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6 eGFR Equations (beta)


The Hospital Diet


© 1997 Andrew Lundin, M.D. All rights reserved. Reproduced with permission.


All your stories about horrible hospital diets imposed on dialysis patients ring true. I wonder why the NKF Council of Renal Dieticians has not taken up this issue as an education program for their colleagues. Have they or is it worth suggesting?


My experience covers the gamut. My first two years on dialysis were not adequate and I survived by sticking to a very strict diet. That is one of the purposes of a "renal" diet - to minimize uremic complications. Other outcome of prescribing a renal diet is an attempt to slow the progression of the kidney disease. Several of you have pointed out the dangers of this diet when one goes too long, namely malnutrition.


If one is started on subadequate dialysis, then a renal diet will minimize uremic symptoms but also shorten survival. I was within weeks of death when I started medical school and my dialysis time was increased to 14 hrs. With good dialysis, the appetite should increase so much so that the dietary restrictions of dialysis come into play. Ergo the "dialysis" diet.


I view the dialysis diet as a diet of moderation. All things can be eaten but in moderation, some more restricted than others. One has to eat also in relation to the dialysis treatment. This required an understanding of food content and time of absorption into the blood for dialysis. Another way to look at it is to look for endpoints. How much fluid weight have I gained since my last treatment and what did I eat to do it? If I gained too much where should I cut down? What is my potassium level? What did I eat in the past days since the last treatment? Can I eat more? Remember that the amount of salt or sodium (preservatives, baking soda) that you eat will make you thirsty. K levels can safely rise to 6.5 mEq/L in a dialysis patient. Higher increases the anxiety scale. Is it checked on the first dialysis (after 2 days off) or midweek? Midweek K values probably should be lower.


What is the right BUN to look for as an end point?

There are a number of variables that can effect the BUN level, but when patients are hungry I do not worry about how much protein they eat as long as the phosphorous and K are in safe limits. If the BUN number scares the doctor then increase the dialysis. Clearly too much protein ingested can cause other problems but few ingest to that level.

I used to have what I call the "anorexia nervosa of dialysis". Fear of eating lest I suffer the side effects and complications. I observed my patients eating, enjoying it and not complainting. I now try to do the same and am gaining weight.

Peter Lundin, M.D.

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