Hemodialysis in the correction of uremia patients in the body disorder of pH and water electrolytes at the same time, some nutrients in the human body is inevitably filtered out of the body, a large amount of nutrient loss makes the patient's body more and more weak, light dialysis malnutrition, heavy can not carry out hemodialysis maintenance treatment, some patients even died as a result. Malnutrition is prevalent in patients on maintenance hemodialysis and is closely related to the prognosis of patients. Nutritional therapy for hemodialysis patients should not only correct malnutrition, but also prevent excessive accumulation of metabolites, maintain the balance of the internal environment, make the electrolytes, acids and alkalis, and trace elements in the body close to normal, increase the patient's disease resistance, enhance the physique and reduce complications, improve the quality of life, restore the ability to work, and return to society.
1. Adequate hemodialysis can improve appetite, increase protein intake, and reduce catabolism by improving acidosis and reducing insulin resistance.
2. Supplement nutrients For patients with maintenance hemodialysis, based on the patient's eating habits, calculate the daily protein, carbohydrate and fat intake of the patient, and give targeted nutritional supplements to the patient:
(1) Total calories: 35 to 45Kcal/Kg per day, protein should account for 15% of total calories, fat should account for 35%, carbohydrates accounted for 60%; if patients are extremely emaciated or excessively obese, the total calories should be appropriately increased or decreased.
(2) Protein: 1.2 to 1.6g/Kg per day. Among them, high-quality protein should account for 50% to 70% of the total. The type of protein should be based on animal protein rich in essential amino acids, such as egg whites, milk, fish, lean meat, poultry, etc.; eat less plant protein, such as cereals, various soy products, etc.
(3) Carbohydrates: It is the main ingredient of weekday staple foods, and the intake is 5 to 6 g /(K g·d).
(4) Fat: the intake is 40 ~ 60 g / d, should eat unsaturated fatty acids based vegetable oil, eat less saturated fatty acids rich in foods, such as: animal fat, fat lard, chicken skin, etc. Increasing the unsaturated fatty acids in the diet can reduce the total concentration of high triglycerides and cholesterol in the blood plasma, so that the incidence of hyperlipidemia and hypertriglyceridemia in hemodialysis patients is reduced, thereby reducing atherosclerosis and reducing cardiovascular and cerebrovascular complications. Studies have shown that fish oil is rich in unsaturated fatty acids, reduces triacylglycerol in the blood, and can improve hypertriglyceridemia in patients, but fish oil contains more vitamin A, and excessive intake can cause vitamin A poisoning.
(5) Ketoacid preparation: α ketoacid is an essential amino acid precursor, which can synthesize essential amino acids in the body, can reduce urea nitrogen synthesis, and promote protein synthesis. At present, the domestic application of Kaitong, that is, ketoacid preparations for essential amino acids, oral administration of 6 to 12g per day, can reduce the intake of protein and essential amino acids.
(6) Water and electrolyte intake
(1) Potassium: Hemodialysis patients generally do not need potassium supplementation, and should strictly limit high-potassium foods, high-potassium food types such as mushrooms, sea vegetables, beans, lotus seeds, bananas, oranges, grapes, etc. Daily intake of 2 to 3 g is appropriate. In the cooking method, green leafy vegetables should be blanched in boiling water and then fried in oil, and eat less vegetable soup and lettuce. Feces can eliminate the remaining potassium in the body, so constipation should be prevented and treated. For patients with low urine output and high blood potassium, potassium intake should be strictly restricted, and if there is vomiting, diarrhea and other cases of potassium loss, the amount of potassium supplementation should be determined after checking the serum potassium level.
(2) Sodium: hemodialysis patients should avoid high-salt diet, such as pickled and processed pickles, canned food, cooked food, seasonings, etc. are foods with high sodium content, usually control eating less or not eating, salt intake of 3 to 5g per day, to prevent dry mouth and thirst caused by eating too much salt, so that excessive intake of water causes sodium water retention;
(3) Calcium: Due to the deficiency of active vitamin D in dialysis patients and the body's resistance to the effect of active vitamin D, and the restriction of phosphorus intake in the diet, the blood calcium concentration is often low. Adequate calcium and vitamin D supplementation should be given to patients under close monitoring of serum calcium and phosphorus levels. The milk calcium in milk is easily absorbed by the body, so it can be used as the first choice, followed by fish and shrimp. Regular experimental examination, found that the blood calcium is too low, you can take calcium preparations such as calcium carbonate, calcium gluconate, phosphorus-calcium binders, etc., to increase the concentration of blood calcium.
(4) Phosphorus: Patients on hemodialysis should limit the intake of phosphorus, such as eating less high-phosphorus foods, such as nuts, chocolate, coffee, nuts, animal offal, shrimp, beans and other foods with high phosphorus.
(5) Water: maintenance hemodialysis patient weight change is the best indicator of fluid balance, the increase or decrease of body fluids can be obtained by direct measurement of weight, during the two dialysis to increase the weight per day to control the weight of 3% to 5% of the body weight is appropriate. Water intake includes food, fruit, drinks, infusions and all other fluids that enter the body, and should be replenished accordingly if there is additional loss.
Total daily inlet water ml = previous day's urine output ml + 500 ml. On the day of dialysis, the weight of hemodialysis patients can also be maintained by adjusting the ultrafiltration amount of dialysis.
(7) Vitamin supplementation: Dialysis patients need to supplement vitamin B 14mg, vitamin B 6 10mg and other B vitamins every day; vitamin C 100mg, folic acid 1mg, vitamin D 0.25 ~ 0.5 μg, vitamin E 15 μg.
(8) Selenium deficiency supplementation: after selenium is absorbed through the gastrointestinal tract, plasma is carried into various tissues in the body, with the highest content in the kidneys, liver, pancreas, pituitary gland and hair, relatively low blood in intramuscular bones, and the lowest content of fatty tissue. Selenium has anti-aging, anti-red blood cell hemolytic effect, but also has the function of anti-peroxide, scavenging oxygen free radicals, has anti-cancer effect. The normal value of selenium in the blood is 1.27 to 4.3 μmol/L in the United States, and it is reported differently in different regions in China, about 0.392 to 0.82 μmol/L. The incidence of hemodialysis centers and vascular emergencies is 70% to 87.23%, and selenium deficiency is one of the important reasons. Treatment should be supplemented according to the concentration of selenium, sodium selenite 500 μg / day or selenium yeast containing selenium 1 000 μg, can last for 1 month, dialysis patients should strictly grasp the dose when supplementing selenium, strictly prevent excessive selenium supplementation will appear hair loss and nail damage and other symptoms.
(9) Zinc deficiency supplementation: the human body consumes zinc from the diet every day about 61.54 ~ 215.4 μmol / L, and the biological half-life of zinc is about 87 days, mainly absorbed in the upper part of the small intestine. The normal value of serum zinc is about 10.77 to 17.5 μmol/L, and 65.2% of the zinc absorbed into the blood enters the muscle tissue, and up to 0.2 μmol/L in the brain, which is the tissue with the highest zinc content. Zinc is mainly excreted from stool and urine. Zinc participates in the composition of more than 200 enzymes in the body, catalyzes the activity of enzymes, maintains the normal function of enzymes, and participates in the endocrine regulation of growth factors and sex hormones in the body, affecting growth and development and gonadal function. Zinc deficiency can also cause taste, olfactory disorders, loss of appetite and even refusal to eat, cataracts, testicular atrophy, and male breast hyperplasia. If the serum zinc is less than 9.2 μmol/L, zinc supplementation is required, and 5mg/L of zinc supplementation is dripped into the liquid every day, which is safer. Zinc can also be added to the hemodialysis fluid 400 μg/L, continuous treatment for 8 weeks, serum zinc can be improved.