Effect of Dietary Intervention in Patients with CKD on Hemodialysis

Abstract

Background: Chronic Kidney Disease (CKD) is becoming a major global health concern, with growing incidence and prevalence rates around the world. Patients with End Stage Renal Disease (ESRD) are required to undergo longterm Hemodialysis. Nutrition plays a vital role in the management of ESRD Patients undergoing Hemodialysis. Diet is an important part of the treatment plan along with medications. The elements of the renal diet include obtaining adequate calories and protein while limiting certain nutrients such as Sodium, Potassium and Phosphorus. Protein requirements are higher during dialysis due to loss of proteins and amino acids lowered by dialysis,. Studies suggest that a Dietary Protein Intake(DPI) of about 1.2g/kg/d is necessary to ensure neutral or positive nitrogen balance in most clinically stable MHD patients. Dietary Intervention, like the protein sources coming from all high biological values (HBV) which include milk protein isolate/or concentrate, whey protein concentrate etc. is needed to improve their nutritional status. Sodium and fluid intake must be strictly controlled. These recommendations tend to be individualized for each patient based on fluid gains between dialysis treatments, blood pressure control and residual renal function. By reducing the Sodium intake, the thirst sensation is decreased which may improve compliance with fluid restriction and reduce Inter Dialytic Weight Gain(IDWG). The ESPEN recommendations are 1.8-2.5g/day for sodium, forfluid-1000 ml plus urine volume. Objective: To Study The Effect Of Nutrition Intervention In The Renal Parameters In Patients With Ckd On Hemodialysis. Methodology: The Study Was Conducted On 60 Patients From The Hemodialysis Unit Of Svs Medical College Hospital (svsmch), Mahabubnagar. Svsmch Is A 1000 Bedded Hospital. Age Of The Subjects Varies From 20 Years To 60 Years Of Both Genders. All Cases Had Clinical And Laboratory Evidence Of Chronic Kidney Disease. Specific Questionnaires Were Prepared And Used To Collect Medical, Dietary History And Knowledge Of The Patients On Food & Fluid Restriction. The Data Thus Collected Was Computerized In A Specific Program Developed On Microsoft Excel 2007 Software. The Database So Prepared Was Analyzed With The Help Of Statistical Analysis, T Test, P Test And The Results Were Transferred To Predesigned Classified Tables, Bar Diagrams And Pie Diagrams Prepared According To The Aims And Objectives Of The Study. Results: It Was Found That There Was No Insignificant Difference Between Control And Experimental Groups Before Nutritional Intervention (p>0.05). The Obtained Data Showed That The Mean Value Of Creatinine After The Nutrition Education Program In Experimental Group Was Significantly (p<0.05) Decreased Than Before Nutrition Education Program Represented (7.5433+1.7335mg/dl Vs 10.2900+1.9876mg/dl) Whereas Other Biochemical Parameters Show Insignificant Change After The Nutrition Education Program. Results Also Show Prevalence Of Hemodialysis Is More At The Age Of 51 + Years. The Number Of Male Received Hemodialysis Was Higherthan Female, Conclusion: The Above Parameters Indicate That There Is An Urgent Need For Dietary Intervention Using Nutrition Education Program For Improving Knowledge And Skills In Nutritional Practices Of Hemodialysis Patients Towards Their Disease And Dietary Management To Improve Their Nutritional Status Which Includes Weight Recording, Diet, Exercises And Lifestyle Changes. Therefore Nutritional Counseling By Qualified Dieticians Should Be Mandatory In Renal Units As Part Of The Medical Therapy Management To The Nutritional Status Of Hd Patients.