Nutrition Intervention of Patient with Chronic Kidney Disease (Stage 4) on Maintenance Hemodialysis

Chronic Kidney Disease is characterized by gradual and irreversible deterioration in the function of kidneys..

We report the case of 27 years old, female patient suffering from CKD (Stage 4) on Maintenance Hemodialysis. Dietary intervention was tailored for her using her past medical history and dietary intake. The dietary interventions were planned in 4 steps for 12 weeks that included nutritionally adequate food intake, Increase frequency of meals, modification & improvement in food preparation techniques, provision of educational material related to diet in dialysis. The patient lost 1 kg weight during the 3rd week of intervention followed by no further weight loss. Creatinine level improved form 4.7 mg/dL to 3.7 mg/dL indicating improvement in renal function.

Dietary assessment and modification should be an essential part of treatment in management of chronic kidney disease patients.

Keywords:Chronic Kidney Disease; Dietary Modification

Chronic kidney disease (CKD) incorporates multiple disorders affects kidney and other associated organs of body [1]. Patients are typically diagnosed late in the course of illness, after over 75% of kidney function has been lost. It’s a growing problem affecting with prevalence raging form 8-16% worldwide, affecting largely poor pollution and features poor prognosis and high treatment cost [2].

CKD complications include risk of increased cardiovascular mortality, decreased bone health, acute renal failure, anemia kidney disease progression [3]. Diabetes mellitus is regarded major contributor of CKD across the globe. Since the incidence of diabetes is high in developing and under developed countries, concomitantly prevalence of CKD is also on the rise.

Nutritional management is cornerstone in management of CKD patients since malnutrition is very common in such patients which affects their quality of life and survival. here is increased risk of developing CKD in obese patients due to increased metabolic demands, intraglomerular pressure damaging the kidney. Obesity also becomes a great concern in patients undergoing dialysis and appropriate dietary management becomes essential to improve the kidney function and chances of survival. We reported a case of nutrition intervention of Patient with CKD (Stage 4) on Hemodialysis for decreasing and maintaining her weight in order to improve kidney function.

27 years old, female patient suffering from CKD (Stage 4) on Maintenance Hemodialysis with a history of osteodystrophy was presented to Shaikh Zayed Hospital (Kidney Outpatinet Department) with poor dietary intake due to nutrition-related knowledge deficit with chief complain of 14 kg weight gain in 18 months. The patient had no information or awareness regarding diet in dialysis and was consuming calorie-restricted diet without any guidance from a health professional. The diet consumed was inadequate diet in terms of calories and nutrients. The anthropometric measurement included; height 165 cm; weight 82kg; BMI 30 kg/m2 with 14 kg weight gain in eighteen months. Her Blood Urea Nitrogen (BUN) was 33.1 mg /dL which was elevated as per the references values. Her triglycerides and cholesterol were also elevated along with total proteins. Two years back, the patient took treatment for hair growth and legs pain, called Hijama (a cupping process in which blood is sucked out). Because of the treatment her hemoglobin levels dropped to 4g/dL, blood sugar level raised to 400mg/dL. Her usual dietary intake was two serving of cereals in breakfast, two servings of meet and cereal in dinner. Fluid intake was two cups per day with no lunch and snacks. Her food frequency revealed that there were decreased intake of vegetables and fruits and regular intake of rice and mutton.

The dietary interventions were planned in 4 steps for 12 weeks that included nutritionally adequate food intake, Increase frequency of meals, modification & improvement in food preparation techniques, provision of educational material related to diet in dialysis (Table 1 & Figure 1). The patient lost 1 kg weight during the 3rd week of intervention followed by no further weight loss.

Loss of lean body mass that is attributed to increased protein metabolism is evident is most of the patients undergoing dialysis in CKD [4]. Another aspect that develops in such patients is malnutrition–inflammation complex syndrome, with the account of malnutrition and the chronic inflammation [5,6]. The main aim to provide nutritional interventions to such patients is to control the accumulation of specific mineral such as potassium and phosphorous and to prevent the assimilation of metabolic waste products. Though dialysis is the main stay of treatment in CKD grade IV patients, but it also adversely affects the energy needs of the patients. Glucose is removed from the dialysate resulting in decreased energy intake with loss of protein form the peritoneal membrane. The dialysis modality affects the nutritional needs of CKD patients. For instance, PD patients have to decrease their energy intake because of the absorption of glucose from the dialysate. On the other hand, their protein requirements may be higher because of protein losses through the peritoneal membrane. Malnutrition may manifest as under or over nutrition in such patients. Under nutrition may also be manifested due to strict dietary restriction imposed on such patients due to which their condition further worsens [7]. Dietary prescription tailored as per need of the patients by clinical dietitian should always be preferred for CKD patients [8].

Dietary assessment and modification should be an essential part of treatment in management of chronic kidney disease patients.