Hello everyone, I am Dr. Chen Zhou, Department of Nephrology, Shanghai Changhai Hospital, today we continue the topic of diet, focusing on the following: CKD5d - dialysis patients, how to eat scientifically?
What is CKD5d?
Stage 5d of CKD is the end-stage stage of chronic kidney disease (CKD), where kidney function has become severe and renal replacement therapy such as hemodialysis (HD), peritoneal dialysis (PD), or kidney transplantation (KT) is required.
Patients with kidney disease at this stage will develop life-threatening complications such as uremia if they cannot remove metabolic waste and excess water from the body in a timely and effective manner.
CKD5d - How should dialysis patients eat scientifically?
For patients with chronic kidney disease who have undergone renal replacement therapy, if they are on adequate dialysis, in principle, the diet is the same as that of a normal person. However, dialysis treatment only replaces part of the kidney's work, and it does not filter blood as well as healthy kidneys. Therefore, it is still necessary for dialysis patients to adjust their diet.
The two kidneys of normal people are working around the clock (5+2, white + black), and the frequency of hemodialysis in the dialysis center is usually only 3 times a week, about 4 hours each time, and there is still a big gap in time and efficiency.
If dialysis patients consume too much water, salt or too many nutrients through their diet, these substances will accumulate in the body, causing certain discomfort and other problems. Therefore, it is important to pay attention to the following issues in the diet:
01
Consume high-quality protein in moderation
Protein is one of the essential nutrients for the human body, which can provide amino acids to synthesize various important enzymes, hormones, antibodies and other substances. But for patients with CKD5d - dialysis, too much or too little protein intake can be problematic.
Excessive protein intake will increase the production of nitrogen waste (such as urea, creatinine, etc.), increasing the burden on the kidneys and dialysis organs, and too little protein intake will lead to malnutrition, weakened immunity, anemia and other problems.
Therefore, it is recommended to consume a moderate amount of high-quality protein every day, that is, protein that contains all essential amino acids and has a high digestion and absorption rate. These high-quality proteins mainly come from animal foods, such as fish, poultry, eggs, milk, etc.
In general, you need to consume about 1.0-1.2 g/kg of body weight of high-quality protein per day. For example, a 60-kilogram person needs to eat 60-72 grams of high-quality protein per day. This is equivalent to two eggs (12 grams), a glass of milk (8 grams), a piece of fish (20 grams), a piece of chicken (20 grams) and a piece of lean meat (10 grams).
02
Limit sodium, potassium, and phosphorus
Sodium, potassium, and phosphorus are one of the essential electrolytes for the human body, which can maintain the acid-base balance of body fluids, neuromuscular excitability, bone stability, and other functions. However, for patients with CKD5d - dialysis, the intake of these electrolytes is also limited.
This is because the kidneys and dialysis organs cannot completely remove excess sodium, potassium, and phosphorus from the body, and if you consume too much, it can cause dangerous symptoms such as sodium and water retention, high blood pressure, arrhythmia, and hyperphosphatemia.
It is recommended to limit the intake of sodium, potassium, and phosphorus every day, and determine the specific value based on your own blood test results and your doctor's advice. In general, the daily intake should not exceed 2 grams of sodium (equivalent to 5 grams of table salt), no more than 2 grams of potassium, and no more than 0.8 grams of phosphorus.
When choosing food, pay attention to the food label, understand the composition and nutrient content of the food, and avoid foods high in sodium, potassium and phosphorus. For example, you should eat less or no high-sodium foods such as pickles, pickled products, instant noodles, and soy sauce, eat less or no high-potassium foods such as bananas, oranges, grapes, tomatoes, potatoes, and spinach, and eat less or no high-phosphorus foods such as nuts, beans, liver, and chocolate.
03
Control fluid intake
Water is the source of life, and the human body needs enough water to maintain normal metabolism and circulation. However, for CKD5d - dialysis patients, water intake should also be controlled to a certain extent. This is because the kidneys and dialysis organs cannot completely excrete excess water from the body, and if you consume too much, it can cause dangerous symptoms such as water intoxication, edema, and heart failure.
It is recommended to control your fluid intake every day, and to determine a specific value based on your urine output and dialysis intervals. In general, the daily fluid intake should not exceed urine output plus 500 ml.
For example, if a person has a urine output of 500 ml per day, then he can drink 1000 ml of fluids per day. It is important to note here that liquids include not only water, but also beverages such as soups, juices, milk, and foods with a high water content, such as watermelon, tomatoes, etc.
04
Supplementation of vitamins and trace elements
We know that vitamins and trace elements are one of the essential nutrients for the human body, and they can participate in various biochemical reactions and regulate various functions of the body. However, for patients with CKD5d - dialysis, the intake of these nutrients should also be supplemented to a certain extent.
This is because the kidneys and dialysis organs cannot fully retain the vitamins and trace elements needed in the body, and some drugs and diseases can also affect their absorption and utilization. If these nutrients are deficient, it can cause problems such as anemia, neuropathy, and osteoporosis.
It is recommended to supplement some special vitamins and trace elements every day, which needs to be determined according to your own nutritional status and the advice of your doctor. Generally speaking, some water-soluble vitamins (such as vitamin B complex, vitamin C, etc.) need to be supplemented every day, because they are easily carried away by the dialysate, and some trace elements (such as iron, zinc, selenium, etc.) need to be supplemented, because they are easily consumed by blood loss or inflammation.
Finally, we briefly summarize that for people with chronic kidney disease, the dietary principle needs to depend on the specific stage of kidney disease, and the most important thing to practice scientific eating and drinking is to eat and drink as usual, and not to disrupt your usual eating patterns and habits because of special circumstances such as gatherings and festivals.
Of course, if blood pressure, blood sugar, uric acid and other indicators are well controlled, on the basis of a scientific diet, it is also a pleasure to occasionally drink delicious food and enrich your food types!
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