Human Pathology Information and Drawings

In patients with renal diseases like hemodialysis patients, phosphorus and potassium are some of the minerals that aren’t that good for the kidneys in the renal diseases , mostly because the kidneys excrete mostly of this nutrients, so the dietary intake of potassium in an important aspect of the diet of patients with end-stage renal diseases.

The diet should be individualized for each patient, based on the preferences (food likes or dislikes). The potassium is widely distributed in foods, so it is important on hemodialysis patient to limit the quantities of potassium and phosphorus by altering the method of preparing. Dietary potassium is usually not a problem with peritoneal dialysis as the patients are dialyzed daily.

On the other hand, the phosphates levels are almost impossible to control in end-stage renal diseases by a simple diet. Phosphate binders are necessary to maintain acceptable blood levels, but it is also important that the patient limit the intake of dietary phosphorus. As the potassium, the phosphorus levels must be controlled by dietary restrictions that depend for each patient depending on food preferences.

There are some types of food that contains high quantities of potassium and therefore must be avoided or consumed rarely or in small quantities like orange juice, bananas, cantaloupe, honeydew melon, prunes, peanuts, potatoes, black-eyed peas, sweet potatoes, spinach.

There are also some types of food that contains high quantities of phosphorus and therefore must be avoided or consumed rarely or in small quantities like bran cereal, milk and his derivates (like cheese, yogurt and butter), whole wheat bread, black-eyed peas, peanuts, lima beans and cocoa.

In the Handbook of Nutrition, Second Edition, they are some meal plans for 4 different calorie levels (between 1800 to 2400 kcal). I will focus mostly on the 2000 kcal program because that is the normal intake of calories for a day for a normal person.

The 2000 kcal program for peoples with renal diseases:

Breakfast

½ cup grits

1 piece toast

½ c apple juice

½ c 2% milk

1 t margarine

Lunch

1 c rice

1 slide bread

1 c garden salad

½ c pears

3 oz skinless chicken breast

1 t of margarine

1 T salad dressing

Afternoon snack

2 slices of bread

1 oz lean ham

1 t mayonnaise

Dinner

½ c mash potatoes

1 roll

1 c greens

½ c of fruit cocktail

3 oz of lean beef

2 t of margarine

2 sugar cookies

Bedtime snack

5 vanilla wafers

½ c cup pineapple

Glossary

t – tea spoon

T – table spoon

c – cup

oz – ounce

The diet must contain all the essentials proteins and carbohydrates but limit the potassium and phosphorus levels. To summarize, the patients with acute or chronic renal disease are susceptible to the development of profound malnutrition. Protein-energy imbalances worsen prognosis regardless of disease stage. A complete nutrition assessment plus monitoring can help identify malnutrition before there is a significant depletion in visceral protein stores and weight loss. The important treatment objectives are to communicate with the patient and to monitor the laboratory indices and to modify the nutritional therapy depending of there actual condition.