energy intake essential to optimize nutritional
status
⚫ Present in (Carbohydrates – Fats - Protein)

⚫ Calculated based on your

⚫current weight,
⚫weight loss goals
⚫age and gender
⚫physical activity and metabolic stress
35 kcal/kg/d < 60 yrs
30–35 kcal/kg/d ≥ 60 yrs

Regular physical activity should be encouraged, and energyintake should be

increased according to the level of physical activity (Opinion).
To increase the energy content of meals:

 Add extra oil to rice,noodles,breads,crackers,and

cooked vegetables.
 Add extra salad dressing.
 N on-protein calorie (N P C ) supplement can be added

(J Ren Nutr. Nov. 2012 )

 Sodium
Serum Sodium (nl 133-145 mEq/L)

⚫ Plays vital role in regulation of fluid balance and blood

pressure

In CKD& HD:-
⚫ May result in :-
 high blood pressure,
 fluid retention/swelling (edema)
 lead to shortness of breath
 Excessive thirst
 CHF
Sources of D ietary Sodium
Cook at home with low-sodium ingredients
1,000- 4,000mg/d

Cut out: • Salt for

• High-sodium condiments
• Processed, cured foods CKD&HD
patient
Add: • Herbs • Lemon
• Spices • Vinegar diets

Eat out less (especially Fast Food)

Read labels

No Added Salt (NAS)

 Fluids
“any food that is liquid at room temp”
Soup, gelatin, ice cream, ect.
HD
⚫Urine Output + 1000 ml
⚫Limit IDWG (2-5% Estimated Dry weight )

⚫Excess fluid buildup ⚫Fluid restriction estimations

are based upon:-
 Edema,HTN,CHF and
 Urinary output
Breathlessness
 Disease state
 D elays wound healing  Treatment modality (dialysis,etc.)
 Tips for thirst and fluid control!

Keep your mouth wet

⚫ Track your fluids ◦ Keep your mouth clean
🞄toothpaste for dry mouth (biotene)
⚫ Avoid chewing lots of ice
◦ Rinse your mouth with cold water, but
⚫ Avoid refills at restaurant
don’t swallow it
⚫ Avoid super-sized beverages
⚫ Limit salty foods
◦ Rinse your mouth with chilled
⚫ Small glasses at meals & meds
mouthwash
⚫ Add lemon or Lime juice to water

◦ Chew on gum: Quench gum

⚫ Hot weather, temperature
⚫Keep your skin cool: cold wash ◦ Try lemon wedges or freeze grapes &
cloth, mist-bottle strawberries
⚫Keep your lips moist with a chap
stick
If diabetic, control blood sugars